국내에서 발생하고 있는 사람 브루셀라증의 임상적 특성

김연숙,최영실,오원섭,권기태,이혁,이선희,손준성,김신우,장현하,정숙인,고관수,박미연,백경란,송재훈 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

배경 : 2002년 내국인에서의 첫 사람 브루셀라증의 증례 보고 이후 국내에서 사람 브루셀라증이 빠른 증가를 보이고 있다. 이에 연구자들은 국내에서 발생하는 브루셀라증의 임상적 특성을 연구하고자 하였다. 방법 : 2003년부터 2006년 7월까지 7개 대학병원에 내원한 환자들을 대상으로 WHO의 진단기준에 의하여 확진된 브루셀라증 환자들의 의무기록을 후향적으로 조사분석 하였다. 배양된 균은 삼성서울병원에 의뢰하여 16S rRNA 유전자 분석방법을 이용하여 종을 확인하였고, 표준시험관응집검사는 국립보건원에 의뢰하여 시행하였다. 결과 : 34예의 환자들이 브루셀라증으로 확진되었고, 31명이 남자였다. 혈액에서 B. abortus가 증명된 경우가 8예, 표준시험관 응집검사상 의미 있는 항체가 상승을 보인경우가 26예이었다. 환자들은 대부분 축산업관련 종사자였고, 추후 브루셀라증으로 확진된 소와의 직접 접촉을 통해 감염된 것으로 여겨진다. 국내 사람 브루셀라증의 가장 흔한 증상은 발열이었고, 위장관계 합병증이 가장 흔히 동반되었다. 치료로는 doxycycline/rifampicin이 24예의 환자에서 doxycycline/aminoglycoside (streptomycin 혹은 gentamicin)이 10예의 환자에서 6주 이상의 기간 동안 투여되었다. 치료에 반응을 보이지 않는 환자는 없었고, 재발이 1예 있었다. 결론 : 국내에서 발생하는 사람 브루셀라증의 원인균으로 현재까지 분리 동정된 것은 B. abortus이며, 소 브루셀라증의 증가로 인해 인체감염사례가 함께 증가하는 것으로 사료된다. 위험 직업군 종사자들에서 감염된 소와의 직접 접촉을 통해 주로 발생하고 있는 브루셀라증의 임상종상은 국외에서 발생하는 경우와 유사한 양상을 보이고 있으며 치료에 대한 반응은 비교적 좋은 편이긴 하나, 추후 보다 많은 환자들을 대상으로 한 연구가 필요하리라 사료된다. 사람 브루셀라증의 조절을 위해서는 소 브루셀라증의 조절이 필수적이며, 브루셀라증의 조절에 성공한 선진국의 사례를 적극적으로 도입해야 할 것으로 생각된다. Background : Since the first Korean case of human brucellosis was reported in 2002, the incidence of human brucellosis has been rapidly increasing. We performed this study to evaluate the clinical characteristics of human brucellosis occurring in South Korea. Materials and Methods : Demographic features, clinical manifestations, and therapeutic outcomes of cases confirmed as brucellosis according to WHO diagnostic criteria were evaluated. Species of Brucella isolates were identified with 16S rRNA gene sequencing method. Serologic diagnosis was performed with standard tube agglutination test (STA). Results : A total of 34 cases were enrolled from 2003 to 2006 in six hospitals. Eight cases were confirmed with the isolation of Brucella from blood and 26 cases were confirmed with titer of antibodies ≥1:160 by STA. Male (31) was predominant and most of the patients were cattle farmers. The most common transmission route was direct contact with infected or their cattle byproducts. Fever was the most prominent symptom and fatigue followed. Gastrointestinal and musculoskeletal systems were commonly complicated. Patients were treated with doxycycline and rifampin or aminoglycosides for more than 6 weeks. All patients responded well to the therapeutic regimens, but one patient relapsed 10 months after treatment. Conclusion : Brucellosis occurring in Korea has been caused by B. abortus, whose preferred natural host animals are cattle. Korean patients were infected through direct contact with bovine brucellosis. Clinical manifestations of brucellosis were similar to those occurring worldwide. Therapeutic outcomes were good among patients with brucellosis in Korea. In order to prevent human brucellosis, measures to eradicate bovine brucellosis should precede.

