Childhood Brucellosis--a Microbiological, Epidemiological and Clinical Study

Abstract

A total of 5726 blood specimens (from children aged 14 years and younger) were studied for the serological evidence of brucellosis. Ninety-three (1.6 per cent) showed diagnostic agglutinin titres with a geometric mean titre of 403 (SD +/- 547). Forty-three (59.7 per cent) blood specimens yielded the growth of Brucella melitensis. Thirty-nine patients (41.93 per cent) were shepherds, who constituted the major occupational group affected in the present series. More than 60 per cent of the patients had a history of both consumption of fresh goat's milk and close animal contact. The habit of consuming fresh goat's milk to obtain relief from chronic ailments was noted in nine patients. Seventy-three (78.49 per cent) were males and 20 (21.51 per cent) were females, with a male to female ratio of 3:1. The disease occurred mainly in the school age group (mean age 10.3 years). All the patients had an acute history of less than 2 months. Forty-nine (52.68 per cent) patients presented with persistent fever, 19 (20.43 per cent) with joint pain, and the rest with a combination of fever and joint pain with and without low backache, fever being the commonest complaint. One case presented with involuntary movements of limbs alone and the other with burning feet only. Pityriasis alba was the consistent physical finding, with fever in the majority of the patients. The major joint found to be involved was the knee (52.77 per cent). The synovial fluid obtained from the knee joint of five patients demonstrated Brucella agglutinins and also three grew B. melitensis. Eight patients presented with complications that included skin lesions (3), carditis (2), neurobrucellosis such as chorea (1), peripheral neuritis (1), and meningitis (1). Brucella melitensis biotype 1 was successfully isolated from the papular eruption of one out of three cases who presented with skin lesions. To our knowledge this is the fourth confirmed isolation of B. melitensis from skin lesions with brucellosis, reported in the literature. The cerebrospinal fluid obtained from the meningitis patient was positive for B. agglutinins. To our knowledge chorea of brucellar origin appears to be the first case reported in the literature. In 15 cases (16.13 per cent) brucellosis was suspected clinically whereas 78 (83.87 per cent) cases, only serological evidence of brucellosis confirmed the diagnosis. None of the cases relapsed. In our experience an initial combination therapy with a three-drug regimen followed by a two-drug regimen for a minimum of 6 weeks has been found to be effective in the prevention of a relapse.

A Comparative Study of Microplate Agglutination Test (MAT) with Enzyme Linked Immunosorbant Assay (ELISA) for Diagnosis of Brucellosis

“…They have also showed no incidence of Brucella antibodies in healthy individuals. 10 similar findings has been recorded in the present study. In a study by Roy et al, (1965) out of 351 samples screened, 21 were positive in diagnostic titres (6%).…”

“…In a study by Roy et al, (1965) out of 351 samples screened, 21 were positive in diagnostic titres (6%). 10 Joshi and Omprakash screened 800 samples and have found diagnostic titres in 39 cases (4.9%) 11 . In study by Gokhale et al, (1999) out of 72 patients 6 were Seropositive for brucellosis (8.3%).…”

Human Brucellosis in Macedonia – 10 Years of Clinical Experience in Endemic Region

“…Nevertheless, the highest cure rate can be achieved with a triple therapy (3) and adding a third drug to the standard regimen seems to be beneficial (63). In two reports, children treated with three drugs had a better outcome than those treated with two drugs (65,66). Almost 84% of the patients in the present study were treated with a combination of three antimicrobial agents, based on our previous experience that three-drug therapy was better than two-drug therapy (unpublished data).…”

Seroprevalence and Risk Factors for Brucellosis in a High-Risk Group of Individuals in Bangladesh

“…This is because the occupations described in this study are male dominated in Bangladesh. Several other studies have indicated gender as significant risk factors for brucellosis (Wassif et al, 1992;Shehata et al, 2001;Mantur et al, 2004;Meky et al, 2007).…”