BACKGROUND: Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES: To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS: We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA: We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as13C or14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS: We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS: In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions.

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Non-invasive diagnostic tests for Helicobacter pylori infection

A systematic review of studies providing frequency estimates of brucellosis in humans and ruminants and risk factors for Brucella spp. seropositivity in humans in the Middle East was conducted to collate current knowledge of brucellosis in this region. Eight databases were searched for peer-reviewed original Arabic, English, French and Persian journal articles; the search was conducted on June 2014. Two reviewers evaluated articles for inclusion based on pre-defined criteria. Of 451 research articles, only 87 articles passed the screening process and provided bacteriological and serological evidence for brucellosis in all Middle Eastern countries. Brucella melitensis and B. abortus have been identified in most countries in the Middle East, supporting the notion of widespread presence of Brucella spp. especially B. melitensis across the region. Of the 87 articles, 49 were used to provide evidence of the presence of Brucella spp. but only 11 provided new knowledge on the frequency of brucellosis in humans and ruminants or on human risk factors for seropositivity and were deemed of sufficient quality. Small ruminant populations in the region show seroprevalence values that are among the highest worldwide. Human cases are likely to arise from subpopulations occupationally exposed to ruminants or from the consumption of unpasteurized dairy products. The Middle East is in need of well-designed observational studies that could generate reliable frequency estimates needed to assess the burden of disease and to inform disease control policies.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/353B1CAC9072628F461D54964C0929E8/S0950268815002575a.pdf/div-class-title-systematic-review-of-brucellosis-in-the-middle-east-disease-frequency-in-ruminants-and-humans-and-risk-factors-for-human-infection-div.pdf

Systematic review of brucellosis in the Middle East: disease frequency in ruminants and humans and risk factors for human infection

Caprine brucellosis is a chronic infectious disease caused by the gram-negative cocci-bacillus Brucella melitensis. Middle- to late-term abortion, stillbirths, and the delivery of weak offspring are the characteristic clinical signs of the disease that is associated with an extensive negative impact in a flock's productivity. B. melitensis is also the most virulent Brucella species for humans, responsible for a severely debilitating and disabling illness that results in high morbidity with intermittent fever, chills, sweats, weakness, myalgia, abortion, osteoarticular complications, endocarditis, depression, anorexia, and low mortality. Historical observations indicate that goats have been the hosts of B. melitensis for centuries; but around 1905, the Greek physician Themistokles Zammit was able to build the epidemiological link between "Malta fever" and the consumption of goat milk. While the disease has been successfully managed in most industrialized countries, it remains a significant burden on goat and human health in the Mediterranean region, the Middle East, Central and Southeast Asia (including India and China), sub-Saharan Africa, and certain areas in Latin America, where approximately 3.5 billion people live at risk. In this review, we describe a historical evolution of the disease, highlight the current worldwide distribution, and estimate (by simple formula) the approximate costs of brucellosis outbreaks to meat- and milk-producing farms and the economic losses associated with the disease in humans. Successful control leading to eradication of caprine brucellosis in the developing world will require a coordinated Global One Health approach involving active involvement of human and animal health efforts to enhance public health and improve livestock productivity.

/pdf/caprine-brucellosis-a-historically-neglected-disease-with-3lugjqeog5.pdf

Caprine brucellosis: A historically neglected disease with significant impact on public health.

The aim of this study was to characterize the genetic basis of multidrug resistance in Gram-negative bacteria isolated from bovine mastitis cases in Egypt. Multidrug resistance phenotypes were found in 34 of 112 (30.4%) Gram-negative bacterial isolates, which harbored at least one antimicrobial resistance gene. The most prevalent multidrug-resistant (MDR) species were Enterobacter cloacae (8 isolates, 7.1%), Klebsiella pneumoniae (7 isolates, 6.3%), Klebsiella oxytoca (7 isolates, 6.3%), Escherichia coli (5 isolates, 4.5%), and Citrobacter freundii (3 isolates, 2.7%). The most commonly observed resistance phenotypes were against ampicillin (97.0%), streptomycin (94.1%), tetracycline (91.2%), trimethoprim-sulfamethoxazole (88.2%), nalidixic acid (85.3%), and chloramphenicol (76.5%). Class 1 integrons were detected in 28 (25.0%) isolates. The gene cassettes within class 1 integrons included those encoding resistance to trimethoprim (dfrA1, dfrA5, dfrA7, dfrA12, dfrA15, dfrA17, and dfrA25), aminoglycosides (aadA1, aadA2, aadA5, aadA7, aadA12, aadA22, and aac(3)-Id), chloramphenicol (cmlA), erythromycin (ereA2), and rifampicin (arr-3). Class 2 integrons were identified in 6 isolates (5.4%) with three different profiles. Furthermore, the β-lactamase encoding genes, bla(TEM), bla(SHV), bla(CTX-M), and bla(OXA), the plasmid-mediated quinolone resistance genes, qnr and aac(6)-Ib-cr, and the florfenicol resistance gene, floR, were also identified. To the best of our knowledge, the results identified class 2 integrons, qnr and aac(6)-Ib-cr from cases of mastitis for the first time. This is the first report of molecular characterization for antimicrobial resistance in Gram-negative bacteria isolated from bovine mastitis in Africa.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1348-0421.2011.00323.x