경상북도 거주 고위험군에서 브루셀라 감염에 관한 혈청 역학적 연구

이관,박우원,김성환,이도영,박미연,허영주,임현술,Lee, Kwan,Park, Woo-Won,Kim, Sung-Hwan,Lee, Do-Young,Park, Mi-Yeoun,Hur, Young-Ju,Lim, Hyun-Sul 대한예방의학회 2007 예방의학회지 Vol.40 No.4

Objectives : Cases of human brucellosis in Korea have recently increased due to the increasing incidence of bovine brucellosis. The authors conducted this study to elucidate the status of brucellosis through seroepidemiologic study. Methods : We selected our study population from a high risk group. We conducted a questionnaire survey and obtained blood samples to determine the seroprevalence of brucellosis antibodies for 10 days in February, 2005. The titers of brucellosis were measured by the combination of standard tube agglutination test (STA) and enzyme-linked immunosorbent assay (ELISA) test. Results : Our study subjects comprised 1,075 cases: 971 livestock workers, 51 veterinarians, and 53 artificial inseminators. In the STA test, 27 cases (2.5%) had titers of greater than or equal to 1:20. Of 1,068 cases (7 cases were excluded due to previous brucellosis), 7 cases of brucellosis were diagnosed with titers of 1:160, giving a seroprevalence of brucellosis of 0.66%. The seroprevalence in the male group was 0.95%, and that of livestock workers, veterinarians, and artificial inseminators was 0.52%, 4.17%, and 0.00%, respectively. The Spearman's correlation coefficient between the positive rate of bovine brucellosis per capita and household and human brucellosis was 0.806 and 0.744, respectively. The concordance rate between the Korea National Institute of Health and the Gyeongsangbuk-do Institute of Health and Environment by the STA and ELISA tests was 94.7% and 100.0%, respectively. Conclusions : The study results indicated in higher seroprevalence rate among veterinarians than among livestock workers and artificial inseminators. Because veterinarians may be exposed to this high risk, effective working guidelines for veterinarians to guard against brucellosis must be developed. Moreover, more extensive epidemiologic research for laboratory workers and meat handlers is needed.

Association of farmers’ knowledge, attitude and practices with bovine brucellosis seroprevalence in Myanmar

Hlaing Su Su,Kubota Satoko,Makita Kohei,Win Ye Tun,Myint Hnin Thidar,Kono Hiroichi 아세아·태평양축산학회 2024 Animal Bioscience Vol.37 No.3

Objective: This study aimed to identify the relationship between bovine brucellosis prevalence, farmers’ knowledge, attitude, practice (KAP), and social factors on migratory draft cattle and smallholder dairy farms in the central dry zone of Myanmar. Methods: This cross-sectional study was conducted on 54 migratory and 38 dairy cattle farms between August 2020 and February 2021. A structured questionnaire was used to identify farmers’ behaviors. Bulk milk was sampled and tested using indirect enzyme-linked immunosorbent assay (I-ELISA). STATA 17 was used for all the analyses. Results: Migratory cattle farms had a higher farm level brucellosis prevalence (14.8%) than dairy farms (2.6%; χ2 = 3.75; df = 1; p = 0.05). Only 2.8% of the farmers had knowledge about brucellosis, while 39.1% and 41.6% had attitudes and farm practices with respect to brucellosis, respectively in the study area. Socio-economic attribute of training in animal husbandry (p<0.01), raising system (p<0.01), practice of separating the aborted cow (p<0.01) were negatively associated to brucellosis. The overall farm level brucellosis prevalence was strongly associated with cattle herd size (p = 0.01), free movement grazing practices (p<0.01), practice of self-removal of placental debris without using personal protective equipment (p<0.01) and farmers' attitudes towards eating cow placenta debris (p<0.01). Conclusion: Farmers had little knowledge of brucellosis. Attitudes and practices differed significantly between migratory and dairy farmers. Training and extension programs are necessary to make farmers aware of their KAP situation since livestock migration and the custom of eating cow placental debris contribute to the spread of brucellosis. Persistent efforts are required to reduce the adverse effects of brucellosis. Therefore, the study suggests that a feasible control intervention and public awareness campaigns need to be conducted regarding methods of preventing human exposure to brucellosis.

