Volume 87, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Acute and convalescent serum samples were collected from febrile inpatients identified at two hospitals in Moshi, Tanzania. Confirmed brucellosis was defined as a positive blood culture or a ≥ 4-fold increase in microagglutination test titer, and probable brucellosis was defined as a single reciprocal titer ≥ 160. Among 870 participants enrolled in the study, 455 (52.3%) had paired sera available. Of these, 16 (3.5%) met criteria for confirmed brucellosis. Of 830 participants with ≥ 1 serum sample, 4 (0.5%) met criteria for probable brucellosis. Brucellosis was associated with increased median age ( = 0.024), leukopenia (odds ratio [OR] 7.8, = 0.005), thrombocytopenia (OR 3.9, = 0.018), and evidence of other zoonoses (OR 3.2, = 0.026). Brucellosis was never diagnosed clinically, and although all participants with brucellosis received antibacterials or antimalarials in the hospital, no participant received standard brucellosis treatment. Brucellosis is an underdiagnosed and untreated cause of febrile disease among hospitalized adult and pediatric patients in northern Tanzania.


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  1. Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV, , 2006. The new global map of human brucellosis. Lancet Infect Dis 6: 9199.[Crossref] [Google Scholar]
  2. Corbel MJ, Elberg SS, Cosivi O, , 2006. Brucellosis in Humans and Animals. Geneva: World Health Organization. [Google Scholar]
  3. Godfroid J, Scholz HC, Barbier T, Nicolas C, Wattiau P, Fretin D, Whatmore AM, Cloeckaert A, Blasco JM, Moriyon I, Saegerman C, Muma JB, Al Dahouk S, Neubauer H, Letesson JJ, , 2011. Brucellosis at the animal/ecosystem/human interface at the beginning of the 21st century. Prev Vet Med 102: 118131.[Crossref] [Google Scholar]
  4. Al Dahouk S, Nockler K, Hensel A, Tomaso H, Scholz HC, Hagen RM, Neubauer H, , 2005. Human brucellosis in a nonendemic country: a report from Germany, 2002 and 2003. Eur J Clin Microbiol Infect Dis 24: 450456.[Crossref] [Google Scholar]
  5. Roop RM, 2nd Gaines JM, Anderson ES, Caswell CC, Martin DW, , 2009. Survival of the fittest: how Brucella strains adapt to their intracellular niche in the host. Med Microbiol Immunol (Berl) 198: 221238.[Crossref] [Google Scholar]
  6. Kunda J, Fitzpatrick J, Kazwala R, French NP, Shirima G, Macmillan A, Kambarage D, Bronsvoort M, Cleaveland S, , 2007. Health-seeking behavior of human brucellosis cases in rural Tanzania. BMC Public Health 7: 315.[Crossref] [Google Scholar]
  7. John K, Kazwala R, Mfinanga GS, , 2008. Knowledge of causes, clinical features and diagnosis of common zoonoses among medical practitioners in Tanzania. BMC Infect Dis 8: 162.[Crossref] [Google Scholar]
  8. Franco MP, Mulder M, Gilman RH, Smits HL, , 2007. Human brucellosis. Lancet Infect Dis 7: 775786.[Crossref] [Google Scholar]
  9. Pappas G, , 2010. The changing Brucella ecology: novel reservoirs, new threats. Int J Antimicrob Agents 36 (Suppl 1): S8S11.[Crossref] [Google Scholar]
  10. Pappas G, Akritidis N, Bosilkovski M, Tsianos E, , 2005. Brucellosis. N Engl J Med 352: 23252336.[Crossref] [Google Scholar]
  11. Afifi S, Earhart K, Azab MA, Youssef FG, El Sakka H, Wasfy M, Mansour H, El Oun S, Rakha M, Mahoney F, , 2005. Hospital-based surveillance for acute febrile illness in Egypt: a focus on community-acquired bloodstream infections. Am J Trop Med Hyg 73: 392399. [Google Scholar]
