BACKGROUND: Despite the continuing high incidence of brucellosis, vague aspects of pathophysiology, diagnosis, and treatment continue to exist, particularly with regard to the ability of Brucella species to survive inside the host. METHODS: A quantitative real-time polymerase chain reaction assay was used for monitoring bacterial DNA load in brucellosis-affected patients throughout different disease stages. Three or more specimens per patient were obtained (1 at diagnosis, 1 at the end of treatment, and at least 1 during the follow-up period) from 39 patients with acute brucellosis. RESULTS: The majority of patients (87% at the end of treatment, 77% at 6 months after treatment completion, and 70% at >2 years after treatment) exhibited persistent detectable microbiological load despite being asymptomatic. The 3 patients who experienced relapse did not exhibit any statistically significant difference in their bacterial load at any stage of disease or during follow-up. CONCLUSION: Brucella melitensis DNA persists despite appropriate treatment and apparent recovery. This finding offers a new insight into the pathophysiology of the disease: B. melitensis is a noneradicable, persisting pathogen.
BACKGROUND: Despite the continuing high incidence of brucellosis, vague aspects of pathophysiology, diagnosis, and treatment continue to exist, particularly with regard to the ability of Brucella species to survive inside the host. METHODS: A quantitative real-time polymerase chain reaction assay was used for monitoring bacterial DNA load in brucellosis-affected patients throughout different disease stages. Three or more specimens per patient were obtained (1 at diagnosis, 1 at the end of treatment, and at least 1 during the follow-up period) from 39 patients with acute brucellosis. RESULTS: The majority of patients (87% at the end of treatment, 77% at 6 months after treatment completion, and 70% at >2 years after treatment) exhibited persistent detectable microbiological load despite being asymptomatic. The 3 patients who experienced relapse did not exhibit any statistically significant difference in their bacterial load at any stage of disease or during follow-up. CONCLUSION:Brucella melitensis DNA persists despite appropriate treatment and apparent recovery. This finding offers a new insight into the pathophysiology of the disease: B. melitensis is a noneradicable, persisting pathogen.
Authors: Susan N Hocevar; Christopher D Paddock; Cedric W Spak; Randall Rosenblatt; Hector Diaz-Luna; Isabel Castillo; Sergio Luna; Glen C Friedman; Suresh Antony; Robyn A Stoddard; Rebekah V Tiller; Tammie Peterson; Dianna M Blau; Rama R Sriram; Alexandre da Silva; Marcos de Almeida; Theresa Benedict; Cynthia S Goldsmith; Sherif R Zaki; Govinda S Visvesvara; Matthew J Kuehnert Journal: Ann Intern Med Date: 2014-02-18 Impact factor: 25.391