Serotesting of Human Brucellosis on Wider Area of Bosnia and Herzegovina

The study involved  individuals from different regions of Bosnia and Herzegovina, whose sera were tested in the Laboratory for specific diagnosis of human brucellosis in Microbiology Department of Medical Faculty of University in Sarajevo, during the period from . to . Sera were tested using Brucelloslide Test, qualitative agglutination test Rose Bengal. Using the agglutination test, we serologically confirmed a diagnosis of human brucellosis in  (.) seropositive individuals, whereof  (.) men and  (.) women. Individuals with human brucellosis were the most present in the age group of - (.) and - (.). One serologically confirmed death case was registered. The most seropositive individuals were from Zenica-Doboj Canton (.), Sarajevo Canton (.), Herzegovina-Neretva Canton (.), Central Bosnia Canton (.) and Una-Sana Canton (.). During our four-year study, it was serologically confirmed that human brucellosis is present in Bosnia and Herzegovina and, through seropositive testing, we revealed the level of general exposition to Brucella spp. on wider area of Bosnia and Herzegovina.


Introduction
Genus Brucella is consisted of small, immobile, Gramnegative coccobaccili which are pathogenic for humans and animals.The first human cases of brucellosis were described in ., by J.A. Marston, physician with the British army settled in Malta ().Brucellae are intracellular parasites that can be transmitted to a range of animal species, including humans ().Four Brucella species, B. abortus, B. melitensis, B. suis and B. canis, can cause brucellosis when transmitted to humans.General infection routes in humans are digestive tract (consuming contaminated milk), mucosa (splashing route), skin (contact with infected animal tissues) or inhalation.Brucellosis is a system-affecting disease able to involve any of the major organ systems.Clinical disease manifestations are therefore very different.The most frequent described symptoms include periodical fever, cold, night sweating, headache, physical pains, anorexia and weakness.Additionally, infection focuses can occur in liver, reticuloendothelial system, bones and joints, urogenital tract, central nervous system, eyes, skin, lungs and heart (endocarditis) ().The treatment of brucellosis includes a logn-term antibiotic therapy, with recurrences if the therapy is discontinued too early or if microorganisms are in particularly deep focus of infection.These recurrences usually occur in  or  months after the therapy discontinuation.Controlling and supervising brucellosis is based on limited disease spreading and possible eradication of the infection in animals, pasterizing the milk and milk products, and reducing professional risk, wherever it is possible.

Patients and Methods
During the period from . to ., sera from  individuals from different regions of Bosnia and Herzegovina, clinically suspected to have brucellosis, were tested in the Laboratory for specific diagnosis of human brucellosis in Microbiology Department of Medical Faculty of University in Sarajevo.Blood samples were collected by venipuncture, and isolated serum samples were preserved on -C until testing.Sera were tested using Brucelloslide Test, qualitative agglutination test Rose Bengal.

Results
Out of  clinically suspect serotested individuals during the four-year period mentioned above, anti-Brucella antibodies were detected in tested sera in  (,) individuals, while the result of agglutination test Rose Bengal remained negative in  (,) individuals (Chart ).Serotesting results for  individuals clinically suspected to have human brucellosis are represented in Table ., for the period from . to .During .,  individuals clinically suspected to have brucellosis, were serotested.Agglutination test was positive in  (,) individuals, while the result remained negative in  (.) individuals.During .,  individuals were serotested, whereof  (,) individuals had a positive agglutination test, while the result remained negative in  (,) individuals.Out of  individuals serotested in .,  SADETA HAMZIĆ ET AL.: SEROTESTING OF HUMAN BRUCELLOSIS ON WIDER AREA OF BOSNIA AND HERZEGOVINA (,) individuals had a positive agglutination test, while the result remained negative in  (,) individuals.During .,  individuals were serotested, whereof  (,) individuals had a positive agglutination test, while the result remained negative in  (,) individuals.Chart . represents the rate between seropositive and negative individuals in overall diagnostic specimen for the period from . to .Out of  seropositive individuals, there were  (,) men and  (,) infected women.The most seropositive individuals were confirmed in the age group of - (,) and - (,).One serologically confirmed death case was registered.Out of  seropositive individuals confirmed during .,  of them (,) were from Mostar,  (,) from Sarajevo,  (,) from Gornji Vakuf,  (,) from Blagaj.Three seropositive individuals in .were from Sarajevo.During ., out of  seropositive individuals,  of them (,) were from Zenica, while  (,) from Sarajevo.During ., we had  seropositive individuals, whereof  (,) from Zenica,  (,) from Sarajevo,  (,) from Konjic,  (,) from Busovača,  (,) from Visoko,  (,) from Travnik and  (,) from Novi Travnik, Cazin, Breza, Žepče, Olovo and Tešanj.The results of serological diagnosis of human brucellosis for cantons, for the period from . to ., are represented in Table .During the four-year period, we recorded the highest seroprevalence of human brucellosis in Zenica-Doboj Canton (,), Sarajevo Canton (,), Herzegovina-Neretva Canton (,), Central Bosnia Canton (,) and Una-Sana Canton (,).

Discussion
Brucellosis is a zoonosis of the world-wide importance, especially in developing countries.According to the World Health Organization, the annual incidence of cases reported in endemic areas varies between  and  per  inhabitants, with serological diagnosis in minimum  of human population ().Professions traditionally related to the higher risk include farmers, veterinarians, shamblers and butchers, as well as laboratory personnel.However, effective control steps in ranch industry, as well as more frequently consuming unpasterized milk products, lead to the fact that brucellosis is disease most commonly caused by nutrition ().Significant increase in the proportion of food-home transmissions is the main reason for a great need for tests that would be fast and reliable detectors of brucellae in food and environment.Through specific diagnostic of the cases suspected for human brucellosis, as well as through seroprevalent testing, we tried to reveal a level of general exposition to Brucella spp.Immediate actions should focus on public education that will help decrease the risk of brucellosis: Supervising and controlling disease outbreaks in already determined seats.Defining sources and routes of disease transmissions.Consume only boiled or pasteurized milk, or dairy products prepared from milk treated in this way.Wash hands thorougly after handling raw meat or milk.

Conclusions.
Detecting specific anti-Brucella antibodies using agglutination test Rose Bengal, we serologically diagnosed human brucellosis in  (.) clinically suspect individuals..The highest prevalence of human brucellosis was present in Zenica-Doboj Canton (.)..Agglutination test Rose Bengal can provide a useful diagnostic information..A fast diagnostic of human brucellosis has important implications of public health and laboratory security.