Laboratory-acquired brucellosis: a Spanish national survey

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Summary

A retrospective postal survey was carried out among 1240 clinical microbiology laboratory workers in Spain. Overall, 75 (43 microbiologists and 32 technicians) had suffered from laboratory-acquired brucellosis (LAB). Considering the total number of replies (N=628), the rate of LAB was 11.9%. The risk of suffering from LAB was clearly related to the number of isolates of Brucella spp. per year. A major break in biosafety measures was recognized in 60 cases (80%). In nine cases, processing was considered to be secure, and in six cases, the source of infection was unknown. Diagnosis was based on serology in all cases. In 51 cases (68%), blood cultures confirmed diagnosis. A variety of regimens were used to treat the 75 LAB cases. The combination of tetracycline and streptomycin was the most commonly used regimen (in 35 patients), followed by the combination of tetracycline and rifampicin (in 19 cases). Only 10 patients (13.3%) suffered from complications. No differences in resolution were observed according to the antimicrobial regimen. Microbiological laboratory workers are still at risk of developing LAB. Improvements in safety seem to be the best means of prevention.

Introduction

Brucellosis is still an important endemic zoonosis in extensive areas of the world1, 2, 3, 4 and one of the most frequent professional diseases of veterinarians and those working in the meat industry.4, 5, 6 The disease is also recognized as an important professionally acquired infection in microbiology laboratories, even in developed countries.7, 8, 9, 10, 11, 12, 13, 14 However, extensive surveys of the risk of acquiring brucellosis among microbiologists have not been performed previously.

We conducted a nationwide survey in Spain among members of the Spanish Society for Clinical Microbiology and Infectious Diseases (SEIMC). Questionnaires were also sent to senior microbiologists and technical supervisors of microbiology laboratories in Spanish public hospitals, in order to determine the incidence of laboratory-acquired brucellosis (LAB).

Section snippets

Methods

The SEIMC includes the majority of staff working in Spanish clinical microbiology laboratories. It is composed of two sections (Microbiology and Infectious Diseases). At the time of the study (1998–1999), the microbiology section had 1240 registered members.

We carried out a retrospective postal survey of the 1240 clinical microbiology laboratory workers in Spain. Data requested in the survey included the following: name, sex, age and staff grade. The number of samples per day processed for

Results

Out of 1240 surveys sent, 628 replies were received (50.6%). Of these, 388 were from medical staff and 240 were from microbiology technicians. Overall, 75 of those surveyed had suffered from LAB (11.9%). A total of 11.1% of facultative staff and 13.3% of technicians who replied had suffered from LAB. No statistically significant differences were found between the groups. Of the 75 LAB cases, 31 were male and 44 were female. This represented 16.3% and 10.0% of all males and females who replied,

Discussion

A large number of laboratory workers are exposed to different occupational health risks. In microbiology laboratory staff, infection is probably the most frequent laboratory-associated hazard.14 Traditionally, brucellosis has been considered to be the most important laboratory-acquired bacterial infection.15 Although in many countries, the incidence of brucellosis has fallen, the existence of sporadic cases in these countries and its permanence as an endemic disease in others, such as the

Acknowledgements

The authors thank Odorina Tello and Salvador de Mateo Ontañón from Instituto de Salud Carlos III in Madrid, Spain for providing data of the incidence of brucellosis in Spain. The authors thank Dr L. Vigil for useful discussion and suggestions.

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This work was presented in part at the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 1999, San Francisco, USA.

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