Clinical Interpretation of Detection of IgM Anti-Brucella Antibody in the Absence of IgG and Vice Versa ; a Diagnostic Challenge for Clinicians
, , et | 27 mars 2019
À propos de cet article
Article Category: original-paper
Publié en ligne: 27 mars 2019
Pages: 51 - 57
DOI: https://doi.org/10.21307/pjm-2019-006
Mots clés
© 2019 Maryam Labibzadeh et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Patients with positive IgG and negative IgM anti-Brucella antibodies.
| Age | Sex | Risk factors | Symptoms | Other diagnostic tests | Final diagnosis | |
|---|---|---|---|---|---|---|
| 1 | 48 yr | M | No | Arthralgia | Culture negative, ANA positive | Connective tissue disease |
| 2 | 45 yr | F | No | Fever, knee joint pain | Culture negative, Rubella IgG positive, ANA positive | Connective tissue disease |
| 3 | 59 yr | M | No | Paralysis (TIA) | Culture negative | Stroke |
| 4 | 36 yr | M | No | Fever, cough, | Culture negative | Tuberculosis |
| 5 | 31 yr | M | No | Fever and fatigue | Culture negative, Monospot positive, VCA-IgM positive | EBV – infectious mononucleosis |
| 6 | 35 yr | F | No | Joint pain | Culture negative, ANA positive | Polyarthralgia |
| 7 | 7 yr | M | No | Fever | Culture negative, RSAT negative | Meningitis |
| 8 | 34 yr | M | Worker at slaughter-house | Fever | Culture positive, VCA-IgM negative | Brucellosis |
| 9 | 35 yr | M | No | Fever, fatigue, malaise | Culture negative | PUO |
| 10 | 45 yr | M | No | High-grade fever | Culture negative | Self-limited febrile syndrome |
| 11 | 64 yr | M | No | Fever and weight loss | Culture negative, HIV-Ab positive | HIV |
| 12 | 27 yr | M | No | Fever and low BP | Culture and RSAT negative | Septic shock of unknown origin |
| 13 | 17 yr | M | No | Fatigue and dizziness | Culture negative | – |
| 14 | 26 yr | M | No | dizziness | – | – |
| 15 | 46 yr | M | No | Pancytopenia | Culture negative | Lymphoproliferative disease |
| 16 | 17 yr | F | No | Joint pain | Culture negative, ANA positive | Connective Tissue Disease |
| 17 | 31 yr | F | No | Fever | Culture negative | PUO |
| 18 | 17 yr | M | No | Fever and abdominal pain | Culture negative, Syphilis-Ig positive | Syphilis |
| 19 | 28 yr | M | No | Abdominal pain | Culture negative | Self-limited unspecified abdominal pain |
| 20 | 44 yr | M | Medical laboratory Technologist | Generalized abdominal pain | Culture negative | Prostate malignancy |
| 21 | 22 yr | M | No | Neck and right shoulder pain | Culture negative, ANA negative | Mechanical neck pain |
| 22 | 32 yr | M | No | Low-grade fever | Culture negative, HBsAg positive | Hepatitis-B |
The serology patterns for Brucella-specific antibodies (ELISA).
| Serology Pattern | Number of Samples | Number of Patients | Number of times serology was repeated with the same results | |
|---|---|---|---|---|
| 1 | IgG−IgM− | 991 | 976 | 1 |
| 2 | IgG+IgM+ | 68 | 38 | 2–5 |
| 3 | IgG+IgM− | 28 | 22 | 1–5 |
| 4 | IgG−IgM+ | 15 | 15 | 0 |
Patients with positive IgM and negative IgG anti-Brucella antibodies.
| Age | Sex | Risk factors | Symptoms | Other diagnostic tests | Final diagnosis | |
|---|---|---|---|---|---|---|
| 1 | 14 yr | F | No | Chest pain, cough and fever | Negative blood culture and RSAT | URTI |
| 2 | 30 yr | M | No | Shoulder pain | Negative blood culture and RSAT | Cervicalgia |
| 3 | 40 yr | F | No | Fever and arthralgia | Negative blood culture and positive RSAT | Acute cystitis |
| 4 | 32 yr | F | No | Abdominal pain and splenomegaly | Negative blood culture and RSAT, ANA positive | SLE |
| 5 | 22 yr | F | No | Arthralgia | – | Multiple sclerosis |
| 6 | 37 yr | F | No | Fever and back ache | – | Spondylarthrosis |
| 7 | 25 yr | M | No | Fever and body aches | Positive Syphilis-Ig, Negative blood culture and RSAT | Syphilis, HTN |
| 8 | 17 yr | M | No | Myalgia and arthralgia | Positive ANA, Negative blood culture and RSAT | Connective tissue disease/SLE |
| 9 | 31 yr | F | No | Arthralgia | Positive ANA and dsDNA, Negative blood culture and positive RSAT | SLE |
| 10 | 24 yr | M | Nurse in a Medical Unit | Fever and fatigue | Negative blood culture and positive RSAT | PUO |
| 11 | 30 yr | M | No | Fever and Myalgia | Influenza PCR positive, Negative blood culture and positive RSAT | Influenza |
| 12 | 30 yr | F | No | Backache | Negative blood culture and negative RSAT, ANA positive | CTD/SLE |
| 13 | 39 yr | M | No | Fever cough chest pain hemoptysis | Negative RSAT | Community acquired pneumonia |
| 14 | 22 yr | M | No | Hematuria | Negative blood culture and negative RSAT | Renal stones |
| 15 | 24 yr | M | No | Fever | Negative blood culture and negative RSAT | PUO |