Serodiagnosis Of Human Brucellosis : Validity Of Brucella-Specific IgM Antibodies Dipstick Test As A Screening Modality Of Febrile Patients
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Objectives: This study aimed to evaluate the diagnostic yield and clinical utility of dipstick test as a rapid screening test for patients presenting with clinical manifestations mimicking acute brucellosis. Patients & Methods: The study included 117 patients with febrile disease lasting for more than 2 months with associated history suggestive of getting brucellosis; there were 76 males and 41 females with mean age of 42 ± 6.7 years. Family's members of patients gave positive blood cultures were invited for investigations using the dipstick test as screening and blood culture for conformation of positive result All patients with suggestive clinical data were considered as brucellosis patients under investigations and were subjected to the following: Rose Bengal (RB) test, the standard agglutination test (SAT), serum levels of anti-brucella IgG and Ig NI were determined by ELISA kits and the dipstick assay for the detection of Brucella-specific IgM antibodies, and culture using Bactec system. Results: Blood culture for brucellosis diagnosed 14 positive cultures of which 11 samples gave positive RB, 10 samples gave dipstick tests, 8 samples gave SAT test and IgG and IgM were detected in 6 and 7 samples, respectively with higher sensitivity rate for RB, dipstick, SAT, IgM and IgG in a descending order of frequency with corresponding NPV. ROC curve defined a high diagnostic yield of RB, dipstick and SAT with AUC significant versus the null hypothesis. Regression analysis defined RB and dipstick tests as significant predictors for the presence of brucellosis infection in 2 models of analysis. Family members of the 14 patients with positive culture, 110 persons; 90 were seronegative and 20 were seropositive, among seropositive cases, 4 gave positive blood cultures despite 8 were symptomatic. Conclusion: Dipstick test was an accurate rapid screening test and significantly improved the diagnostic yield of acute cases of brucellosis and helps for rapid initiation of therapy until the diagnosis was assured using blood culture.