title: Epidemiological and Clinical Features of Brucellosis in the Country of Georgia.
abstract: BACKGROUND
  Brucellosis is an endemic disease in the country of Georgia. According to the National Center for Disease Control and Public Health of Georgia (NCDC), the average annual number of brucellosis cases was 161 during 2008-2012. However, the true number of cases is thought to be higher due to underreporting. The aim of this study was to provide current epidemiological and clinical information and evaluate diagnostic methods used for brucellosis in Georgia.
  
  
  METHODS
  Adult patients were eligible for participation if they met the suspected or probable case definition for brucellosis. After consent participants were interviewed using a standardized questionnaire to collect information on socio-demographic characteristics, epidemiology, history of present illness, and clinical manifestation. For the diagnosis of brucellosis, culture and serological tests were used.
  
  
  RESULTS
  A total of 81 participants were enrolled, of which 70 (86%) were from rural areas. Seventy-four percent of participants reported consuming unpasteurized milk products and 62% consuming undercooked meat products before symptom onset. Forty-one participants were positive by the Wright test and 33 (41%) were positive by blood culture. There was perfect agreement between the Huddelston and Wright tests (k = 1.0). Compared with blood culture (the diagnostic gold standard), ELISA IgG and total ELISA (IgG + IgM), the Wright test had fair (k = 0.12), fair (k = 0.24), and moderate (k = 0.52) agreement, respectively.
  
  
  CONCLUSIONS
  Consumption of unpasteurized milk products and undercooked meat were among the most common risk factors in brucellosis cases. We found poor agreement between ELISA tests and culture results. This report also serves as an initial indication that the suspected case definition for brucellosis surveillance purposes needs revision. Further research is needed to characterize the epidemiology and evaluate the performance of the diagnostic methods for brucellosis in Georgia.
authors.affiliation: U.S. Army Medical Research Directorate-Georgia (USAMRD-G), Tbilisi, Georgia, United States of America.
authors.forename: Tamar
authors.initials: T
authors.lastname: Akhvlediani
authors.affiliation: Walter Reed Army Institute of Research (WRAIR), Silver Spring, Maryland, United States of America.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Bautista
authors.affiliation: National Center for Disease Control and Public Health, Tbilisi, Georgia, United States of America.
authors.forename: Natalia
authors.initials: N
authors.lastname: Garuchava
authors.affiliation: National Center for Disease Control and Public Health, Tbilisi, Georgia, United States of America.
authors.forename: Lia
authors.initials: L
authors.lastname: Sanodze
authors.affiliation: Virsaladze Scientific-Research Institute of Medical Parasitology and Tropical Medicine, Tbilisi, Georgia, United States of America.
authors.forename: Nora
authors.initials: N
authors.lastname: Kokaia
authors.affiliation: National Center for Disease Control and Public Health, Tbilisi, Georgia, United States of America.
authors.forename: Lile
authors.initials: L
authors.lastname: Malania
authors.affiliation: National Center for Disease Control and Public Health, Tbilisi, Georgia, United States of America.
authors.forename: Nazibrola
authors.initials: N
authors.lastname: Chitadze
authors.affiliation: National Center for Disease Control and Public Health, Tbilisi, Georgia, United States of America.|I. Javakhishvili Tbilisi State University, Tbilisi, Georgia, United States of America.
authors.forename: Ketevan
authors.initials: K
authors.lastname: Sidamonidze
authors.affiliation: U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Rivard
authors.affiliation: U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hepburn
authors.affiliation: U.S. Army Medical Research Directorate-Georgia (USAMRD-G), Tbilisi, Georgia, United States of America.|Walter Reed Army Institute of Research (WRAIR), Silver Spring, Maryland, United States of America.
authors.forename: Mikeljon P
authors.initials: MP
authors.lastname: Nikolich
authors.affiliation: National Center for Disease Control and Public Health, Tbilisi, Georgia, United States of America.
authors.forename: Paata
authors.initials: P
authors.lastname: Imnadze
authors.affiliation: U.S. Army Medical Research Directorate-Georgia (USAMRD-G), Tbilisi, Georgia, United States of America.|National Center for Disease Control and Public Health, Tbilisi, Georgia, United States of America.
authors.forename: Nino
authors.initials: N
authors.lastname: Trapaidze
mesh_terms: D000328:Adult; D000818:Animals; D002006:Brucellosis / Q000453:epidemiology* / Q000473:pathology; D002417:Cattle; D002418:Cattle Diseases / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult