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Clinical and Vaccine Immunology, November 2006, p. 1190-1196, Vol. 13, No. 11
1071-412X/06/$08.00+0     doi:10.1128/CVI.00086-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Secondary Serological Response of Patients with Chronic Hepatosplenic Suppurative Brucellosis{triangledown}

R. Díaz,1 J. Ariza,2* I. Alberola,3 A. Casanova,4 and M. F. Rubio1

Department of Microbiology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain,1 Infectious Disease Service, Department of Medicine, Hospital Universitario de Bellvitge, Universidad de Barcelona, Barcelona, Spain,2 Department of Internal Medicine, Clinica Universitaria, Universidad de Navarra, Pamplona, Spain,3 Department of Microbiology, Hospital Universitario de Bellvitge, Universidad de Barcelona, Barcelona, Spain4

Received 6 March 2006/ Returned for modification 15 June 2006/ Accepted 16 August 2006

Chronic hepatosplenic suppurative brucellosis (CHSB) is a local reactivation of a previous brucellosis, coursing with an immunoglobulin G (IgG) and IgA secondary immunological response. The observation of two cases of CHSB with an apparent IgM response gave rise to a detailed serological study of three of our patients. We studied the first sample from all three patients and successive samples from two of them. In cases 1 and 2, we found samples with positive IgM lateral flow and IgM enzyme-linked immunosorbent assay results concomitantly with rheumatoid factor (RF); after absorption with anti-RF serum, these results were rendered negative. In patients 2 and 3 the diagnosis of brucellosis was delayed, because none of the test results were initially very significant. However, a clear seroconversion of IgG antibodies was observed in subsequent months; titers of the Brucellacapt and Coombs tests increased in similar ways, although Brucellacapt decreased more rapidly than Coombs, which persisted at high titers for years. In patient 3 a relapse was observed in the fourth year of follow-up, detected by Coombs and also by IgG lateral flow and counterimmunoelectrophoresis (CIEP), although not by the rose bengal, agglutination, or Brucellacapt tests. Serological changes in CHSB may sometimes be mild and are detected mainly by the Coombs test. Brucellacapt does not offer additional information, although IgG lateral flow and CIEP may be of some use. Careful surveillance of titer changes in the Coombs test is the best marker of infection activity. As the disease progresses, an intense IgG response may develop and RF sometimes appears, simulating an IgM response.

* Corresponding author. Mailing address: Infectious Disease Service, Department of Medicine, Hospital Universitario de Bellvitge, Universdad de Barcelona, C/Feixa Llarga s/n 089087, L'Hospitalet de Llobregat, Barcelona, Spain. Phone: 034-93-2607625. Fax: 034-93-2607637. E-mail: jariza{at}csub.scs.es.

{triangledown} Published ahead of print on 30 August 2006.

Clinical and Vaccine Immunology, November 2006, p. 1190-1196, Vol. 13, No. 11
1071-412X/06/$08.00+0     doi:10.1128/CVI.00086-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Casanova, A., Ariza, J., Rubio, M., Masuet, C., Diaz, R. (2009). BrucellaCapt versus Classical Tests in the Serological Diagnosis and Management of Human Brucellosis. CVI 16: 844-851 [Abstract] [Full Text]  


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