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      Perspectives for the Treatment of Brucellosis in the 21st Century: The Ioannina Recommendations

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          Abstract

          The authors provide evidence-based guidance on treating human brucellosis, and discuss the future clinical trials that would help address the controversies surrounding treatment.

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          Most cited references57

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          Brucellosis: an overview.

          M Corbel (1997)
          Brucellosis remains a major zoonosis worldwide. Although many countries have eradicated Brucella abortus from cattle, in some areas Brucella melitensis has emerged as a cause of infection in this species as well as in sheep and goats. Despite vaccination campaigns with the Rev 1 strain, B. melitensis remains the principal cause of human brucellosis. Brucella suis is also emerging as an agent of infection in cattle, thus extending its opportunities to infect humans. The recent isolation of distinctive strains of Brucella from marine mammals has extended its ecologic range. Molecular genetic studies have demonstrated phylogenetic affiliation to Agrobacterium, Phyllobacterium, Ochrobactrum, and Rhizobium. Polymerase chain reaction and gene probe development may provide more effective typing methods. Pathogenicity is related to production of lipopolysaccharides containing a poly N-formyl perosamine O chain, CuZn superoxide dismutase, erythrlose phosphate dehydrogenase, stress-induced proteins related to intracellular survival, and adenine and guanine monophosphate inhibitors of phagocyte functions. Protective immunity is conferred by antibody to lipopolysaccharide and T-cell-mediated macrophage activation triggered by protein antigens. Diagnosis still centers on isolation of the organism and serologic test results, especially enzyme immunoassay, which is replacing other methods. Polymerase chain reaction is also under evaluation. Therapy is based on tetracyclines with or without rifampicin, aminoglycosides, or quinolones. No satisfactory vaccines against human brucellosis are available, although attenuated purE mutants appear promising.
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            An overview of human brucellosis.

            Susan Young (1995)
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              Clinical pharmacokinetics of doxycycline and minocycline.

              S Saivin, G Houin (1988)
              Doxycycline and minocycline are second-generation tetracyclines. They are readily absorbed, distributed throughout the organism as a function of their lipophilicity and eliminated in both the urine and the faeces. The influence of age, renal disease, malnutrition and hyperlipidaemia is reviewed, together with the main pharmacokinetic interactions.
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                Author and article information

                Journal
                Journal ID (nlm-ta): PLoS Med
                Journal ID (publisher-id): pmed
                Journal ID (publisher-id): plme
                Journal ID (pmc): plosmed
                Title: PLoS Medicine
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Print): 1549-1277
                ISSN (Electronic): 1549-1676
                Publication date (Print): December 2007
                Publication date (Electronic): 27 December 2007
                Volume: 4
                Issue: 12
                Electronic Location Identifier: e317
                Author notes
                * To whom correspondence should be addressed. E-mail: gpele@ 123456otenet.gr
                Article
                Publisher ID: 07-PLME-PF-1078R1
                DOI: 10.1371/journal.pmed.0040317
                PMC ID: 2222927
                PubMed ID: 18162038
                SO-VID: cd749787-c302-4747-95bc-a8eb47146286
                Copyright © This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
                History
                Page count
                Pages: 7
                Categories
                Subject: Policy Forum
                Subject: Infectious Diseases
                Subject: Infectious Diseases
                Subject: Microbiology
                Subject: Medicine in Developing Countries
                Custom metadata
                citation Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, et al. (2007) Perspectives for the treatment of brucellosis in the 21st century: The Ioannina recommendations. PLoS Med 4(12): e317. doi: 10.1371/journal.pmed.0040317

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                ScienceOpen disciplines: Medicine

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