  12. Reddy EA, Shaw AV, Crump JA, , 2010. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis 10: 417432.[Crossref] [Google Scholar]
  13. John K, Fitzpatrick J, French N, Kazwala R, Kambarage D, Mfinanga GS, MacMillan A, Cleaveland S, , 2010. Quantifying risk factors for human brucellosis in rural northern Tanzania. PLoS ONE 5: e9968.[Crossref] [Google Scholar]
  14. Kassahun J, Yimer E, Geyid A, Abebe P, Newayeselassie B, Zewdie B, Beyene M, Bekele A, , 2006. Sero-prevalence of brucellosis in occupationally exposed people in Addis Ababa, Ethiopia. Ethiop Med J 44: 245252. [Google Scholar]
  15. Swai ES, Schoonman L, , 2009. Human brucellosis: seroprevalence and risk factors related to high risk occupational groups in Tanga Municipality, Tanzania. Zoonoses Public Health 56: 183187.[Crossref] [Google Scholar]
  16. 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]
  17. Baba MM, Sarkindared SE, Brisibe F, , 2001. Serological evidence of brucellosis among predisposed patients with pyrexia of unknown origin in the north eastern Nigeria. Cent Eur J Public Health 9: 158161. [Google Scholar]
  18. Swai ES, Mshanga D, Sanka NP, Marandu NH, , 2005. Prevalence of bovine brucellosis in smallholder dairy farming area, Moshi, Tanzania. Bull Anim Health Prod Afr 53: 97105. [Google Scholar]
  19. Shirima GM, Cleaveland S, Kazwala RR, Kambarage DM, French N, McMillan A, Kunda J, Mfinanga GS, Fitzpatrick J, , 2007. Sero-prevalence of brucellosis in smallholder dairy, agropastoral, pastoral, beef ranch and wildlife animals in Tanzania. Bull Anim Health Prod Afr 55: 1321. [Google Scholar]
  20. Karimuribo ED, Ngowi HA, Swai ES, Kambarage DM, , 2007. Prevalence of brucellosis in crossbred and indigenous cattle in Tanzania. Livestock Research for Rural Development 19: 2007. Available at: http://www.lrrd.org/lrrd19/10/kari19148.htm. Accessed May 2, 2012. [Google Scholar]
  21. Mahlau EA, , 1967. Further brucellosis surveys in Tanzania. Bull Epizoot Dis Afr 15: 373378. [Google Scholar]
  22. McDermott JJ, Arimi SM, , 2002. Brucellosis in sub-Saharan Africa: epidemiology, control and impact. Vet Microbiol 90: 111134.[Crossref] [Google Scholar]
  23. Marcotty T, Matthys F, Godfroid J, Rigouts L, Ameni G, Gey van Pittius N, Kazwala R, Muma J, van Helden P, Walravens K, de Klerk LM, Geoghegan C, Mbotha D, Otte M, Amenu K, Abu Samra N, Botha C, Ekron M, Jenkins A, Jori F, Kriek N, McCrindle C, Michel A, Morar D, Roger F, Thys E, van den Bossche P, , 2009. Zoonotic tuberculosis and brucellosis in Africa: neglected zoonoses or minor public-health issues? The outcomes of a multi-disciplinary workshop. Ann Trop Med Parasitol 103: 401411.[Crossref] [Google Scholar]
  24. National Bureau of Statistics, ORC Macro, 2005. Tanzania Demographic and Health Survey 2004–05. Dar es Salaam, Tanzania: National Bureau of Statistics and Calverton, MD: ORC Macro, 381. [Google Scholar]
  25. Crump JA, Ramadhani HO, Morrissey AB, Msuya LJ, Yang LY, Chow SC, Morpeth SC, Reyburn H, Njau BN, Shaw AV, Diefenthal HC, Bartlett JA, Shao JF, Schimana W, Cunningham CK, Kinabo GD, , 2011. Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected children and infants in northern Tanzania. Trop Med Int Health 16: 830837.[Crossref] [Google Scholar]
