Particular qualities of laboratory approaches in complex diagnosis of human brucellosis

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Abstract

Brucellosis is an infectious particularly dangerous zoonotic disease caused by bacteria of the genus Brucella, among which B. melitensis, B. abortus, and B. suis have pathogenic potential, causing a severe and often chronic course of the disease.

Laboratory diagnostics is crucial for the detection of human cases, since the clinical symptoms of human brucellosis are variable and nonspecific. Laboratory diagnosis of brucellosis is based on three different approaches: direct bacteriological method, indirect method using serological and allergic tests and direct express method in different formats of molecular polymerase chain reaction.

Despite the accumulated experience of using serological tests and the highly sensitive polymerase chain reaction method, the isolation of Brucella culture is considered the gold standard in the laboratory diagnosis of brucellosis due to its clinical and epidemiological relevance. The currently available automated systems of the bacteriological method have increased its sensitivity and shortened the detection time of Brucella species.

The main limitations of serological tests are the lack of general interpretation criteria, low specificity due to cross-reactions with other bacteria and low sensitivity at an early stage of the disease. At the same time, in Russia, serological tests account for more than 99% of all laboratory tests and remain the main diagnostic tool. This is due to their inexpensive and convenient use at the place of medical care in endemic areas and high negative prognostic value.

Polymerase chain reaction in various formats of rapid tests diagnoses the DNA of the pathogen in a few hours with high sensitivity and specificity. Nevertheless, a positive polymerase chain reaction result requires careful interpretation and does not necessarily indicate an active infection.

For the convenience of using diagnostic approaches to brucellosis in practical medicine and determining the activity of the infectious process, it is necessary to improve diagnostics and develop express methods.

The review shows both the most routine and modern laboratory methods currently available for laboratory diagnosis of brucellosis.

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About the authors

Yuri K. Kulakov

N.F. Gamaleya Federal Research Centre of Epidemiology and Microbiology

Email: ykulakov@mail.ru
ORCID iD: 0000-0002-4482-9369
SPIN-code: 7720-0692

MD, Cand. Sci. (Med.)

Russian Federation, 18, Gamalei street, Moscow, 123098

Asiyat A. Dalgatova

Charodinskaya Central District Hospital

Email: doctorchar2017@mail.ru
ORCID iD: 0000-0002-7414-4360

MD

Russian Federation, Tsurib village, Charodinsky district, 368450 RD

Olga A. Burgasova

N.F. Gamaleya Federal Research Centre of Epidemiology and Microbiology; Peoples' Friendship University of Russia

Author for correspondence.
Email: olgaburgasova@mail.ru
ORCID iD: 0000-0002-5486-0837
SPIN-code: 5103-0451

MD, Dr. Sci. (Med.), Professor

Russian Federation, 18, Gamalei street, Moscow, 123098; 6, Miklukho-Maklaya Street, Moscow, 117198

Valeria V. Bacalin

Peoples' Friendship University of Russia

Email: bacalinmed@gmail.com
ORCID iD: 0000-0002-0491-9925
SPIN-code: 5549-1731

Resident of the Department of Infectious Diseases with courses in Epidemiology and Phthisiology

Russian Federation, 6, Miklukho-Maklaya Street, Moscow, 117198

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