Brucellosis in Children

Abstract

Background: Brucellosis, a multisystem infection that may imitate other conditions, shows a low incidence during childhood and may be misdiagnosed. Brucellosis has become a major medical problem in a number of the provinces in Iran. Objectives: To study the epidemiology, clinical and laboratory features, and management of brucellosis. Patients and Methods: We reviewed the charts of all patients who were diagnosed with brucellosis and showed an agglutination titer of 1:160 or more for Brucella at the Department of Pediatric Infectious Diseases, Qods Hospital from March 1995 to March 2004. We collected information on the age, gender, history of unpasteurized milk or milk-product ingestion, presenting symptoms, and physical signs of the patients. We also collected results of routine laboratory tests, treatment, and treatment outcome. Results: Patients younger than 12 years of age constituted all cases of brucellosis admissions. One hundred seventy-five patients (107 male and 68 female, 1.6:1 ratio) were diagnosed with brucellosis and had a Brucella titer of 1:160 with an odds ratio (OR) of 1:160. Eighty-seven patients (50%) were 1-6 years of age, 86 patients (49%) were 7-12 years of age, and only 2 patients were < 1 year of age. One hundred (57%) patients were from rural areas, and 75 (43%) were from cities. The most frequent seasons of disease occurrence were summer (76, 43%) and spring (52, 30%); there were fewer cases in winter (24, 14%) and autumn (23, 13%). One hundred fourteen cases (65%) had a history of consuming unpasteurized milk or milk products. The most frequent symptoms were arthralgia (79%) and fever (78%). The most common physical findings were fever (51%) and arthritis (26%). Of the cases, 157 (89.5%) were acute, and 17 (9%) were chronic. A normal white blood cell count was found in 123 cases (71%); anemia, in 33 (19%); increased erythrocyte sedimentation rate (ESR), in 92 (53%); positive C-reactive protein (CRP), in 85 (48%), and positive radiologic changes, in 20 (11%). The most common antibiotics used were cotrimoxazole plus gentamycin in 83 cases (47.5%) and cotrimoxazole plus rifampin in 72 cases (41%). Conclusions: Brucellosis presents in various ways and should be differentiated from arthritis in countries where Brucella is endemic. Symptoms, signs, and first-line laboratory findings are not distinguishing; accordingly, agglutination tests and, if possible, blood culture should be performed in any child with prolonged fever. Treatment is effective, but disease prevention by education of high-risk families is indicated.

Different Clinical Presentations of Brucellosis

“…In this study, 71% of the patients had arthralgia and in terms of clinical type, 70.7% had the acute form. The results of the current study were similar to those of the studies in other countries; and arthritis was the most common complications of brucellosis ( 22 ). On physical examination, sweating (66.7%) and fever (57.2%) were mostly observed in the acute form the disease.…”

“…The primary transmission route of brucellosis is by the ingestion of unpasteurized dairy products in the endemic countries; whereas in the developed countries infection occurs mostly due to occupational exposure ( 21 ). Similar to other studies, the majority of patients, 439 (45.9%) cases, had risk factors such as history of consuming unpasteurized milk or milk products ( 22 ). In contrast to the current study results about residency and risk factors, some experts showed that chronic brucellosis were from rural areas because of consumption of unpasteurized dairy products or contact with animals ( 9 ).…”

Epidemiological and Clinical Features of People with Malta Fever in Iran: A Systematic Review and Meta-Analysis

“…The frequency of Malta fever among ranchers and farmers was reported in 24 studies, which varied from 4.8% (in Pourahmad et al's [50] study) to 47.5% (in Bahador et al's [38] study). The frequency of Malta fever among students was reported in 16 studies, which varied from 6.7% (in Kassiri et al's [4] study) to 50% (in Ayazi et al's [16] study). The frequency of Malta fever among housewives was reported in 22 studies, varying from 4% (in Sharifi-Mood's study) to 44.2% (in Esmaeilnasab et al's [56] study).…”

“…The references were checked and four articles were found. Four articles were found to be duplicated and were published under two titles in different journals 4 , 13 , 14 , 15 , 16 , 17 , 18 , 19 . After assessing the full text of articles and excluding the irrelevant ones, 58 studies were controlled through assessment checklist and 11 articles were omitted.…”

Prevalence and risk factors of brucellosis among veterinary health care professionals

“…Transmission of infection from infected animals to humans is mainly by contact with infected animals, consumption of unsterilized milk, milk and meat products. Human to human transmission can occur through blood transfusion [8], bone marrow transplantation [9], sexual contact [10,11] transplacental transmission, exposure to mother's fomites during delivery or through breast breeding [12,13].…”