Brucellosis is a zoonotic disease that is endemic in Saudi Arabia. It is transmitted to humans through direct contact with infected animals or by consuming unpasteurized dairy products. A 36-year-old Saudi man presented with left hip pain, fever, and a history of consuming unpasteurized milk. Sacroiliitis was documented by positive results from serological tests (ELISA) and magnetic resonance imaging. Treatment consisted of non-steroidal anti-inflammatory drugs (NSAIDs), doxycycline, rifampicin, and IV gentamicin.

BACKGROUND: The development of preventive measures and promotion of healthcare delivery systems for disease management is dependent on detecting the incidence rates of the diseases and important risk factors. The current study aimed to determine some epidemiological indices and trends of the human brucellosis incidence in Iran between 2009 and 2017.
METHODS: A descriptive cross-sectional study.
METHODS: In the current study, online data were gathered from all cases of brucellosis who were potentially or definitely diagnosed and registered in medical centers, hospitals, laboratories, and private clinics in all districts of Iran. Epidemiologic questionnaires were used to collect data on demographic and background characteristics, risk factors, high-risk behaviors, and lab test results, respectively, based on the national brucellosis control plan.
RESULTS: A total of 138,448 cases of brucellosis have been studied in Iran from 2009 to 2017. The highest (25.89) and the lowest (12.07) incidence rates were observed in 2014 and 2009, respectively. In this nine-year study, the highest incidences were reported in the Hamedan, Lorestan, Kordestan, and Kermanshah provinces. The cumulative percentages of the disease were estimated for different variables at the following rates: by gender: 57.9% for males; by age groups: 36.2% and 16.7% for the 25-44 and16-24 years age groups, respectively; by occupation: 33.2% for housewives; and by residential area: 75.7% for rural residents.
CONCLUSIONS: Based on the obtained results, although the incidence of human brucellosis in Iran has declined since 2015, the number of cases has remained high.

Brucellosis is a major zoonotic disease caused by Brucella species. Historically, the disease received over fifty names until it was recognized as a single entity, illustrating its protean manifestations and intricacies, traits that generated conundrums that have remained or re-emerged since they were first described. Here, we examine confusions concerning the clinical picture, serological diagnosis, and incidence of human brucellosis. We also discuss knowledge gaps and prevalent confusions about animal brucellosis, including brucellosis control strategies, the so-called confirmatory tests, and assumptions about the primary-binding assays and DNA detection methods. We describe how doubtfully characterized vaccines have failed to control brucellosis and emphasize how the requisites of controlled safety and protection experiments are generally overlooked. Finally, we briefly discuss the experience demonstrating that S19 remains the best cattle vaccine, while RB51 fails to validate its claimed properties (protection, differentiating infected and vaccinated animals (DIVA), and safety), offering a strong argument against its current widespread use. These conundrums show that knowledge dealing with brucellosis is lost, and previous experience is overlooked or misinterpreted, as illustrated in a significant number of misguided meta-analyses. In a global context of intensifying livestock breeding, such recurrent oversights threaten to increase the impact of brucellosis.

Brucellosis is an important occupational disease, mainly among veterinarians, because of their frequent contact with sick animals, contaminated secretions and live attenuated anti-Brucella vaccines. This study aimed to determine the prevalence of accidental exposure to S19 and RB51 vaccine strains and occupational brucellosis among veterinarians registered to administer vaccinations in Minas Gerais, Brazil, as well as to identify the risk factors associated with accidental exposure to anti-Brucella abortus vaccines. Data were collected through an online questionnaire. Three hundred and twenty-nine veterinarians were included in the analyses using stratified random sampling. A multivariate logistic regression analysis was used to evaluate the predictors of accidental exposure to S19 and RB51 strains. Nearly one third of the veterinarians registered to administer bovine brucellosis vaccination in Minas Gerais, 32.83% (108/329) (95% confidence interval [CI]: 27.78-38.19%), reported having been accidentally exposed to S19 or RB51 vaccine strains. The exposure factors associated with this outcome included a score of personnel protective equipment (PPE) use during work (odds ratio [OR], 0.94; 95% CI: 0.89-0.98) and a score of knowledge about brucellosis symptoms, classified as poor (base category), intermediate (OR, 0.26; 95% CI: 0.07-0.87) or good (OR, 0.22; 95% CI: 0.07-0.62). In addition, 4.56% (15/329) (95% CI: 2.57-7.41%) of veterinarians reported that they had brucellosis, of which 46.67% (7/15) considered that the disease was due to accidental exposure to anti-B. abortus live attenuated vaccine. The prevalence of accidental exposure to B. abortus vaccine strains among veterinarians from Minas Gerais enrolled in the control of bovine brucellosis was high. The reduced knowledge about human brucellosis symptoms and lack of appropriate PPE use were risk factors from unintentional contact with S19 and RB51 vaccine strains.

Brucellosis (malta fever) is a zoonotic infection caused by a gram-negative coccobacillus which is a facultative intracellular pathogen. It causes a chronic granulomatous infection, similar in histology to tuberculosis. Brucellosis remains a diagnostic dilemma due to misleading, nonspecific manifestations and increasing trend of unusual presentations. In brucellosis, the nervous system involvement occurs in only 5 to 7% of untreated patients, and it may manifest with encephalitis, meningoencephalitis, radiculitis, and peripheral and cranial neuropathies. Transverse myelitis is an unusual occurrence. Here, the authors are reporting an unusual case of neurobrucellosis in an elderly male patient who visited multiple hospitals with recurring febrile encephalopathy and paraparesis. The diagnosis was suspected by his occupational history of working as an abattoir worker and was confirmed by the presence of high titers of Brucella immunoglobulin (Ig) M and IgG antibodies in the serum. The patient was managed with injection gentamicin for 2 weeks along with oral course of doxycycline and rifampicin for 6 weeks. He made a good clinical recovery and went back to work with mild residual deficits.

Brucellosis is a serious infectious disease which causes great direct and indirect economic loses for animal holders worldwide such as the reduction of milk and meat production through abortions/culling of positive reactors, the expense of disease control/eradication and farmers compensation. Although the disease was eradicated from most of the industrial countries, it remains one of the most common zoonotic diseases in developing countries being responsible for more than 500,000 new cases yearly. Brucella is considered to be a bioterrorism organism due to its low infectious doses (10-100 bacteria), capability of persistence in the environment, rapid transmission via different routes including aerosols, and finally due to its difficult treatment by antibiotics.There are many reasons to believe that a new comeback of brucellosis may occur in near future. This expectation is supported by the recent discovery of new atypical Brucella species with new genetic properties and the recent reports of (man to man) disease transmission as will be discussed later. The development of new concepts and measurements for disease control is urgently required. In the present review, the evolution of Brucella and the different factors favoring its comeback are discussed.

OBJECTIVE: Numerous studies have reported the epidemiological and clinical features of Malta fever incidence in Iran. Review and synthesis of the related literature through meta-analysis can provide an appropriate measurement for aforementioned indices. Therefore, the present study aimed to determine the epidemiological and clinical features of people with Malta fever in Iran.
METHODS: The required documents were obtained through searching national and international databases. In each study, standard deviation of the indices was calculated using binomial distribution formulas. Finally, the heterogeneity index was determined between studies using Cochran (Q) and I (2) tests.
RESULTS: Combining the results of 47 articles in the meta-analysis indicated that 57.6% (55.02-60.1%) and 42.3% (49.8-44.9%) of the patients were male and female, respectively. Most of the patients lived in rural areas; 68.4% (63.6-73.2%) compared to 31.4% (26.7-36.3%). In addition, 20.8% (17.4-24.2%) of the patients were ranchers and farmers, 16.9% (14.5-19.4%) were students, and 31.6% (27-36.2%) were housewives. Of the patients studies, 50.5% (35.6-65.2%) experienced contact with animals and 57.1% (46.4-67.9%) used unpasteurized dairy products. Fever, joint pain, and sweating were detected among 65.7% (53.7-77.8%) and 55.3% (44.4-66.2%), respectively.
CONCLUSIONS: The present study revealed that the frequency of male patients with brucellosis was considerably more than that of female patients. The number of patients with Malta fever in rural areas was significantly more than in urban areas. High-risk behavior, unprotected contact with animals, and using unpasteurized dairy products were among the most significant factors affecting Malta fever incidence in Iran. Fever, joint pain, and sweating were detected among most of the patients with Malta fever.

This article shows that socio-economic factors, defined here as practices, knowledge, interests, beliefs and experiences have a role in the adoption of brucellosis control strategies in the Bajío region, Mexico. We combined qualitative and quantitative methods to show that socio-economic factors with regard to goat husbandry and brucellosis control are not taken into account in the current policy to combat the disease in Mexico. Farmers ranked constraints like the price of goat milk more important than the control of the disease. The impact of brucellosis in goats is hidden to farmers, and the term brucellosis is still a strange name to them; it is better known as \'la fiebre de Malta\' (Malta fever), which farmers are aware of and which they avoid by not drinking goat milk. Brucellosis control measures cause losses such as abortion due to vaccination and ear infections due to ear tagging. In the villages of the state of Michoacán, the uptake of a vaccination and testing programme was almost complete because it was offered for free, whereas in villages of Jalisco, vaccination was not adopted thoroughly because the cost of vaccination was high for farmers and because of a lack of veterinarians offering the service. Neither compensation for culling suspected infected goats does exist nor the infrastructure, like slaughterhouses, to ensure that goats that are brucellosis seropositive are not resold to neighbouring farmers. This article disputes the idea that brucellosis is confined to the lack of awareness and participation of farmers in control measures, but rather that policies are promulgated without a good knowledge of goat husbandry and farmers\' perceptions. We claim that governmental authorities should reformulate the policy to take into account socio-economic factors shaping farmers\' behaviour so that effective control measures will be adopted by goat farmers.

BACKGROUND: We conducted a retrospective cohort study to evaluate the clinical manifestations, laboratory findings, complications and treatment of brucellosis in the State of Qatar.
METHODS: The medical records of patients in Hamad Medical Corporation, Doha, Qatar were reviewed from January 2000 to December 2006. History, various socio-demographic features, clinical and biochemical parameters, therapeutic features, and complications were retrospectively collected from the patient database.
RESULTS: Around three quarters of the study population were males. History of raw milk consumption and animal contact were seen in 41.7% and 12.5% respectively. The main presenting features of our cohort were fever, chills and sweating (93.1%, 62.5% and 58.3% respectively). Positive antibody titre (>1:160) was detected in 95.8% and positive blood culture was reported in 63.9% of the cohort. Splenomegaly was observed in 19.4%, hepatomegaly in 15.3% and lymphadenopathy in 9.7% of the cases. Approximately half of our patients were treated with a combination of doxycycline and streptomycine and nearly one quarter received doxycycline and rifampicine combination therapy.
CONCLUSIONS: Brucellosis is an important public health problem worldwide. It is associated with significant morbidity and mortality. It may affect any organ system and can present with a variety of clinical features. Diagnosis of brucellosis requires serological tests with or without blood culture. Treatment with at least two antibiotics for six weeks or more appears to be effective.