An Outbreak of Brucellosis: An Adult and Pediatric Case Series

Abstract

Background Brucellosis is recognized as a neglected zoonotic disease and a major public health threat. The purpose of this study was to characterize epidemiological risk factors and healthcare utilization and compare clinical aspects of disease among adult and pediatric cases in North Texas. Methods A retrospective chart review of electronic medical records was completed at 3 large tertiary centers—Parkland Health and Hospital System, Clements University Hospital, and Children’s Medical Center—between January 1, 2007 and June 1, 2017. Demographic, clinical, and laboratory variables were collected. Cases were defined as confirmed or probable. Results Twenty-eight cases of brucellosis were identified: 26 confirmed (9 children, 17 adults) and 2 probable cases (1 child, 1 adult). Half (n = 14) were diagnosed in 2016 during an outbreak in Dallas County. Risk factors associated with infection were consumption of unpasteurized cheese (71%), recent travel (54%), close contact to a confirmed human brucellosis case (36%), and exposure to animals (11%). Median days of symptoms was 10 and 16 for children and adults, respectively. The majority (79%) of patients visited the emergency department before diagnosis and 93% were hospitalized. Fever was the most common symptom in children (80%) and adults (100%). Hepatitis (75% of children) and anemia (82% of adults) were the most common laboratory abnormalities. The most common complication in children was splenic lesions (40%), and the most common complication in adults was hepato/splenomegaly (39%). Conclusions The diagnosis of Brucella infection requires a high index of suspicion and should be considered in patients presenting with a febrile illness and a compatible exposure history.

Follow-up Brucellacapt and Rose Bengal Tests in 110 Children with Brucellosis

“…7 In this study, complicated brucellosis was observed only in four cases supporting the information that focal disease complications were less frequent in children than adults. 10 Clinical response to preferred treatment regimen was consistent with a recent big meta-analysis. 11 Relapses occurred in 6.4% of followed-up cases at an average of 6 months after treatment.…”

Estudio de casos confirmados de brucelosis humana en Puebla, México

“…En nuestros 39 casos confirmados las manifestaciones clínicas más frecuentes fueron bastante inespecíficas (fiebre, cefalea, astenia, adinamia/ artralgia/mialgia, náuseas, dolor abdominal y diaforesis). Sin embargo, no en todos los estudios se reportan estos síntomas en la misma proporción; por ejemplo, en un estudio realizado en China, los pacientes presentaron principalmente astenia (74%), hiperhidrosis (55%), dolor muscular y articular (59,5%); en nuestro estudio estas manifestaciones obtuvieron los porcentajes más bajos [24][25][26] . En un meta-análisis internacional, los adultos manifestaron astenia (81%), fiebre (73%), artralgia (65%), mialgia (56%), diaforesis (55%), dolor lumbar (49%) y escalofríos (47%).…”

“…refieren manifestaciones gastrointestinales como dolor abdominal/vómito/diarrea hasta en 50%, mientras que en nuestro estudio no pasan de 20% e incluso la diarrea no la presentó paciente alguno. La cefalea sí se presentó en cifras similares: EUA en 40% y México en 45,5%; la astenia, la adinamia y las artralgias se refieren en EUA con una mayor frecuencia que en nuestro estudio (40%); las artralgias en el meta-análisis internacional fueron de las manifestaciones principales con un 71% de frecuencia, sin embargo, la astenia y las mialgias sólo se presentaron en 24 y 18%, lo cual es similar a los resultados de nuestro estudio 13,25 .…”

“…La brucelosis afecta a diferentes mamíferos, incluido el humano en todos los grupos de edad 3,7,8 . Las especies que afectan más frecuentemente al ser humano son Brucella melitensis, B. abortus, B. suis y B. canis 4 .…”

A Congenital Brucellosis Case of 34-day-old Girl

“…On physical examination, ndings are hepatomegaly and splenomegaly, lymphadenopathy, osteoarticular manifestations, genitourinary complications, neurological ndings, mucocutaneous manifestations, and pulmonary manifestations. The disease is transmitted via consumption of unpasteurized dairy products, direct contact with infected animals, inhalation of contaminated aerosols, and rarely human-to-human transmission [3]. Although intrauterine transmission, transmission during delivery, and transmission through breast milk are indeed among the main routes of transmission in the mammalian reservoirs, limited data support vertical transmission of human brucellosis [4,5].…”