The false sero-negativity of brucella standard agglutination test: Prozone phenomenon

Year 2011, Volume: 1 Issue: 03, 110 - 113, 01.09.2011

Hasan Karsen Nebi Sökmen Fazilet Duygu İrfan Binici Hüseyin Taşkıran

https://doi.org/10.5799/ahinjs.02.2011.03.0025

Cited By: 4

Abstract

Objectives: We aimed to assess prozone phenomenon that is quite rare and causes false negativity in serological diagnosis of brucellosis with standard dilution titers. Materials and methods: In this study the tests of four cases that have false negative serological results were evaluated. Blood cultures were obtained from all cases while cerebrospinal fluid cultures were studied in the two cases. Standard agglutination test (SAT) and Coombs test were performed to all patients. Results: SAT and Coombs test was negative in titers up to 1/640 in all cases. The SAT and Coombs tests in cerebrospinal fluid (CSF) of the two cases with neurobrucellosis diagnosis were negative, as well. Since the clinical and laboratory findings suggested the brucellosis, the serums were restudied by diluting up to 1/10240 titer and we saw that the first 3 cases became positive at a titer of 1/1280. The fourth case remained negative and therefore, we applied high dilution Coombs test. This time the test gave a positive result at 1/10240 titer beginning from 1/2560 titer. B.melitensis was isolated from two cases. Conclusion: SAT and Coombs\' test must be diluted to titers 1/2560 or more in order to exclude false sero-negativity in cases with clinical and laboratory findings suggesting brucellosis.

Keywords

Brucellosis; prozone phenomenon; standard agglutination test; Coombs test

The false sero-negativity of brucella standard agglutination test: Prozone phenomenon

Abstract

Keywords

-

References

• Buzgan T, Karahocagil MK, Irmak H, et al. Clinical manifesta- tions and complications in 1028 cases of brucellosis: a ret- rospective evaluation and review of the literature. Int J Infect Dis 2010; 14: 469-478.
• Abdolbagi MH, Nejad MR, Jafari S, Hasibi M, Soudbakhsh A. Clinical and laboratory findings in neurobrucellosis: review of 31 cases. Arch Iran Med 2008; 11: 21-25.
• Dilmener M: Brusellozun Klinik Prezentasyonları. (in Turkish) Klimik Derg. 1990;1: 23-25.
• Hall WH. Brucellosis. In: Evans AS, Brachman PS, eds. Bac- terial infections of humans. 2nd ed. New York and London: Plenum Publishing Corporation; 1991; 133-151.
• Young EJ. Brucella Species. In: Mandell GL, Bennett J, Dolin R, eds. Principles and practice of infectious diseases. 5th ed. New York: Churchill Livingston; 2000; 2386-2391.
• Chu MC and Weyant RS. Brucella. In: Murray PR, Baron EJ, Pfaller MA, Jorgensen JH, Yolken RH, eds. Manual of Clinical Microbiyology. 8th ed. Washington: ASM Pres; 2003; 797-804.
• Young EJ. Serologic Diagnosis of Human Brucellosis: Analysis of 214 Cases by Agglutinasyon Tests and Review of the Lit- erature. Reviews of Infectious Dis 1991; 13: 359-72.
• Gotuzzo E, Celillo C. Brucella. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious diseases. Philadelphia: Har- court Brace Jovanovich Inc; 1992;1513-1518.
• Badur S. Brusellozda Serolojik Tanı ve Seroepidemiyoloji. (in Turkish) Klimik Derg. 1990; 1: 17-20.
• Serra J, Vinas M. Laboratory diagnosis of brucellosis in a ru- ral endemic area in northeastern Spain. Int Microbiol. 2004; 7: 53–58.
• Bilgehan H. Klinik Mikrobiyolojik Tanı. İzmir: Barış Yayınları, Fakülteler Kitabevi; (in Turkish) 2002; 223-228.
• Otero JR, Fuertes A, Palenque E, Noriega AR. Microtiter- adapted method that facilitates the Coombs test for brucel- losis. J Clin Microbiol 1982; 16: 737-738.
• Sousa AS, Torres C, Campello MG, et al. serological diagno- sis of neurobrucellosis. J Clin Pathol 1990; 1: 79-81.
• Hendricks MK, Perez EM, Burger PJ, Mouton PA. Brucel- losis in childhood in the Western Cape. S Afr Med J 1995; 3: 176-178.
• Guven GS, Cakir B, Oz G, Tanriover MD, Turkmen E, Sozen T. Could remembering the prozone phenomenon shorten our diagnostic journey in brucellosis? A case of Brucella spondy- lodiscitis. Rheumatol Int 2006; 10: 933-935.
• Deepak S, Bronson SG, Sibi, Joseph W, Thomas M. Brucella isolated from bone marrow. J Assoc Physicians India 2003; 51: 717-718.
• Kambal AM, Mahgoub ES, Jamjoom GA, Chowdhury MN. Brucellosis in Riyadh, Saudi Arabia. A microbiological and clinical study. Trans R Soc Trop Med Hyg 1983; 6: 820-824.