Frequencies of CD4+ T Regulatory Cells and their CD25high and FoxP3high Subsets Augment in Peripheral Blood of Patients with Acute and Chronic Brucellosis

Abbas Bahador,Jamshid Hadjati,Niloofar Hassannejad,Hadi Ghazanfari,Mohammadreza Maracy,Sirous Jafari,Maryam Nourizadeh,Amirhooshang Nejadeh 질병관리본부 2014 Osong Public Health and Research Persptectives Vol.5 No.3

Objectives: Brucellosis remains one of the most common zoonotic diseases worldwide. In humans, brucellosis can be a serious, debilitating, and sometimes chronic disease. Different mechanisms can be postulated as to the basis for the induction of the chronic status of infectious diseases that T regulatory cells are one of the most important related mechanisms. The current study was designed to determine whether percentage of CD4+Treg cells and their CD25high and FoxP3high subpopulations in peripheral blood are changed in human brucellosis samples in comparison to a control group. Methods: In total, 68 brucellosis patients (acute form: n Z 43, chronic form: nZ25) and 36 healthy volunteers entered our study. After isolating of peripheral blood mononuclear cells, heparinized venous blood samples were obtained from both patients and healthy donors, CD4, CD25, and FoxP3 molecules were evaluated by two- and three-color flow cytometric methods. Results: The results revealed a new finding in relation to Treg cells and human brucellosis. The numbers of CD4+Treg cells and their CD25high and FoxP3high subsets increase significantly in the peripheral blood of acute and chronic forms of brucellosis samples compared with healthy groups, with this increase being greater in the chronic group. Conclusion: There seems to be a correlation between increase of CD4+Treg cells and their subsets and the disease progress from healthy state to acute and chronic brucellosis.

소 도축 관련 종사자에서 브루셀라증의 혈청유병률 및 위험요인

유석주,최영실,임현술,이관,박미연,주재신,강영아,Yoo, Seok-Ju,Choi, Young-Sill,Lim, Hyun-Sul,Lee, Kwan,Park, Mi-Yeoun,Chu, Chae-Shin,Kang, Young-A 대한예방의학회 2009 예방의학회지 Vol.42 No.4

Objectives : The incidence of zoonoses in Korea has increased recently. However, the study of high risk groups for zoonoses has not been conducted to date in Korea. Thus, we did this study to obtain data on brucellosis among slaughterhouse workers in Korea. Methods : We evaluated the structure of slaughterhouses and the process of slaughtering by reviewing the relevant literature and doing field studies. We visited 73 slaughterhouses and 62 residual products handle houses across the country. In addition, we conducted a questionnaire survey of the work activities, and obtained blood samples in order to determine the seroprevalence and risk factors of brucellosis. The titers of brucellosis antibodies were measured using the standard tube agglutination test SAT). We diagnosed subjects as seropositive for Brucellosis if the titers were more than 1:160. The data collected was evaluated using SPSS ver. 17.0. Results : We included 1,503 subjects and obtained 1,482 blood samples among them: 849 workers involved in slaughtering, 351 handlers of residual products, 190 inspectors and their assistants, and 92 grading testers and their assistants. The seroprevalence of brucellosis among the slaughterhouse workers was 0.8% (95% CI=0.4-1.5). Broken down, the seroprevalence of brucellosis among the workers involved in slaughtering was 0.7% (95% CI=0.3-1.6), the handlers of residual products was 1.7% (95% CI=0.7-3.9) respectively. Risk factors for contracting brucellosis among slaughterhouse workers were being splashed with cattle blood around the mouth, cattle secretions around the body and not putting on protective apron while at work. Conclusions : An educational program is needed for high risk groups on zoonoses about the prevention of infection. Thus, effective working guidelines for workers who participate in the slaughter of animals must be developed in order to protect them from zoonoses.

