Volume 85, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



An outbreak of acute febrile illness was reported among Somali pastoralists in remote, arid Northeast Kenya, where drinking raw milk is common. Blood specimens from 12 patients, collected mostly in the late convalescent phase, were tested for viral, bacterial, and parasitic pathogens. All were negative for viral and typhoid serology. Nine patients had antibodies present by at least one of the tests, four of whom had evidence suggestive of acute infection by the reference serologic microscopic agglutination test. Three patients were positive for leptospiral antibody by immunoglobulin M enzyme-linked immunosorbent assay, and two were positive for malaria. Although sensitive and specific point-of-care testing methods will improve diagnosis of acute febrile illness in developing countries, challenges of interpretation still remain when the outbreaks are remote, specimens collected too late, and positive results for multiple diseases are obtained. Better diagnostics and tools that can decipher overlapping signs and symptoms in such settings are needed.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Sergon K, Njuguna C, Kalani R, Ofula V, Onyango C, Konongoi LS, Bedno S, Burke H, Dumilla AM, Konde J, Njenga MK, Sang R, Breiman RF, , 2008. Seroprevalence of Chikungunya virus (CHIKV) infection on Lamu Island, Kenya, October 2004. Am J Trop Med Hyg 78: 333337. [Google Scholar]
  2. Dahouk SA, Tomaso H, Nockler K, Neubauer H, Frangoulidis D, , 2003. Laboratory-based diagnosis of brucellosis: a review of literature. Part II: Serological tests for brucellosis. Clin Lab 49: 577589. [Google Scholar]
  3. Fadeel MA, Wasfy MO, Pimentel G, Klena JD, Mahoney FJ, Hajjeh RA, , 2006. Rapid enzyme-linked immunosorbent assay for the diagnosis of human brucellosis in surveillance and clinical settings in Egypt. Saudi Med J 27: 975981. [Google Scholar]
  4. Brown SL, Klein GC, McKinney FT, Jones WL, , 1981. Safranin O-stained antigen microagglutination test for detection of Brucella antibodies. J Clin Microbiol 13: 398400. [Google Scholar]
  5. Yagupsky P, , 1999. Detection of Brucellae in blood cultures. J Clin Microbiol 37: 34373442. [Google Scholar]
  6. Gad El-Rab MO, Kambal AM, , 1998. Evaluation of a Brucella enzyme immunoassay test (ELISA) in comparison with bacteriological culture and agglutination. Infect 36: 197201. [Google Scholar]
  7. Araj GF, , 1999. Human brucellosis: a classical infectious disease with persistent diagnostic challenges. Clin Lab Sci 12: 207212. [Google Scholar]
  8. Bajani MD, Ashford DA, Bragg SL, Woods CW, Aye T, Spiegel RA, Plikaytis BD, Perkins BA, Phelan M, Levett PN, Weyant RS, , 2003. Evaluation of four commercially available rapid serologic tests for diagnosis of leptospirosis. J Clin Microbiol 41: 803809.[Crossref] [Google Scholar]
  9. Almuneef M, Memish ZA, , 2002. Persistence of Brucella antibodies after successful treatment of acute brucellosis in an area of endemicity. J Clin Microbiol 40: 2313.[Crossref] [Google Scholar]
  10. Cumberland PC, Everard CO, Wheeler JG, Levett PN, , 2001. Persistence of anti-leptospiral IgM, IgG and agglutinating antibodies in patients presenting with acute febrile illness in Barbados 1979–1989. Eur J Epidemiol 17: 601608.[Crossref] [Google Scholar]
  11. Wright FJ, Cooke ER, D'Souza J, , 1953. Observations on brucellosis in Kenya. Trans R Soc Trop Med Hyg 47: 117129.[Crossref] [Google Scholar]
  12. Jumba MM, Mirza NB, Mwaura FB, , 1996. Agglutinins for Brucellae antigens in blood sera of an urban and rural population in Kenya. East Afr Med J 73: 204206. [Google Scholar]