Molecular characterization of antimicrobial resistance in Gram-negative bacteria isolated from bovine mastitis in Egypt.

Sub-clinical mastitis limits milk production and represents an important barrier to profitable livestock economics worldwide. Milk production from cows in Nigeria is not at optimum levels in view of many factors including sub-clinical mastitis. The overall herd-level prevalence rate for SCM was 85.33% (256/300 heads of cows) while the quarter-level prevalence rate of SCM was 43.25% (519/1,200 quarters). The prevalence of SCM was 50.67%, 43.67%, 39.67% and 39.13% for the left fore-quarter, right hind-quarter, left hind-quarter and right fore-quarter, respectively. The Rahaji breed had the highest prevalence of SCM with 65.91% (29/44), while the White Fulani breed had the least with 32.39% (57/176). A total of 32.33% (97/300) had only one mammary quarter affected, 30.33% (91/300) had two quarters affected, 16.00% (48/300) had three quarters affected while 6.67% (20/300) had all the four quarters affected. A total of 53.00% had SCM in multiple quarters (159/300). The risk of SCM decreased significantly among young lactating cows compared to older animals (OR = 0.283; P < 0.001; 95%CI = 0.155; 0.516). The Rahaji breed had significantly higher risk compared with the White Fulani breed (OR = 8.205; P = 0.013; 95% CI = 1.557; 43.226). Improved sanitation (washing hands before milking) will decrease the risk of SCM (OR = 0.173; P = 0.003; 95% CI = 0.054; 0.554). SCM is prevalent among lactating cows in the Nigerian Savannah; and this is associated with both animal characteristics (age, breed and individual milk quarters) and milking practices (hand washing).Good knowledge of the environment and careful management of the identified risk factors with improved sanitation should assist farm managers and veterinarians in implementing preventative programmes to reduce the incidence of SCM.

https://repository.up.ac.za/bitstream/handle/2263/20889/Shittu_Subclinical(2012).pdf;sequence=1

Sub-clinical mastitis and associated risk factors on lactating cows in the Savannah Region of Nigeria

The primary objective of this study was to determine the aetiology of bovine mastitis in ten herds of Holstein Friesian cow in Jordan, the prevalence of mastitis pathogens in dairy cows and their resistance to selected antimicrobial agents. Milk samples were collected from 220 lactating cows to determine the clinical and subclinical mastitis by white side test and confirmed by cultural tests. It was found that 138 quarters 15.7% had been diagnosed as clinical mastitis with definite gross pathological lesions and change in udder secretion, in addition to that 276 quarters 31.4% showed subclinical mastitis. The incidence of mastitis was found to be increased in older cows. Staphylococcus aurous was considered to be the most common cause of both clinical and subclinical mastitis and followed by coli forms, streptococcus spp., corynebacterium spp., proteus spp. and pseudomonas spp. Sensitivity tests was applied to different isolated strains using tertracycline, ampicillin, neomycin, erythromycin, penicillin G and sulphamethoxazol trimethoprim.