Bacteriological and etiological investigation of bovine brucellosis in South Korea with importance on control strategies

이진주(Jin Ju Lee),성소라(So-Ra Sung),염은지(Eun Ji Yum),김성엽(Seong Yeob Kim),김시철(Si-Chul Kim),서윤정(Yoon-Jeong Seo),최정수(Jeong-Soo Choi),윤순식(Soon-Seek Yoon) 한국예방수의학회 2022 예방수의학회지 Vol.46 No.1

In Korea livestock farms breeding cattle have been suffering from re-emerging problems of Brucella (B.) abortus infection while steady decline of bovine brucellosis. Therefore, this study underscored the identification and association of etiological agent of brucellosis in cattle in South Korea. The incidence of brucellosis in cattle was analyzed by bacteriological and molecular methods in 187 brucellosis-suspicious farms of 11 regions between 2018 and 2020. Brucella isolates from various specimens were identified by Brucella-specific multiplex PCR. Epidemiological data were collected by local official veterinarians through history taking from farmers and animal data systems. In 230 of 560 cattle (40.9%) and 94 of 187 farms (50.3%), a total of 313 B. abortus were isolated from various specimens, the majority of isolates were from supramammary lymph node (41%). In epidemiological findings, the majority of positive cases were mainly caused by resurgence (43.7%) and unknown (37.2%). Of 94 positive cases isolated B. abortus, abortion in cattle infected by B. abortus occurred in 51 farms (54.3%) where led to resurgence in 30 farms and environmental survival of B. abortus in 9 farms. Consequently, these findings revealed the existence of etiological agent of bovine brucellosis in Korea, which still occurred at low levels in distinct regions where are allowed to call for persistent biosecurity. Thus, we highlight that brucellosis in Korea needs to take more effective control strategies with potential evidence. Moreover it is ultimately important to maintain a constant monitoring for eradication of brucellosis.

How to improve the human brucellosis surveillance system in Kurdistan Province, Iran: reduce the delay in the diagnosis time

Meysam Olfatifar,Seyed Mehdi Hosseini,Payam Shokri,Soheila Khodakarim,Naghmeh Khadembashi,Sajjad Rahimi Pordanjani 한국역학회 2020 Epidemiology and Health Vol.42 No.-

OBJECTIVES: Spatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis. METHODS: An exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas. RESULTS: The spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables. CONCLUSIONS: The cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.

Prevalence state of canine brucellosis in South Korea during 2015 and 2016

Jung, Ji-Youl,Yoon, Soon-Seek,Lee, Seung-Hee,Park, Jung-Won,Lee, Jin-Ju,Her, Moon,So, ByungJae,Kim, Jae-Hoon The Korean Society of Veterinary Science 2018 大韓獸醫學會誌 Vol.58 No.3

We investigated the prevalence of canine brucellosis in companion and stray dogs between March 2015 and December 2016 and determined the disease characteristics based on the geographic distribution, sex and age of the dogs in South Korea. We conducted a large-scale survey using serological and bacteriological tests. Samples were collected from 2,394 dogs (1,825 companions and 569 strays). Thirty (1.3%) samples were positive for Brucella canis antibodies including 16 (0.9%) from companion dogs and 14 (2.5%) from stray dogs. Two (1.0%) of the 196 samples cultured from the stray dogs were positive. When compared with male dogs, the female companion and stray dogs had a significantly higher prevalence of brucellosis. Moreover, the prevalence of canine brucellosis was significantly higher in stray dogs older than 6 years and the prevalence of the disease in companion dogs was highest in Incheon (2.1%) and Jeolla (2.1%) provinces. Stray dogs from the Daejeon metropolitan area had the highest prevalence of brucellosis (7.9%). National control measures for canine brucellosis have not previously been implemented. Our findings suggest that appropriate screening tests and control measures are necessary to improve the health of dogs and to protect public health in Korea, particularly with the rapid growth of the companion animal industry.

