부산대학교 도서관

The use of enzyme-linked immunosorbent assay (ELISA) for the detection of IgG and IgM antibodies antibrucella has become widespread in the diagnosis of human brucellosis. IgM anti-Brucella antibodies are indicative of acute infection. Between 2009–2013, 5307 patients were evaluated for serologic diagnosis at the Microbiology Laboratory of the Albacete General Hospital. A ELISA IgM-positive, IgG-negative anti-Brucella antibody serology pattern was detected in 17 of those patients. Epidemiology data, symptoms, laboratory data, treatment and outcome from these patients were reviewed. Sixteen patients presented with musculoskeletal pain, fatigue and/or fever and 1 was asymptomatic. Five patients received treatment with doxycycline combined with rifampin, gentamycin or streptomycin during 6–12 weeks, with no improvement. None of the 17 patients were finally diagnosed with brucellosis. Our results indicate that anti-Brucella IgM positive serology, per se, is not enough to diagnose acute brucellosis and other methods should be used for confirmation. Brucella serology data should be interpreted taking into account the patient's clinical history and epidemiological context. Author Summary: Human brucellosis may present with a wide variety of symptoms and signs. Adequate laboratory diagnostic methods become necessary. The diagnostic method that proves infection caused by Brucella spp. is the isolation of the bacteria from body fluids or tissues, but the difficulty in obtaining positive bacterial cultures has led to the development of other diagnostic techniques. Rose Bengal test, Wright agglutination, Coombs antibrucella, immunocapture techniques, and serology to detect specific IgG and IgM antibodies usually by enzyme-linked immunosorbent assay (ELISA), are the serological methods most often used for the diagnosis of brucellosis. The use of ELISA techniques has become widespread in recent years. The detection of specific IgM by using ELISA is considered indicative of acute or recent infection. However, IgM antibody detection in the absence of IgG may lead to an erroneous diagnosis of acute brucellosis. We described a series of patients in which serology detected IgM but not IgG antibrucella antibodies. In these patients the clinical picture and the outcome are not suggestive of active infection caused by Brucella spp. This finding supports the conclusion that Brucella serology data should be interpreted taking into account the patient's clinical history and epidemiological context. [ABSTRACT FROM AUTHOR]