Prevalence and Distribution of Mastitis Pathogens and their Resistance Against Antimicrobial Agents in Dairy Cows in Jordan

Isolation and Identification of Mannheimia haemolytica and Pasteurella multocida in Sheep and Goats using Biochemical Tests and Random Amplified Polymorphic DNA (RAPD) Analysis

Mastitis in One Humped She-Camels (Camelus dromedarius) in Jordan

Problem statement: This study was conducted to describe and report for the first time outbreaks of natural C.pseudotuberculosis infection in adult camel herds (Camelus dromedarius) in Jordan. An infectious disease syndrome was reported in three camel herds (Camelus dromedarius) intensively raised at south province in Jordan. Approach: The herds included over 160 adult camels out of which about 8% were affected with multiple muscle and subcutaneous abscesses at various sites of the body. The camels were also heavily infested with ticks. Results: The infected camels did not respond favorably to several broad spectrum antibiotics. Post-mortem examination of 5 carcasses revealed emaciation and presence of external and internal multiple abscesses particularly in the lungs. The abscesses were encapsulated by fibrous tissue and contained creamy yellowish white pus. The lymph nodes were slightly congested and swollen. Conclusion: Corynebacterium pseudotuberculosis type I strain or biovar ovis (the known cause of caseous lymphadenitis in sheep) was isolated from pus, lymph nodes, ticks, milk, blood and liver samples. The clinical symptoms, nature and distribution of lesions of caseous lymphadenitis in camels are not as typical as in sheep. Recommendations for pseudotuberculosis control were given.

Corynebacterium pseudotuberculosis Infection (Caseous Lymphadenitis) in Camels (Camelus dromedarius) in Jordan

This communication describes outbreaks of Corynebacterium pseudotuberculosis (C.p.) infection in two herds of camels (Camelus dromedarius) for the first time in Saudi Arabia. The herds consisted of about 2,500 adult local and imported camels. Over a period of four months about 15% developed numerous muscular and subcutaneous abscesses particularly on the hind-quarters, shoulders, at the base of the neck and tail, under the jaw and on the joints. Both herds were heavily infested with ticks of Hyalomma species. The affected camels did not respond favourably to antibiotics. Post-mortem examination of eight camels revealed emaciation and presence of multiple external and internal abscesses particularly in the lungs and liver. The body lymph nodes were slightly enlarged and congested but without abscess formation. The abscesses contained odourless, non-granular and non-calcified thin creamy yellowish white pus. Corynebacterium pseudotuberculosis Type I strain (Barakat, Selim, Atef, Saber, Nafie and EI-Ebeedy, 1984) or biovar ovis (Songer, Beckenback, Marshall, Olson and Kelley, 1988), was isolated from the following specimens: 1. 27 pus specimens; 2. 10 out of 12 lymph nodes; 3. 10 out of 14 engorged Hyalomma ticks; 4. four out of six milk samples; 5. three blood specimens and 6. one out of two liver specimens. In addition, Staphylococcus aureus, C. renali, C. equi, Shigella and E. coli were occasionally isolated. Guinea-pigs which were inoculated intradermalIy and intraperitoneally with 0-1 or 0-2ml of 72 hours broth culture of isolated C.p. died three weeks post-inoculation. Post-mortem examination revealed multiple abscesses in the liver, lungs and at the site of inoculation. The organism was recovered from the pus and heart blood. In the present investigation natural C.p. infection produced a chronic disease in camels where intensive husbandry was practised. Clinically, pathologically and microbiologically the disease in camels resembled caseous lymphadenitis of sheep with the exception of: a) the predominance of muscular and subcutaneous abscesses; b) lack of pus formation in the lymph nodes, although they contained C.p. ; c) the abscesses contained thin creamy yellowish white pus. This was also observed in an investigation on Ethiopian camels (Domenech, Guidot and Richard, 1977). In an investigation in Iran on camels natural C.p. infection resulted in caseous lymphadenitis or cheesy gland disease (Esterabadi, Entessar, Hedayati, Narimani and Sadri, 1975). The difference in colour and consistency from that of sheep could be due to the nature of phagocytic enzymes with those of camels being more liquefactive. The isolation of C.p. from ticks indicates that ticks may have a role in

Azmi D. Hawari

Papers

Prevalence and Distribution of Mastitis Pathogens and their Resistance Against Antimicrobial Agents in Dairy Cows in Jordan

Isolation and Identification of Mannheimia haemolytica and Pasteurella multocida in Sheep and Goats using Biochemical Tests and Random Amplified Polymorphic DNA (RAPD) Analysis

Mastitis in One Humped She-Camels (Camelus dromedarius) in Jordan

Corynebacterium pseudotuberculosis Infection (Caseous Lymphadenitis) in Camels (Camelus dromedarius) in Jordan

Corynebacterium pseudotuberculosis infection in camels (Camelus dromedarius) in Saudi Arabia.