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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 28  |  Issue : 2  |  Page : 453-456

Incidence of false-positive seroreactivity to brucellosis in tuberculous patients


1 Department of Tropical Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Tropical Medicine, Menoufia Fever Hospital Ministry of Health, Menoufia, Egypt

Date of Submission02-Oct-2013
Date of Acceptance31-Dec-2013
Date of Web Publication31-Aug-2015

Correspondence Address:
Waleed Mohamed Albakrawy
Department of Tropical Medicine, Menoufia Fever Hospital Ministry of Health, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.163901

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  Abstract 

Objectives
This work aimed to study the incidence of false-positive brucellosis among tuberculosis (TB) patients and to study the difference between the standard tubal agglutination method and enzyme-linked immunosorbent assay (ELISA) in the presence of false-positive results when used in the diagnosis of brucellosis.
Background
The diagnosis of brucellosis is usually made by the standard tubal agglutination method and ELISA, but false-positive results are observed by the two methods in TB patients as well as normal individuals. Comparison between the TB patients and normal individuals for the presence of false-positive brucellosis is very important.
Patients and methods
A comparison between TB patients and normal individuals was performed for the presence of false-positive brucellosis using both tubal agglutination methods and ELISA; tubal agglutination methods and ELISA were compared for false-positive results when used in diagnosing brucellosis.
Results
Ten percent of TB patients had false seropositive brucellosis by both ELISA and tubal agglutination methods, whereas 2.5% of normal individuals had false seropositive brucellosis by both ELISA and tubal agglutination methods; these results were statistically insignificant. There were no statistically significant differences between the results obtained by Brucella ELISA and tubal agglutination methods when used in the diagnosis of brucellosis.
Conclusion
Four out of 40 TB patients showed false positive seroreactivity for brucellosis, whereas one out of 40 individuals included as controls showed false positive seroreactivity for brucellosis; these results were statistically insignificant. That is, there was no statistically significant difference between TB patients and normal individuals in false positive seroreactivity for brucellosis.
There was no statistically significant difference between the results obtained from ELISA and the tubal agglutination test in false positive seroreactivity for brucellosis.

Keywords: brucellosis, false-positive seroreactivity, tuberculosis


How to cite this article:
Nouh MA, El Bassuoni MA, Anis SE, Masoud BM, Albakrawy WM. Incidence of false-positive seroreactivity to brucellosis in tuberculous patients. Menoufia Med J 2015;28:453-6

How to cite this URL:
Nouh MA, El Bassuoni MA, Anis SE, Masoud BM, Albakrawy WM. Incidence of false-positive seroreactivity to brucellosis in tuberculous patients. Menoufia Med J [serial online] 2015 [cited 2020 Feb 17];28:453-6. Available from: http://www.mmj.eg.net/text.asp?2015/28/2/453/163901


  Introduction Top


Tuberculosis (TB) is a common infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis, in humans. TB usually attacks the lungs but can also affect other parts of the body. It spreads through the air when patients who have an active TB infection cough or sneeze (air transmits their saliva, which contains M. tuberculosis) [1] .

Brucellosis, also called Malta fever, Mediterranean fever, or undulant fever, is a highly contagious zoonosis caused by ingestion of unsterilized milk or meat from infected animals or close contact with their secretions. Transmission from human to human, through sexual contact or from mother to child, is rare but possible [2] .

Brucellosis and TB are two important public health hazards of particular concern in developing countries and the Middle East [3] .

These two infectious diseases have some overlapping clinical features; hence, diagnosis relies mainly on paraclinical studies. Brucellosis serological tests are reported to have high sensitivity [4] .

The aim of this work is to study the incidence of false-positive brucellosis seroreactivity in patients with pulmonary TB.


  Patients and methods Top


The present study was carried out on 80 individuals: 40 patients with pulmonary TB treated at the Menoufia Chest Hospital from 1 June 2011 till 1 June 2012 and 40 individuals who were age-matched and sex-matched healthy controls.

They were classified into two groups:

  1. Group 1: 40 patients with TB after treatment for 1 year.
  2. Group 2: 40 age-matched and sex-matched healthy controls.
Inclusion criterion of the patient group was as follows:

  1. All patients with a confirmed diagnosis of TB.
Some patients were excluded for the following reasons:

  1. A history of brucellosis.
  2. Exposure to domestic animals or their products.


All groups were subjected to the following:

  1. Full assessment of history to record relevant information such as clinical history, with a focus on a history of brucellosis or exposure to domestic animals or their products.
  2. Blood tests: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count.
  3. Blood chemistry including random blood glucose, blood urea, serum creatinine, SGPT, SGOT, and serum bilirubin.
  4. Anti-brucella IgG by an enzyme-linked immunosorbent assay (ELISA).
  5. PCR for Brucella for those who had positive anti-Brucella IgG by ELISA.
The results were statistically analyzed and are presented in [Figure 1] and [Figure 2] and [Table 1] [Table 2] [Table 3] [Table 4].
Figure 1: Statistical study of erythrocyte sedimentation rate (ESR) levels among the group s studied

