Lakhasly

Brucellosis is a considerable public health problem in the Indian
subcontinent, owing to the predominant agrarian population. Moreover,
~80% of the country's population resides in rural areas, in close proximity to animals [1,3]. This predisposes this population to the risk of
certain zoonotic diseases. Brucella has a propensity to affect both
immunocompetent as well as immunocompromised individuals. It is one
of the most common occupational hazards as well as a significant cause of
PUO in endemic regions. Moreover, owing to the non-specific presentation, diagnosis of the infection is usually delayed. The disease follows a
chronic course with formation of granulomas further infecting multiple
organs, terminating in an array of clinical presentation. A recent
knowledge, attitude and practice study delineating risk factors for
brucellosis has revealed that none of the farmers interviewed had any
awareness about the infection, modes of transmission and modalities to
prevent it [10], thereby raising the risk of acquisition of infection. The
infection is caused by Brucella, which is differentiated into six species viz.
B. melitensis, B. abortus, B. canis, B. ovis, B. neotomae and B. suis. Few other
strains isolated from marine mammals are categorized into ‘nomen species [11,12]. Humans are the accidental hosts for this infection and acquire infection directly via contact with infected animals or indirectly
through vehicles like milk, genital discharge and aborted products from
the infected animals. The most commonly implicated species in human
infections is B. melitensis, usually associated with sheep and goats [1,3,8].
Of all the species, B. ovis and B. neotomae have rarely been isolated from
human cases [1,3,8]. Lack of awareness about zoonotic spread, unhygienic practices and poor sanitation escalates the magnitude of
human-to-human transmission of infection.
The present study describes nine cases of brucellosis, of which all but
one was male, with 15–45 years as the most commonly affected age
group. This is in congruence to other studies that have revealed brucellosis to be more common among young adults, involved in agrarian or
animal husbandry work or who reside in close proximity to animals and
consume unpasteurized milk [1,13,14]. However, all age groups and
both the genders are equally susceptible to infection [3]. Despite being
reported from almost all regions of the country, the available literature is
very scarce for the same and most of the available data is from high-risk
groups. One of the studies has reported seroprevalence of 8.5% among
dairy personnel [15], while the other study showed 4.2% amongst
women with frequent abortions [16]. Another study revealed seroprevalence of 4.97% amongst persons exposed to animals [17]. Few studies
have delineated brucellosis as a significant etiological agent implicated in
pyrexia of unknown origin, varying from 0.8 to 6.8% [18,19]. Prevalence
of 3% and 1.8% has been reported among patients attending hospital in
Hubli, while the same was reported to be 1.6% among pediatric age
group [1,20]. Other studies have reported 63 cases from Belgaum, 10 and
92 cases from Vellore and 175 cases from Bikaner [1,21,22]. The varied
prevalence noted in these studies might be attributed to different diagnostic modalities employed. The present study is based on automated
blood culture and identification using MALDI TOF MS. Blood culture is
considered one of the diagnostic tests for brucellosis, however the test
might be negative if performed by conventional culture. The blood clot
and lysis centrifugation cultures have been proposed to provide better
yield, owing to the ability of organism to survive the intracellular
phagocyte defense [23–26]. However, automated blood culture systems
are rapid with better sensitivity and cultures are reported positive within
five days of incubation [27]. In the present study, all cultures were reported to be positive within five days of incubation in automated blood