{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T15:57:49Z","timestamp":1787932669644,"version":"build-2784847793"},"reference-count":49,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T00:00:00Z","timestamp":1571788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Brucellosis is a zoonosis of great and worldwide public health concern that can cause a severe febrile illness in humans. In Pakistan, brucellosis is a critical problem in both animals and humans. This study aimed to gain insight into its prevalence and to analyze the potential risk factors of patients with acute febrile illness (AFI) of an unknown cause, at the hospitals of Rawalpindi and Islamabad in Pakistan. In total, 446 blood samples were collected from patients and screened for brucellosis using the Rose Bengal Plat Test (RBPT). All the serum samples were investigated for Brucella DNA using specific real-time PCR. Age, sex, occupation, urbanicity, socioeconomic status and history of animal contact were recorded and assessed as potential risk factors. The proportion of acute febrile illness patients for whom brucellosis could be suspected was 10.1% by the RBPT. Brucella DNA was detected in 26 (5.8%) cases and identified as B. abortus. Contact with infected animals, consumption of raw milk and socioeconomic status showed a highly significant (p &lt; 0.05) correlation with seropositivity. Elderly patients (19.7% RBPT and 12.1% PCR) and females (13% RBPT and 9.3% PCR) were of high risk of brucellosis. Patients suffering from brucellosis-related manifestations should be screened for brucellosis, especially those in contact with animals or those consuming their unprocessed products, given the increased risk. The results of this study, which highlight that Brucella abortus as an important cause of acute febrile illnesses in humans, aid the development of effective control strategies for human brucellosis in Pakistan.<\/jats:p>","DOI":"10.3390\/ijerph16214071","type":"journal-article","created":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T03:20:36Z","timestamp":1571973636000},"page":"4071","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Acute Febrile Illness Caused by Brucella Abortus Infection in Humans in Pakistan"],"prefix":"10.3390","volume":"16","author":[{"given":"Arbab","family":"Saddique","sequence":"first","affiliation":[{"name":"Animal Physiology Laboratory, Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University, 46000 Rawalpindi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4281-2659","authenticated-orcid":false,"given":"Shahzad","family":"Ali","sequence":"additional","affiliation":[{"name":"Wildlife Epidemiology and Molecular Microbiology Laboratory (One Health Research Group), Discipline of Zoology, Department of Wildlife and Ecology, University of Veterinary and Animal Sciences, Lahore, Ravi Campus, 55300 Pattoki, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamim","family":"Akhter","sequence":"additional","affiliation":[{"name":"Animal Physiology Laboratory, Department of Zoology, Pir Mehr Ali Shah Arid Agriculture University, 46000 Rawalpindi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iahtasham","family":"Khan","sequence":"additional","affiliation":[{"name":"Section of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore Sub- campus, 35200 Jhang, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinrich","family":"Neubauer","sequence":"additional","affiliation":[{"name":"Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 10 96a, D-07743 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falk","family":"Melzer","sequence":"additional","affiliation":[{"name":"Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 10 96a, D-07743 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5616-7833","authenticated-orcid":false,"given":"Aman Ullah","family":"Khan","sequence":"additional","affiliation":[{"name":"Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 10 96a, D-07743 Jena, Germany"},{"name":"Department of Pathobiology, College of Veterinary and Animal Sciences, 35200 Jhang, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asima","family":"Azam","sequence":"additional","affiliation":[{"name":"Department of Zoology, Shaheed Benazir Bhutto Women University, 25000 Peshawar, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8585-4237","authenticated-orcid":false,"given":"Hosny","family":"El-Adawy","sequence":"additional","affiliation":[{"name":"Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 10 96a, D-07743 Jena, Germany"},{"name":"Faculty Medicine of Veterinary, Kafrelsheikh University, 33516 Kafr El-Sheikh, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1093\/clinids\/21.2.283","article-title":"An overview of human brucellosis","volume":"21","author":"Young","year":"1995","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","first-page":"e33765","article-title":"Different clinical presentations of brucellosis","volume":"9","author":"Roushan","year":"2016","journal-title":"Jundishapur J. Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s10096-005-1349-z","article-title":"Human brucellosis in a nonendemic country: A report from Germany, 2002 and 2003","volume":"24","author":"Nockler","year":"2005","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/S1473-3099(07)70286-4","article-title":"Human brucellosis","volume":"7","author":"Franco","year":"2007","journal-title":"Lancet Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1016\/j.ijantimicag.2010.06.013","article-title":"The changing Brucella ecology: Novel reservoirs, new threats","volume":"36","author":"Pappas","year":"2010","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"302","DOI":"10.3201\/eid0702.010232","article-title":"Clinical microbiology in developing countries","volume":"7","author":"Archibald","year":"2001","journal-title":"Emerg. