A Prospective Study of Brucellosis in Children: Relative Frequency of Pancytopenia

Abstract

Hematological complications in brucellosis are common. Pancytopenia, although mainly reported in adults has also been described in children with brucellosis. This investigation was conducted to estimate the relative frequency of pancytopenia in children with brucellosis. The current study was conducted in Al-Khafji joint operation hospital, Saudi Arabia. Sixty patients with brucellosis, were enrolled in the study. Complete blood count (CBC) and blood culture were performed for all cases. Bone marrow (BM) aspiration was considered only in those with pancytopenia. Out of 60 children with brucellosis, 50 (83%) ingested raw animal milk and 27 (45%) had a positive family history of brucellosis. The common presenting symptoms and signs included excessive sweating (68%), bone aches (62%), chills (55%), arthritis (32%), hepatomegaly (18%), and splenomegaly (15%). The main hematological manifestations included anemia (43%), leukopenia (38%) and leukocytosis (20%). Pancytopenia was detected in 11 patients (18%). Blood culture for Brucella was positive in 38% (23 patients). B.melitensis from 21 patients was cultured in vitro. Out of 9 BM aspirate cultures, 3 were positive for B. melitensis. Out of 11 patients with pancytopenia, 9 (82%) patients had bone aches and weakness, 7 (64%) patients had sweating and chills, and 6 (55%) patients had petechiea and purpura. Conclusion: The current study concludes that although pancytopenia is an uncommon complication of brucellosis in children, it does occur. Therefore, brucellosis should be considered in the differential diagnosis of pancytopenia in children, particularly in endemic areas such as Saudi Arabia.

Pattern of childhood brucellosis in Najran, south Saudi Arabia in 2013-2017

“…Our results were not in line with a Turkish study (8) which reported mean age of the study population 8.4±6.4 years, 53.2% females and 46.8% males. Our study found that 15.8 reported a history of ingestion of raw milk and dairy product and only 1.8% of them reported a history of animal contact, which was less than the El-Koumi MA et al study in Saudi Arabia (9) which found (83%) of the cases ingested raw animal milk and (45%) had a positive family history of brucellosis. This agreed with findings of Briones Lara et al (10) which reported 61 % of cases had consumed potentially infected milk or dairy products.…”

Human brucellosis in Turkey: different clinical presentations

“…Roushan et al [18] reported anemia in 15.1%, leukocytosis in 12.2%, leukopenia in 3%, and thrombocytopenia in 3.4% of 469 patients. Pancytopenia has been found in 0.9%-21% of patients in different studies [2,[32][33][34][35]. There are conflicting data about the frequency of pancytopenia in different subgroups of the disease.…”

Small Ruminants and Zoonotic Infections: Live or Dead—Direct or Indirect

“…There are four important species that may cause infection in humans, whereas B. melitensis is considered as the most invasive producing the most severe disease in humans (Godfroid et al 2005;El-Koumi et al 2013). B. melitensis is associated with small ruminants, although B. abortus may occasionally cause infection in sheep and goats.…”

“…The patient may show fever, chills, headache, muscle and joint pains, malaise, nausea, night sweats and lack of appetite for 3-6 weeks. The condition may also show a variety of non-specific haematological changes, such as anaemia and leucopenia (Plommet et al 1998;El-Koumi et al 2013).…”

“…Surveillance, testing and massive immunization of animals, and national brucellosis control are necessary to eradicate the disease (El-Koumi et al 2013). For human consumption, unpasteurized milk and milk products should be avoided.…”