Pathology of Brucellosis: A Review of 88 Biopsies

Akhtar, Mohammed; Ali, Muhammad

doi:10.5144/0256-4947.1989.247

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…Brucellosis is a multi-system disease [9] and clinical presentation in children is mainly in the form of fever, arthropathies, visceromegaly and anemia [10,11]. By far, the most common presentation was pyrexia of unknown origin.…”

Section: Discussionmentioning

confidence: 99%

Brucellosis in Pediatric Patients: A Review of 114 Cases from Asir Region

Nabi

Mir

1992

Ann Saudi Med

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Over a period of four years, 114 children (> 28 days to ≤ 12 years) with seropositive brucellosis were admitted to Khamis Mushayt Civil Hospital, constituting 1% of all pediatric admissions. History of contact with domestic animals and ingestion of raw milk was positive, and over 84% of the patients were from the rural areas of Asir. The male:female ratio was 1.2:1, over 59% were of ≤ 5 years of age. Common clinical features observed were fever (80.7%), hepatosplemomegaly (38%), arthropathies (29%), and anemia (34%). Over 36% of the children were undernourished. Serological identification of etiological agents revealed Abortus and melitensis (53.5%), Abortus (32.5%) and melitensis (14%). All patients were treated with a combination of rifampicin and septrin. There were no deaths, drug-induced hepatitis was observed in two cases. It would appear that brucellosis is one of the major causes of morbidity in the pediatric population located in the Asir region and there is an urgent need for an effective control program. Brucellosis is one of the major health problems in both rural and urban Saudi Arabia [1]. While the epidemiology of the disease in the adult population is well documented [2,3], there is a paucity of data on its clinical pattern in Saudi children. This retrospective study was undertaken to evaluate the magnitude of the problem and to analyze the factors related to its clinical presentation in a selected population of pediatric patients requiring hospitalization in a district general hospital in the Asir Province of Saudi Arabia. Material and MethodsCase records of all children (> 28 days to 12 years) with seropositive diagnosis of brucellosis admitted to Khamis Mushayt Civil Hospital over a period of four years (1406H to 1409H) were reviewed. Clinical laboratory, radiological and histological materials were reviewed and the diagnosis was verified or revised in each case. Of a total of 10,973 pediatric admissions, 114 children were identified to have a brucella agglutination titer 1:160. The serological diagnosis of brucellosis was made by collecting 5 cc of blood from each patient and the sera subjected to the slide agglutination test and tube agglutination test using gamma antigen preparation (Gamma Biologicals Inc., Houston, Texas, USA). A double dilution of serum from 1:10 to 1:2560 in tube method and 1:20 to 1:360 in slide method were used for the agglutination test. The tubes were incubated at 37°C for 48 hours. Positive and negative control sera were used for each batch of tests; against both strains of Brucella (B. abortus and B. melitensis) a significant titer of 1:160 was considered as positive for brucellosis.For bacteriological isolation of brucella organism, blood cultures using tryptic soy broth and CO 2 under vacuum (Difco Laboratories, Houston, Texas, USA) were used; standard methods [4] for incubation, subcultures, bacterial identification and antibiotic sensitivity testing procedures were employed. Brucellosis in Pediatric Patients: A Review of 114 Cases from Asir Region Annals of Sau...

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Section: Discussionmentioning

confidence: 99%

Brucellosis in Pediatric Patients: A Review of 114 Cases from Asir Region

Nabi

Mir

1992

Ann Saudi Med

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“…In brucellar arthritis, the synovium shows chronic inflammatory changes without any specific histological pattern [1]. In these circumstances, the precise diagnosis is dependent upon other factors.…”

Section: Discussionmentioning

confidence: 99%

Synovial biopsy

Sankaran-Kutty

Das²,

Kutty³

1998

International Orthopaedics

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“…Undifferentiated febrile illness, arthritis dominant syndrome with hepatosplenomegaly and lymphadenopathy are the usual modes of presentation. Occasionally symptoms related to a single organ predominate, in which case the disease is termed ‘localized’[11]. Epididymo‐orchitis is the most common genitourinary complication [12–16].…”

Section: Introductionmentioning

confidence: 99%

Brucellar epididymo‐orchitis in Saudi Arabia: a retrospective study of 26 cases and review of the literature

Memish

Venkatesh

2001

BJU International

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Objective To review the clinical and laboratory features and response to treatment of patients with acute brucellar epididymo‐orchitis reporting to a tertiary care hospital in Riyadh, and to compare these with other cases reported previously. Patients and methods In this retrospective study, records of all 26 adult patients with brucellosis, who presented with epididymitis or epididymo‐orchitis at a tertiary hospital in Riyadh from 1983 to 2000, were reviewed. Positive blood culture or high agglutination titres of 1 : 320 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Among these cases, epididymitis or epididymo‐orchitis was diagnosed on the basis of a typical history of gradual onset of scrotal pain and findings of enlarged tender testes and/or epididymis. Results Epididymo‐orchitis occurred in 1.6% of all patients with brucellosis. Most (58%) were 25–44 years old; ≈ 77% of the patients presented with acute symptoms of < 2 weeks' duration. All patients complained of swollen painful testicles. Other presenting symptoms included undulant fever (96%), chills (54%) and arthralgia (23%). Four patients had dysuria and one haematuria. Ten patients gave a positive history of ingestion of raw milk and milk products; one patient had laboratory‐acquired brucellosis. Six patients had unilateral epididymo‐orchitis (two with features of florid presentation); the remaining 20 had only orchitis (bilateral in two, right in 10 and left in eight). Leucocytosis was present in six patients; 25 had initial agglutination titres of > 1 : 320 and the remaining patient had a positive blood culture. All patients received combined therapy with streptomycin for the first 2 weeks (or oral rifampicin for 6 weeks) with doxycycline or tetracycline for 6 weeks. All showed improvement, fever subsided in 2–5 days and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. Conclusion In brucellosis‐endemic areas, clinicians encountering epididymo‐orchitis should consider the likelihood of brucellosis. A careful history, a meticulous physical examination and a rapid laboratory evaluation help in diagnosis. Clinical and serological data are sufficient for diagnosis. Leucocytosis is not an atypical feature of brucellar epididymo‐orchitis and so cannot be used for differentiating it from the nonspecific variety. Conservative management with combination antibiotic therapy is adequate for managing brucellar epididymo‐orchitis.

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Pathology of Brucellosis: A Review of 88 Biopsies

Cited by 9 publications

References 22 publications

Brucellosis in Pediatric Patients: A Review of 114 Cases from Asir Region

Brucellosis in Pediatric Patients: A Review of 114 Cases from Asir Region

Synovial biopsy

Brucellar epididymo‐orchitis in Saudi Arabia: a retrospective study of 26 cases and review of the literature

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