  26. Crump JA, Ramadhani HO, Morrissey AB, Saganda W, Mwako MS, Yang LY, Chow SC, Morpeth SC, Reyburn H, Njau BN, Shaw AV, Diefenthal HC, Shao JF, Bartlett JA, Maro VP, , 2011. Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected adults and adolescents in northern Tanzania. Clin Infect Dis 52: 341348.[Crossref] [Google Scholar]
  27. Mayhood MK, Afwamba IA, Odhiambo CO, Ndanu E, Thielman NM, Morrissey AB, Shao JF, Pence BW, Crump JA, , 2008. Validation, performance under field conditions, and cost-effectiveness of Capillus HIV-1/HIV-2 and Determine HIV-1/2 rapid human immunodeficiency virus antibody assays using sequential and parallel testing algorithms in Tanzania. J Clin Microbiol 46: 39463951.[Crossref] [Google Scholar]
  28. Scott LE, Crump JA, Msuya E, Morrissey AB, Venter WF, Stevens WS, , 2011. Abbott RealTime HIV-1 m2000rt viral load testing: manual extraction versus the automated m2000sp extraction. J Virol Methods 172: 7880.[Crossref] [Google Scholar]
  29. Crump JA, Scott LE, Msuya E, Morrissey AB, Kimaro EE, Shao JF, Stevens WS, , 2009. Evaluation of the Abbott m2000rt RealTime HIV-1 assay with manual sample preparation compared with the ROCHE COBAS AmpliPrep/AMPLICOR HIV-1 MONITOR 1.5 using specimens from East Africa. J Virol Methods 162: 218222.[Crossref] [Google Scholar]
  30. Liu YC, Huang WK, Huang TS, Kunin CM, , 1999. Detection of antimicrobial activity in urine for epidemiologic studies of antibiotic use. J Clin Epidemiol 52: 539545.[Crossref] [Google Scholar]
  31. 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]
  32. WHO Multicentre Growth Reference Study Group, 2006. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and Development. Geneva: World Health Organization. Available at: http://www.who.int/childgrowth/standards/technical_report/en/index.html. Accessed January 10, 2012. [Google Scholar]
  33. WHO Expert Committee on Physical Status, 1995. Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. Geneva: World Health Organization. [Google Scholar]
  34. Buchanan AM, Muro FJ, Gratz J, Crump JA, Musyoka AM, Sichangi MW, Morrissey AB, M'Rimberia JK, Njau BN, Msuya LJ, Bartlett JA, Cunningham CK, , 2010. Establishment of hematological and immunological reference values for healthy Tanzanian children in Kilimanjaro Region. Trop Med Int Health 15: 10111021. [Google Scholar]
  35. Saathoff E, Schneider P, Kleinfeldt V, Geis S, Haule D, Maboko L, Samky E, de Souza M, Robb M, Hoelscher M, , 2008. Laboratory reference values for healthy adults from southern Tanzania. Trop Med Int Health 13: 612625.[Crossref] [Google Scholar]
  36. Government of Tanzania, 2002. 2002 Population and Housing Census. Dar es Salaam, Tanzania: Government of Tanzania. [Google Scholar]
  37. Ari MD, Guracha A, Fadeel MA, Njuguna C, Njenga MK, Kalani R, Abdi H, Warfu O, Omballa V, Tetteh C, Breiman RF, Pimentel G, Feikin DR, , 2011. Challenges of establishing the correct diagnosis of outbreaks of acute febrile illnesses in Africa: the case of a likely Brucella outbreak among nomadic pastoralists, northeast Kenya, March–July 2005. Am J Trop Med Hyg 85: 909912.[Crossref] [Google Scholar]
  38. Omer MM, Musa MT, Bakhiet MR, Perrett L, , 2010. Brucellosis in camels, cattle and humans: associations and evaluation of serological tests used for diagnosis of the disease in certain nomadic localities in Sudan. Rev Sci Tech 29: 663669. [Google Scholar]
  39. Makita K, Fevre EM, Waiswa C, Kaboyo W, De Clare Bronsvoort BM, Eisler MC, Welburn SC, , 2008. Human brucellosis in urban and peri-urban areas of Kampala, Uganda. Ann N Y Acad Sci 1149: 309311.[Crossref] [Google Scholar]