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kamal, I.H., Al Gashgari, B., Moselhy, S.S., Kumosani, T.A., and Abulnaja, K.O. (2013). Two-stage PCR assay for detection of human brucellosis in endemic areas. BMC Infect. Dis., 13.","DOI":"10.1186\/1471-2334-13-145"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/S1473-3099(06)70382-6","article-title":"The new global map of human brucellosis","volume":"6","author":"Pappas","year":"2006","journal-title":"Lancet Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s12038-008-0072-1","article-title":"Brucellosis in India\u2014A review","volume":"33","author":"Mantur","year":"2008","journal-title":"J. Biosci."},{"key":"ref_10","first-page":"350","article-title":"Human Brucellosis: Are we neglecting an enemy at the backyard?","volume":"6","author":"Pandit","year":"2013","journal-title":"Med. J."},{"key":"ref_11","first-page":"41","article-title":"Natural history of brucellosis in an endemic region in different time periods","volume":"48","author":"Bosilkovski","year":"2009","journal-title":"Acta Clin. Croat."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"225","DOI":"10.26719\/1998.4.2.225","article-title":"Human brucellosis in Gaza Strip, Palestine","volume":"4","author":"Awad","year":"1998","journal-title":"East Mediterr. Health J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e61764","DOI":"10.5812\/jjm.61764","article-title":"Epidemiological investigation of human brucellosis in Pakistan","volume":"11","author":"Ali","year":"2018","journal-title":"Jundishapur J. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1089\/fpd.2012.1360","article-title":"Seroprevalence and risk factors associated with brucellosis as a professional hazard in Pakistan","volume":"10","author":"Ali","year":"2013","journal-title":"Foodborne Pathog. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2310\/7060.2004.13551","article-title":"Brucellosis and international travel","volume":"11","author":"Memish","year":"2004","journal-title":"J. Travel Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s11250-013-0448-6","article-title":"Isolation and identification of bovine Brucella isolates from Pakistan by biochemical tests and PCR","volume":"46","author":"Ali","year":"2014","journal-title":"Trop. Anim. Health Prod."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.17582\/journal.pjz\/2017.49.3.sc2","article-title":"Molecular identification of bovine brucellosis causing organisms at selected private Farms in Pothohar Plateau, Pakistan","volume":"49","author":"Ali","year":"2017","journal-title":"Pak. J. Zool."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"470","DOI":"10.3855\/jidc.5110","article-title":"Serological, cultural, and molecular evidence of Brucella infection in small ruminants in Pakistan","volume":"9","author":"Ali","year":"2015","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2927","DOI":"10.1128\/jcm.35.11.2927-2930.1997","article-title":"Rapid diagnosis of human brucellosis by peripheral-blood PCR assay","volume":"35","author":"Morata","year":"1997","journal-title":"J. Clin. Microbiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1006\/mcpr.2000.0338","article-title":"Real-time detection of Brucella abortus, Brucella melitensis and Brucella suis","volume":"15","author":"Redkar","year":"2001","journal-title":"Mol. Cell. Probes."},{"key":"ref_21","first-page":"577","article-title":"Laboratory-based diagnosis of brucellosis\u2014A review of the literature. Part II: Serological tests for brucellosis","volume":"49","author":"Tomaso","year":"2003","journal-title":"Clin. Lab."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0378-1135(98)00250-8","article-title":"Efficacy of ELISA compared to conventional tests (RBPT and CFT) for the diagnosis of Brucella melitensis infection in sheep","volume":"64","author":"Jacques","year":"1998","journal-title":"Vet. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.33073\/pjm-2011-004","article-title":"Comparison of different PCR methods for detection of Brucella spp. in human blood samples","volume":"60","author":"Ibrahim","year":"2011","journal-title":"Pol. J. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1128\/JCM.39.4.1661-1664.2001","article-title":"Serum is the preferred clinical specimen for diagnosis of human brucellosis by PCR","volume":"39","author":"Zerva","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_25","first-page":"144","article-title":"Seroprevalence of brucellosis in animals at government and private livestock farms in Punjab","volume":"24","author":"Nasir","year":"2004","journal-title":"Pak. Vet. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1128\/JCM.42.3.1290-1293.2004","article-title":"Real-time multiplex PCR assay for detection of Brucella spp., B. abortus, and B. melitensis","volume":"42","author":"Probert","year":"2004","journal-title":"J. Clin. Microbial."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1007\/s11250-016-1148-9","article-title":"Serological, molecular detection and potential risk factors associated with camel brucellosis in Pakistan","volume":"48","author":"Fatima","year":"2016","journal-title":"Trop. Anim. Health Prod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2160","DOI":"10.3201\/eid2212.160285","article-title":"Human brucellosis in febrile patients seeking treatment at remote hospitals, northeastern Kenya, 2014\u20132015","volume":"22","author":"Njeru","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"15465","DOI":"10.1038\/s41598-018-33915-9","article-title":"Prevalence and risk factors of brucellosis among febrile patients attending a community hospital in south western Uganda","volume":"8","author":"Migisha","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.trstmh.2007.02.027","article-title":"Brucellosis as a cause of acute febrile illness in Egypt","volume":"101","author":"Jennings","year":"2007","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_31","first-page":"117","article-title":"Brucellosis seroprevalence and risk factors for seroconversion among febrile attendants of urban health care facilities in Mali","volume":"4","author":"Steinmann","year":"2006","journal-title":"Rev. Afr. St. Prod. Anim."