الفهرس 
History, epidemiology, microbiology and pathogenesis of brucellaOnly 14 pages are availabe for public view
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Abstract
The aim of this work is to study the pattern of the brucellosis in Menoufia governorate using ELISA test.
Patients and methods:
A total of 150 patients finally diagnosed as brucellosis were selected from inpatients of Menoufia Fever Hospital, Menoufiya Governorate in the period from January 2013 to december 2013. Patients and control subjects were classified into the following groups:
Patients and control subjects were classified into the following groups:
Group I (Patients group): was subdivided into 3 subgroups according to duration of disease.
Group Ia: composed of eighty nine patients with acute brucellosis.
Group Ib: composed of forty two patients with subacute brucellosis.
Group Ic: composed of nineteen patients with chronic brucellosis .
Group II (Control group) : comprised twenty five persons of matched age and sex all were from asymptomatic occupationally exposed persons , all of them had a negative history of brucellosis.
All patients were subjected to the following:-
Thorough history, clinical examination, laboratory investigations including complete urine analysis and stool analysis, complete blood count, ESR and CRP, liver function tests and hepatitis viral markers (when indicated), Rose Bengal slide agglutination test, rapid slide titration test, tube agglutination test for brucellosis, blood culture for
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brucella and radiological investigations including abdominopelvic ultrasonography to all patients and scrotal ultrasonography, chest radiography, radiographic study of the spine ,both sacroilliac joints and peripheral joints and other imaging studies when indicated.
Statistical analysis of the results revealed:
o No statistical significant differences among the studied groups as regarding age and sex .
o Patients with chronic and subacute brucellosis were significantly more frequent among residents of rural areas than patients with acute brucellosis while patients with acute brucellosis were significantly more frequent among residents of urban areas than patients with chronic and subacute brucellosis .
o Ingestion of raw milk and fresh cheese was the commonest mode of transmission in all patients groups followed by direct animal contact.
o Constitutional symptoms and symptoms of localization were present in various proportions in the different patients groups.
o Osteoarticular symptoms were significantly more frequent in the acute stage, weight loss and anxiety were significantly more frequent in the chronic stage while palpitations was significantly more frequent in the subacute stage.
o Fever,jaundice, splenomegaly, lymphadenopathy , hepatomegaly and signs of localization were present in various proportions of patients.
o No significant differences among the three groups as regarding frequencies of elevated erythrocyte sedimentation rate, elevated serum C-reactive protein, elevated serum bilirubin and elevated liver transaminases .
o Anaemia was highly significant among patients with acute brucellosis than patients with subacute and chronic brucellosis while leucopenia
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was highly significant among patients with acute brucellosis and subacute brucellosis than patients with chronic brucellosis.
o No significant differences among the patients at different stages of brucellosis with respect to rates of the focal complications of brucellosis.
o Positive serology was significantly more frequent in the patients at different stages of brucellosis and serology was negative in only 2 patients with acute brucellosis, when confirmed by tube agglutination tests, antibody titers in 3 of them were found below the diagnostic titer ≥1/160. Sensitivity and specificity of agglutination tests of the studied groups were 95.5% and 80 % respectively.
o Positive blood culture was significantly more frequent in acute and subacute stages than in chronic stage.
o ELISA IgM was highly specific (100%) in all groups and sensitivity (95.5%) in acute brucellosis, (100%) in subacute brucellosis and (64%) in chronic brucellosis.while ELISA IgG was specificity in all groups is (80%) and the sensitivity in acute brucellosis was (87.6%), in subacute and chronic brucellosis was (100%).
o Blood culture was specific in all groups (100%) but with low sensitivity, 36%, 36%, 10% in acute, subacute and chronic brucellosis respectively.
o STAT is sensitivity was 88%, 92%, 92% in acute, subacute and chronic brucellosis respectively while its specificity was 80% in all patients groups. o The prevelance of brucellosis is more frequent in spring & summer than autumn & winter
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o The incidence of brucellosis at different stages of disease in Menoufia Governorate as following, Menouf, Ashmoon, Zawiet El naoora, Shebeen then Tala