  40. Dahouk SA, Neubauer H, Hensel A, Schoneberg I, Nockler K, Alpers K, Merzenich H, Stark K, Jansen A, , 2007. Changing epidemiology of human brucellosis, Germany, 1962–2005. Emerg Infect Dis 13: 18951900.[Crossref] [Google Scholar]
  41. Barroso Garcia P, Rodriguez-Contreras Pelayo R, Gil Extremera B, Maldonado Martin A, Guijarro Huertas G, Martin Salguero A, Parron Carreno T, , 2002. Study of 1,595 brucellosis cases in the Almeria province (1972–1998) based on epidemiological data from disease reporting. Rev Clin Esp 202: 577582.[Crossref] [Google Scholar]
  42. Kokoglu OF, Hosoglu S, Geyik MF, Ayaz C, Akalin S, Buyukbese MA, Cetinkaya A, , 2006. Clinical and laboratory features of brucellosis in two university hospitals in southeast Turkey. Trop Doct 36: 4951.[Crossref] [Google Scholar]
  43. Troy SB, Rickman LS, Davis CE, , 2005. Brucellosis in San Diego: epidemiology and species-related differences in acute clinical presentations. Medicine (Baltimore) 84: 174187.[Crossref] [Google Scholar]
  44. Mantur BG, Biradar MS, Bidri RC, Mulimani MS, Veerappa Kariholu P, Patil SB, Mangalgi SS, , 2006. Protean clinical manifestations and diagnostic challenges of human brucellosis in adults: 16 years' experience in an endemic area. J Med Microbiol 55: 897903.[Crossref] [Google Scholar]
  45. Giannakopoulos I, Nikolakopoulou NM, Eliopoulou M, Ellina A, Kolonitsiou F, Papanastasiou DA, , 2006. Presentation of childhood brucellosis in Western Greece. Jpn J Infect Dis 59: 160163. [Google Scholar]
  46. Andriopoulos P, Tsironi M, Deftereos S, Aessopos A, Assimakopoulos G, , 2007. Acute brucellosis: presentation, diagnosis, and treatment of 144 cases. Int J Infect Dis 11: 5257.[Crossref] [Google Scholar]
  47. Buzgan T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, Akdeniz H, , 2010. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis 14: e469e478.[Crossref] [Google Scholar]
  48. Ariza J, Pigrau C, Canas C, Marron A, Martinez F, Almirante B, Corredoira JM, Casanova A, Fabregat J, Pahissa A, , 2001. Current understanding and management of chronic hepatosplenic suppurative brucellosis. Clin Infect Dis 32: 10241033.[Crossref] [Google Scholar]
  49. Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, Soleimani Amiri MJ, Hajiahmadi M, , 2004. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran. Epidemiol Infect 132: 11091114.[Crossref] [Google Scholar]
  50. Tsolia M, Drakonaki S, Messaritaki A, Farmakakis T, Kostaki M, Tsapra H, Karpathios T, , 2002. Clinical features, complications and treatment outcome of childhood brucellosis in central Greece. J Infect 44: 257262.[Crossref] [Google Scholar]
  51. Simsek F, Yildirmak MT, Gedik H, Kanturk A, Iris EN, , 2011. Pulmonary involvement of Brucellosis: a report of six cases. Afr Health Sci 11 (Suppl 1): S112S116. [Google Scholar]
  52. Kochar DK, Sharma BV, Gupta S, Jain R, Gauri LA, Srivastava T, , 2003. Pulmonary manifestations in brucellosis: a report on seven cases from Bikaner (north-west India). J Assoc Physicians India 51: 3336. [Google Scholar]
  53. Hatipoglu CA, Bilgin G, Tulek N, Kosar U, , 2005. Pulmonary involvement in brucellosis. J Infect 51: 116119.[Crossref] [Google Scholar]
  54. Pappas G, Bosilkovski M, Akritidis N, Mastora M, Krteva L, Tsianos E, , 2003. Brucellosis and the respiratory system. Clin Infect Dis 37: e95e99.[Crossref] [Google Scholar]