2003년 경상북도 예천군의 수의사에서 발생한 브루셀라증 1예

임현술,편유장,유영순 東國大學校醫學硏究所 2004 東國醫學 Vol.11 No.2

브루셀라증(brocellosis)은 전 세계적으로 발생하는 인수공통감염증으로 소 등의 가축을 취급하는 직업인에게 주로 발생하는 직업병의 일종으로, 우리나라에서는 2000년부터 제3군 법정전염병으로 분류하여 관리하고 있다. 저자들은 경북 예천군에서 35년간 가축병원을 운영하고 있는 58세 남자 수의사에서2003년 브루셀라증이 발생하였기에 문헌고찰과 함께 보고하는 바이다. 환자는 2003년 5월 10일 발열, 오한, 두통 및 관절통 등이 있어 개인의원을 방문하여 투약을 하였으나 호전이 되지 않았고, 지역 병원에서 입원 치료를 받던 중 6월 29일 서울에 소재한 대학병원으로 후송되었다. 환자의 혈액검체를 국립보건원에 의뢰하여 시행한 표준시험관응집시험에서 브루셀라 항체가는 1:640 역가에서 양성이었고, 혈액배양에서는 그람음성 간균인 Brucella abortus가 분리 동정되었다. 이 환자에서 브루셀라 감염경로는 2003년 4월경 피부에 상처가 있는 상태로 가축을 진료한 적이 있었는데, 제왕절개술을 하는 도중 손에 상처가 생겨도 상처 치료를 하지 않고 분만을 받는 일을 계속 진행하였으므로 가축의 분만을 돕는 일을 하면서 상처나 호흡기를 통하여 감염되었을 것으로 추정하였다. 우리나라에서는 가축 브루셀라증이 간헐적으로 보고되던 것이 1984년 이후 브루셀라 감염이 제주도를 중심으로 소에서 매년 증가하였고 최근 전국적으로 확산되고 있는 추세이므로, 소를 취급하는 수의사나 축산업자에서 브루셀라증이 발생할 가능성이 높다. 따라서 가축과 사람을 대상으로 브루셀라증에 대한 감시체계를 운영하고 고위험군에 대하여 보건 교육을 철저히 하여야 할 것이다. Brucellosis is a zoonosis caused by Brucella. abortus, B. melitensis, B. suis and B. canis. Brucellosis has been an emerging disease since the discovery of B. melitensis by Bruce in 1887. Worldwide, brucellosis remains a major source of disease in humans and domesticated animals. Although reported incidence and prevalence of the disease vary widely from country to country, bovine brucellosis caused mainly by B. abortus is still the most widespread form. In Korea, bovine brucellosis have been occurred. The vaccination for Brucella was done an cows in 1998 after the intervention of the first preventive vaccination. After inoculation, Brucella occurred in a group of cows. And then the first human case occurred in 2002, and then 16 cases in 2003 by B. abortus. We report a case of human brucellosis occurred in a veterinarian. He is a 58-year-old male who has worked for 35 years from 1968 to 2003. We reviewed his clinical features and job contents. Physicians and veterinarians must be concerned about specific environments and clinical patterns of brucellosis. They must make efforts to recognize, evaluate and control the zoonotic diseases.

Diagnostic role of mean platelet volume and neutrophil to lymphocyte ratio in childhood brucellosis

( Sefika Elmas Bozdemir ),( Yasemin Ay Altlntop ),( Salih Uytun ),( Humeyra Aslaner ),( Yasemin Altuner Torun ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.6

Background/Aims: Brucellosis patients present various non-specific clinical symptoms, such as fever, fatigue, sweating, joint pain, arthritis, myalgia, and headache. Based on the nonspecifity of its clinical signs and symtoms, we decided to evaluate whether mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) will contribute to the diagnosis. Methods: In this retrospective study, we reviewed hospital-records of 60 children with a confirmed diagnosis of brucellosis in Kayseri between January 2013 and January 2016, and compared the hematological parameters; white blood cell (WBC) count, hemoglobin (Hb), neutrophil count, lymphocyte count, platelet count, MPV, NLR, and PLR with 55 healthy age and gender matched children. Also, the well known inf lammation markers; erytrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between the patient and control group. Results: We found significant difference among the Hb, platelet count, MPV and NLR values between the patient and control group (p < 0.05). There was no difference between WBC, neutrophil count, lymphocyte count and PLR between the patient and control group (p > 0.05). When the patients were divided into groups as arthritis positive and arthritis negative and compared to the control group; we found that the NLR is more significant in between the arthritis positive and control group (p = 0.013). Also, we found significant difference among the ESR and CRP values between the patient and control group (p < 0.001). Conclusions: The results of this study indicates that MPV and NLR values can be used as markers of inflammation in childhood brucellosis. Also, NLR is more valuable in children with brucella arthritis.