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.4269\/ajtmh.2012.12-0327","article-title":"Brucellosis among hospitalized febrile patients in northern Tanzania","volume":"87","author":"Bouley","year":"2012","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1089\/vbz.2017.2158","article-title":"Prevalence of selected zoonotic diseases and risk factors at a human-wildlife-livestock interface in Mpumalanga province, South Africa","volume":"18","author":"Simpson","year":"2018","journal-title":"Vector Borne Zoonotic Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.diagmicrobio.2005.03.011","article-title":"Detection of Brucella DNA in sera from patients with brucellosis by polymerase chain reaction","volume":"53","author":"Elfaki","year":"2005","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Chipwaza, B., Mhamphi, G.G., Ngatunga, S.D., Selemani, M., Amuri, M., Mugasa, J.P., and Gwakisa, P.S. (2015). Prevalence of bacterial febrile illnesses in children in Kilosa district, Tanzania. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003750"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0399-077X(00)88686-2","article-title":"Epidemiology of human brucellosis in Lebanon in 1997","volume":"30","author":"Kalaajieh","year":"2000","journal-title":"M\u00e9d. Mal. Infect."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1089\/fpd.2011.1029","article-title":"Seroprevalence and risk factors for brucellosis in a high-risk group of individuals in Bangladesh","volume":"9","author":"Rahman","year":"2012","journal-title":"Foodborne Pathog. Dis."},{"key":"ref_38","first-page":"106","article-title":"Seroprevalence of brucellosis in man","volume":"34","author":"Thakur","year":"2002","journal-title":"J. Commun. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e904","DOI":"10.1016\/j.ijid.2010.04.007","article-title":"Brucellosis serology in HIV-infected patients","volume":"14","author":"Abdollahi","year":"2010","journal-title":"Int. J. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"19625","DOI":"10.2807\/ese.15.30.19625-en","article-title":"Seroprevalence of brucellosis in animals and human populations in the western mountains region in Libya, December 2006\u2013January 2008","volume":"15","author":"Ahmed","year":"2010","journal-title":"Euro Surveill."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Tumwine, G., Matovu, E., Kabasa, J., Owiny, D., and Majalija, S. (2015). Human brucellosis: Sero-prevalence and associated risk factors in agro-pastoral communities of Kiboga District, Central Uganda. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-2242-z"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2754\/avb200877010117","article-title":"Serological investigations of brucellosis in cattle, farmers and veterinarians in the kars district of Turkey","volume":"77","author":"Otlu","year":"2008","journal-title":"Acta Vet. Brno"},{"key":"ref_43","first-page":"29","article-title":"Seroepidemiological survey of brucellosis among animal farmers of Yazd province","volume":"31","author":"Salari","year":"2002","journal-title":"Iran. J. Public Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1093\/ije\/25.2.450","article-title":"Seroprevalence of brucellosis among high risk people in northern Jordan","volume":"25","author":"Odeh","year":"1996","journal-title":"Int. J. Epidemiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.prevetmed.2012.02.013","article-title":"The human\u2013animal interface of domestic livestock management and production and its relationship to brucellosis in the country of Georgia 2010: A rapid assessment analysis","volume":"105","author":"Havas","year":"2012","journal-title":"Prev. Vet. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5365\/wpsar.2014.5.1.002","article-title":"Seroprevalence survey of brucellosis among rural people in Mongolia","volume":"5","author":"Tsend","year":"2014","journal-title":"West. Pac. Surveill. Response J."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Ali, S., Akhter, S., Neubauer, H., Scherag, A., Kesselmeier, M., Melzer, F., Khan, I., El-Adawy, H., Azam, A., and Qadeer, S. (2016). Brucellosis in pregnant women from Pakistan: An observational study. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1799-1"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Arif, S., Thomson, P., Hernandez-Jover, M., McGill, D., Warriach, H., and Heller, J. (2017). Knowledge, attitudes and practices (KAP) relating to brucellosis in smallholder dairy farmers in two provinces in Pakistan. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0173365"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"790","DOI":"10.4314\/ahs.v14i4.3","article-title":"Brucella sero-prevalence and modifiable risk factors among predisposed cattle keepers and consumers of un-pasteurized milk in Mbarara and Kampala districts, Uganda","volume":"14","author":"Nasinyama","year":"2014","journal-title":"Afr. Health Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/21\/4071\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:28:36Z","timestamp":1760189316000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/21\/4071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,23]]},"references-count":49,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2019,11]]}},"alternative-id":["ijerph16214071"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16214071","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,23]]}}}