Which diagnostic tests are most effective for confirming a diagnosis of brucellosis in primary care settings?

In primary care settings, the most effective diagnostic tests for confirming brucellosis are serological assays, particularly the standard agglutination test (SAT), which detects antibodies against Brucella species. This test is widely used due to its accessibility, rapid turnaround, and reasonable sensitivity and specificity for initial diagnosis.

Blood cultures can provide definitive diagnosis by isolating Brucella organisms, but they are less practical in primary care due to prolonged incubation times and lower sensitivity in chronic cases. Therefore, blood cultures are generally reserved for hospital or specialist settings.

Molecular methods such as PCR offer high sensitivity and specificity and can detect Brucella DNA early in infection, but their availability in primary care is limited. They are more commonly used in reference laboratories or endemic areas with advanced diagnostic facilities.

Combining serological testing with clinical assessment remains the cornerstone of diagnosis in primary care, with referral for further microbiological or molecular testing if initial results are inconclusive or if the patient is severely ill.

This approach aligns with UK clinical practice emphasizing serology as the first-line diagnostic tool, while recent literature highlights advances in molecular diagnostics that may enhance early detection, especially in endemic regions (Elbehiry et al., 2023) ¹.