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Figure 2: Statistical study of the deferential white blood cell (WBC) counts among the group s studied

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Table 1 Statistical study of hemoglobin, platelets, and white blood cell counts among the groups studied

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Table 2 Statistical study of false positive seroreactivity for brucellosis (ELISA positive & polymerase chain reaction negative) among the groups studied

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Table 3 Statistical study of false positive seroreactivity for brucellosis (tubal agglutination method positive and polymerase chain reaction negative) among the groups studied

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Table 4 Statistical study of false positive brucellosis by the tubal agglutination method and enzyme-linked immunosorbent assay among the groups studied

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  Results Top


In this study, we found that the mean values of ESR first hour and ESR second hour were 107.9 and 124.88 in group 1, respectively, and 8.83 and 13.4 in group 2, respectively; these results were statistically highly significant. Our results are in agreement with those of Ahmad et al. [5] , who found that ESR was significantly higher in pulmonary TB patients compared with normal patients.

In this study, we found that 77.5% of patients in group 1 had ESR more than 100, whereas all of the individuals in group 2 had ESR less than 100. In comparison with our results, Ukpe and Southern [6] reported that 60% of patients with pulmonary TB had ESR above 100.

In this study, we found that the mean value of CRP was 49.5 in the patient group and CRP was negative in the control group. Our results are in agreement with those of Herlina et al. [7] , who reported that CRP was significantly increased in pulmonary TB patients compared with normal patients.

We noted in this study that there was no significant difference in blood urea and serum creatinine concentrations between group 1 and group 2, with mean values of 32.8 ± 7.19 and 0.96 ± 0.20 in group 1, respectively, and 32.75 ± 7.21 and 0.96 ± 0.19 in group 2, respectively. Our results are in agreement with those of Koju et al. [8] , who found that there were no statistically significant differences in blood urea and serum level of creatinine in pulmonary TB patients when compared with controls.

In this study, we found that there was no statistically significant difference in SGPT and SGOT concentrations between group 1 and group 2. Our results are in agreement with those of Koju et al. [8] who found that there were no statistically significant differences in AST and ALT in pulmonary TB patients compared with the controls.

In this study, we noted that the mean values of albumin concentrations were 2.52 ± 0.36 and 4.0 ± 0.21 in group 1 and group 2, respectively, and these results were statistically highly significant. Our results are in agreement with those of Ahmad et al. [5] , who found that the concentration of serum albumin was significantly lower in pulmonary TB patients than in controls.

In this study, we found that there was a highly statistically significant difference in hemoglobin concentrations, platelet count, and white blood cell (WBC) counts between groups 1 and 2, with mean values of 10.5 ± 0.703, 30 1780 ± 32 916, and 10 090.0 ± 1146.5 in group 1, respectively, and 14.0 ± 0.67, 225 500.0 ± 31 487.9, and 7500.0 ± 576.3 in group 2, respectively. Our results are in agreement with those of Ahmad et al. [5] , who found that the concentration of hemoglobin and WBC counts were significantly lower in TB patients than in controls.

Our results are also in agreement with those of Feng et al. [9] , who found that platelet count was significantly higher in pulmonary TB patients than in controls.

Our results are not in agreement with those of Choi et al. [10] , who found that there was no statistically significant difference in WBC counts between patients with pulmonary TB and controls.

The results of this study are not in agreement with those of Koju et al. [8] and Feng et al. [9] , who reported that there was no statistically significant difference in the WBC counts between patients with pulmonary TB and controls.

The results of this study are not in agreement with those of Koju et al. [8] , who found that there was no statistically significant difference in the platelet count between patients with TB and controls.

In this study, we found that the mean values of basophile count (%), eosinophil (%), segmented neutrophil, lymphocytes (%), and monocytes (%) were 0.53 ± 0.51, 6.75 ± 1.5, 44.03 ± 3.42, 38.55 ± 2.37, and 9.28 ± 1.3 in group 1, respectively, and 0.75 ± 0.63, 2.0 ± 0.75, 62.75 ± 2.84, 29.15 ± 2.53, and 4.53 ± 1.09 in group 2, respectively, and these results were statistically highly significant.

The results of this study are in agreement with those of Koju et al. [8] , who found that there was a statistically significant decrease in neutrophil count and significant increase in eosinophil, lymphocytes, and monocyte counts in pulmonary TB patients compared with normal individuals.

The results of this study are not in agreement with those of GambÓn-Deza et al. [11]
, who found that there were no statistically significant differences in peripheral blood lymphocyte populations in pulmonary TB patients compared with the controls.

The results of this study are also not in agreement with those of Feng et al. [9] who found that there were no statistically significant differences in basophile and eosinophil counts in pulmonary TB patients compared with normal individuals.

In this study, we found that 10% of the patients in group 1 had false seropositive brucellosis by both ELISA and tubal agglutination methods, whereas 2.5% of the individuals in group 2 had false seropositive brucellosis by both ELISA and tubal agglutination methods; these results were statistically insignificant.

Our results are in agreement with those of Cakan et al. [12] , who found that there were no statistically significant differences between patients with pulmonary TB and normal individuals in the presence of false-positive seroreactivity for brucellosis.

The results of this study are also in agreement with those of Varshochi et al. [13] , who found that there was no statistically significant difference between patients with pulmonary TB and normal individuals in the presence of false-positive seroreactivity for brucellosis.

Our results are also in agreement with those of Araj et al. [14] , who found that there was no statistically significant difference between normal individuals and patients with various infectious diseases including TB in the presence of false-positive seroreactivity for brucellosis.

We noted in our study that there were no statistically significant differences between the results obtained by Brucella ELISA and tubal agglutination methods in the diagnosis of brucellosis; our results are in agreement with those of Sanaei Dashti et al. [15] , who reported that there were no statistically significant differences between ELISA-IgG and the standard tubal agglutination method in the diagnosis of brucellosis.


  Conclusion Top


There was no difference between TB patients and the control group in the incidence of false-positive brucellosis and no difference between ELISA and the tubal agglutination test in the diagnosis of false-positive brucellosis.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Kumar V, Abbas AK, Fausto N, et al. Robbins basic pathology. 8th ed. Saunders Elsevier; 2007. 516-522.  Back to cited text no. 1
    
2.
Wilkinson and Lise. 'Brucellosis'. The Cambridge World History of Human Disease (Cambridge University Press). J Infect 1993; 55 :158-163.  Back to cited text no. 2
    
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Turunc T, Demiroglu YZ, Uncu H, Colakoglu S, Arslan H A comparative analysis of tuberculous, Brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 2007; 55 : 158-163.  Back to cited text no. 3
    
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Mert A, Ozaras R, Tabak F, Bilir M, Yilmaz M, Kurt C et al. The sensitivity and specificity of Brucella agglutination tests. Diagn Microbiol Infect Dis 2003; 46 :241-243.  Back to cited text no. 4
    
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Ahmad I, Srivastava VK, Prasad R, et al. Deficiency of micronutrient status in pulmonary tuberculosis patients in North India Biomed Res 2011; 22 :449-454.  Back to cited text no. 5
    
6.
Ukpe IS, Southern L. Erythrocyte sedimentation rate values in active tuberculosis with and without HIV co-infection. S Afr Med J 2006; 96 : 427-428.  Back to cited text no. 6
[PUBMED]    
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Koju D, Rao BS, Shrestha B, et al. 'Occurrence of side effects from anti tuberculosis drugs in urban Nepalese populations under DOTS treatment' Kathmandu University, J Sci Engin Technol 2005; 1 :1-8.  Back to cited text no. 8
    
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Feng Y, Yin H, Mai G, Mao L, Yue J, Xiao H, Hu Z Elevated serum levels of CCL17 correlate with increased peripheral blood platelet count in patients with active uberculosis in China. Clin Vaccine Immunol 2011; 18 : 629-632.  Back to cited text no. 9
    
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Choi CM, Kang CI, Jeung WK, Kim DH, Lee CH, Yim JJ Role of the C-reactive protein for the diagnosis of TB among military personnel in South Korea. Int J Tuberc Lung Dis 2007; 11 : 233-236.  Back to cited text no. 10
    
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Gambón-Deza F, Pacheco Carracedo M, Cerdá Mota T, Montes Santiago J. Lymphocyte populations during tuberculosis infection: V beta repertoires. Infect Immun 1995; 63 :1235-1240.  Back to cited text no. 11
    
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Cakan G, Bezirci FB, Kacka A, Cesur S, Aksaray S, Tezeren D, et al. Assessment of diagnostic enzyme-linked immunosorbent assay kit and serological markers in human brucellosis. Jpn J Infect Dis 2008; 61 :366-370.  Back to cited text no. 12
    
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Varshochi M, Majidi J, Amini M, Ghabili K, Shoja MM. False positive seroreactivity to brucellosis in tuberculosis patients: a prevalence study. Int J Gen Med 2011; 4 : 207-210.  Back to cited text no. 13
    
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Araj GF, Lulu AR, Khateeb MI, Saadah MA, Shakir RA ELISA versus routine tests in the diagnosis of patients with systemic and neurobrucellosis. APMIS 1988; 96 : 171-176.  Back to cited text no. 14
    
15.
Sanaei Dashti A, Karimi A, Javad V, Shiva F, Fallah F, Alaei MR, et al. ELISA cut-off point for the diagnosis of human brucellosis; a comparison with serum agglutination test. Iran J Med Sci 2012; 3:9-14.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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