Pulmonary Involvement in Childhood Brucellosis: A Case Report

Abstract

Brucellosis is primarily a zoonotic disease that continues to be an important public health problem. It is a rare, multisystem infection of childhood and it may present with a wide spectrum of clinical presentations and complications. However, lung involvement is extremely rare in the course of childhood brucellosis. This case report describes a 6-year-old child who was referred to our hospital as meningococcemia but diagnosed as lobar pneumonia in follow-up. Brucella agglutination test and bone marrow culture were diagnostic of brucellosis. The patient responded to the combination therapy of rifampicin and trimethoprim-sulfamethoxazole.

Pulmonary Involvement in Brucellosis

“…In the present case, thoracentesis was not performed because the pleural effusion was minimal. According to some authors, the efficacy of blood cultures decreases significantly with the previous use of antibiotics and with subacute and chronic forms of infection (2,6). Negative blood cultures in the present case may be related to the use of antibiotics before the investigation for brucellosis.…”

“…Due to its high degree of morbidity, both for animals and humans, it is a significant cause of economic loss and represents a serious public health problem in many developing countries (2). Inhalation of contaminated aerosols is a route by which Brucella can make direct contact with the respiratory system and, according to some authors, it is a route that has potential for use in biological warfare (6). Because of wide distribution of the microorganism through the bloodstream to various organs, including the lungs, bacteremic spread may be the most probable route for acquiring pulmonary brucellosis (2,4).…”

“…This presentation could be considered the respiratory mononuclear cells' reaction to the invading microbe; it is not considered to truly be respiratory involvement, by us or by most other specialists, unless it takes a prolonged and paroxysmal course (5). In the literature, the following pulmonary manifestations of brucellosis have been reported: lung abscess, empyema, pneumonia, pleural effusion, granulomas, solitary nodules, and hilar and paratracheal lymphadenopathy (4)(5)(6)(7)(8). Pneumonia may be the sole presentation of brucellosis (9).…”

“…Most large studies of patients with brucellosis have only occasionally focused on the respiratory system, with an estimated rate of involvement in less than 1% to 5% of cases (5). Inhalation of contaminated aerosols and bacteremic spread to the lungs are the most probable routes for acquiring pulmonary brucellosis (6). A variety of pulmonary manifestations associated with brucellosis have been documented in the literature, including bronchopneumonia, lung abscess, empyema, pleural effusion, granulomas, solitary nodules, and hilar and paratracheal lymphadenopathy (1,4).…”

Untitled

“…14 effusion, granulomas, solitary nodules, and hilar and paratracheal lymphadenopathies. [15][16][17] Gur and associates, 6 Lubani and associates, 14 and Hatipoglu and associates 15 found that lung involvement of brucellosis was 5%, 0.6%, and 10%.…”