  13. Paul J, Gilks C, Batchelor B, Ojoo J, Amire M, Selkon JB, , 1995. Serological responses to brucellosis in HIV-seropositive patients. Trans R Soc Trop Med Hyg 89: 228230.[Crossref] [Google Scholar]
  14. Schelling E, Diguimbaye C, Daoud S, Nicolet J, Boerlin P, Tanner M, Zinsstag J, , 2003. Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad. Prev Vet Med 61: 279293.[Crossref] [Google Scholar]
  15. Centers for Disease Control and Prevention, 1997. Case definitions for infectious conditions under public health surveillance. MMWR Morb Mortal Wkly Rep 46: 89. [Google Scholar]
  16. Araj GF, Kaufmann AF, , 1989. Determination by enzyme-linked immunosorbent assay of immunoglobulin G (IgG), IgM, and IgA to Brucella melitensis major outer membrane proteins and whole-cell heat-killed antigens in sera of patients with brucellosis. J Clin Microbiol 27: 19091912. [Google Scholar]
  17. Centers for Disease Control and Prevention, 2005. Public health consequences of a false-positive laboratory test result for Brucella–Florida, Georgia and Michigan. MMWR Morb Mortal Wkly Rep 56: 603605. [Google Scholar]
  18. Memish ZA, Almuneef M, Mah MW, Qassem LA, Osoba AO, , 2002. Comparison of the Brucella standard agglutination test with the ELISA IgG and IgM in patients with Brucella bacteremia. Diagn Microbiol Infect Dis 44: 129132.[Crossref] [Google Scholar]
  19. Reddin JL, Anderson RK, Jenness R, Spink WW, , 1965. Significance of 7S and macroglobulin Brucella agglutinins in human brucellosis. N Engl J Med 272: 12631268.[Crossref] [Google Scholar]
  20. Morata PM, Queipo-Ortuño L, Reguera JM, Miralles F, Lopez-Gonzalez JJ, Colmenero JD, , 2001. Diagnostic yield of a PCR-assay in focal complications of brucellosis. J Clin Microbiol 39: 37433746.[Crossref] [Google Scholar]
  21. Queipo-Ortuno MI, Tena F, Colmenero JD, Morata P, , 2008. Comparison of seven commercial DNA extraction kits for the recovery of Brucella DNA from spiked human serum samples using real-time PCR. Eur J Clin Microbiol Infect Dis 27: 109114.[Crossref] [Google Scholar]
  22. Queipo-Ortuno MI, Colmenero JD, Bravo MJ, Garcia-ordonez MA, Morata P, , 2008. Usefulness of a quantitative real-time PCR assay using serum samples to discriminate between inactive, serologically positive and active human brucellosis. Clin Microbiol Infect 14: 11281134.[Crossref] [Google Scholar]
  23. Baddour MM, Alkhalifa DH, , 2008. Evaluation of three polymerase chain reaction techniques for the detection of Brucella DNA in peripheral human blood. Can J Microbiol 54: 352357.[Crossref] [Google Scholar]
  24. Navarro-Martinez A, Navarro E, Castano MJ, Solera J, , 2008. Rapid diagnosis of human brucellosis by quantitative real time PCR: a case report of Brucella spondylitis. J Clin Microbiol 46: 385387.[Crossref] [Google Scholar]
  25. de Geus A, Wolff JW, Timmer VE, , 1977. Clinical leptospirosis in Kenya (I): a clinical study in Kwale District, coast province. East Afr Med J 54: 115124. [Google Scholar]
  26. de Geus A, Wolff JW, Timmer VE, , 1977. Clinical leptospirosis in Kenya (II): a field study in Nyanza province. East Afr Med J 54: 125132. [Google Scholar]
  27. Forrester AT, Kranendonk O, Turner LH, Wolff JW, Bohlander HJ, , 1969. Serological evidence of human leptospirosis in Kenya. East Afr Med J 46: 497506. [Google Scholar]
  28. Silva MV, Camargo ED, Batista L, Vaz AJ, Brandão AP, Nakamura PM, Negrão JM, , 1995. Behavior of specific IgM, IgG and IgA class antibodies in human leptospirosis during the acute phase of the disease and during convalescence. J Trop Med Hyg 98: 268272. [Google Scholar]

Data & Media loading...

  • Received : 14 Jan 2011
  • Accepted : 25 Apr 2011
  • Published online : 01 Nov 2011

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error