  55. Kerem E, Diav O, Navon P, Branski D, , 1994. Pleural fluid characteristics in pulmonary brucellosis. Thorax 49: 8990.[Crossref] [Google Scholar]
  56. Abdollahi A, Morteza A, Khalilzadeh O, Rasoulinejad M, , 2010. Brucellosis serology in HIV-infected patients. Int J Infect Dis 14: e904e906.[Crossref] [Google Scholar]
  57. Hajiabdolbaghi M, Rasoulinejad M, Abdollahi A, Paydary K, Valiollahi P, Seyed Alinaghi S, Parsa M, Jafari S, , 2011. Brucella infection in HIV infected patients. Acta Med Iran 49: 801805. [Google Scholar]
  58. Lawaczeck E, Toporek J, Cwikla J, Mathison BA, , 2011. Brucella canis in a HIV-infected patient. Zoonoses Public Health 58: 150152.[Crossref] [Google Scholar]
  59. Lucero NE, Maldonado PI, Kaufman S, Escobar GI, Boeri E, Jacob NR, , 2010. Brucella canis causing infection in an HIV-infected patient. Vector Borne Zoonotic Dis 10: 527529.[Crossref] [Google Scholar]
  60. Ibarra V, Blanco JR, Metola L, Oteo JA, , 2003. Relapsing brucellosis in a patient infected with the human immunodeficiency virus (HIV). Clin Microbiol Infect 9: 12591260.[Crossref] [Google Scholar]
  61. Moreno S, Ariza J, Espinosa FJ, Podzamczer D, Miro JM, Rivero A, Rodriguez-Zapata M, Arrizabalaga J, Mateos R, Herrero F, , 1998. Brucellosis in patients infected with the human immunodeficiency virus. Eur J Clin Microbiol Infect Dis 17: 319326.[Crossref] [Google Scholar]
  62. Paul J, Gilks C, Batchelor B, Ojoo J, Amir M, Selkon JB, , 1995. Serological responses to brucellosis in HIV-seropositive patients. Trans R Soc Trop Med Hyg 89: 228230.[Crossref] [Google Scholar]
  63. Parker TM, Murray CK, Richards AL, Samir A, Ismail T, Fadeel MA, Jiang J, Wasfy MO, Pimentel G, , 2007. Concurrent infections in acute febrile illness patients in Egypt. Am J Trop Med Hyg 77: 390392. [Google Scholar]
  64. Al-Attas RA, Al-Khalifa M, Al-Qurashi AR, Badawy M, Al-Gualy N, , 2000. Evaluation of PCR, culture and serology for the diagnosis of acute human brucellosis. Ann Saudi Med 20: 224228. [Google Scholar]
  65. Mantecon M de L, Gutierrez MP, Zarzosa M del P, Fernandez-Lago L, Colmenero J de D, Vizcaino N, Bratos MA, Almaraz A, Cubero A, Munoz MF, Rodriguez Torres A, Orduna A, , 2008. Influence of brucellosis history on serological diagnosis and evolution of patients with acute brucellosis. J Infect 57: 397403.[Crossref] [Google Scholar]
  66. Young EJ, , 1991. Serologic diagnosis of human brucellosis: analysis of 214 cases by agglutination tests and review of the literature. Rev Infect Dis 13: 359372.[Crossref] [Google Scholar]
  67. Lucero NE, Escobar GI, Ayala SM, Silva Paulo P, Nielsen K, , 2003. Fluorescence polarization assay for diagnosis of human brucellosis. J Med Microbiol 52: 883887.[Crossref] [Google Scholar]
  68. Irmak H, Buzgan T, Evirgen O, Akdeniz H, Demiroz AP, Abdoel TH, Smits HL, , 2004. Use of the Brucella IgM and IgG flow assays in the serodiagnosis of human brucellosis in an area endemic for brucellosis. Am J Trop Med Hyg 70: 688694. [Google Scholar]
  69. Schurig GG, Sriranganathan N, Corbel MJ, , 2002. Brucellosis vaccines: past, present and future. Vet Microbiol 90: 479496.[Crossref] [Google Scholar]

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  • Received : 20 May 2012
  • Accepted : 12 Sep 2012
  • Published online : 05 Dec 2012

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