Childhood Brucellosis Research Articles

Clinical manifestations and laboratory findings of 496 children with brucellosis in Van, Turkey.

Brucellosis is the most common zoonotic disease worldwide and remains an important human disease especially in developing countries. The aim of the present study was to evaluate clinical manifestations and laboratory findings of childhood brucellosis in Van province of Eastern Turkey. To our knowledge, this is the largest series of childhood brucellosis reported in the literature. In this retrospective study, 496 children with brucellosis were assessed for the clinical manifestations and laboratory findings from July 2009 through December 2013. The diagnosis of brucellosis was based on clinical findings and a standard tube agglutination test (titer ≥ 1:160). Data were analyzed using Minitab version 16. The study included 496 children (boys, 60.5%) with a mean age of 10.0 ± 3.95 years (range, 1-16 years). The most frequent clinical symptoms were arthralgia (46.2%), fever (32.1%), and abdominal pain (17.1%) and the most common clinical signs were peripheral arthritis (10.1%), splenomegaly (2.2%) and hepatomegaly (1.8%). The most contagious seasons were summer and autumn (63.3%). Elevated lactate dehydrogenase and C-reactive protein and erythrocyte sedimentation rate were reported in 63.1%, 58.7%, and 55.2% of the patients, respectively. Anemia (20.4%), thrombocytopenia (15.5%), and leukopenia (12.1%) were the most common hematologic findings. Brucellosis remains a serious public health problem in Turkey. The clinical and laboratory characteristics of childhood brucellosis have been described in order to assist clinicians in diagnosing and monitoring the disease.

Brucellosis in children in Bosnia and Herzegovina in the period 2000 - 2013.

To analyse clinical, laboratory and epidemiological characteristics of brucellosis in children in Bosnia and Herzegovina. The study included 246 children aged 0-18 years, who were hospitalized in Clinics and Departments for Infectious Diseases in Tuzla, Sarajevo, Banja Luka, Zenica and Bihać in the period 2000-2013, in whom the diagnosis of brucellosis was established based on anamnestic data, clinical features and positive results from blood culture and/or positive results from one of the serological tests. In this period, a total of 2630 patients, 246 (9.35%) of whom were children, were treated from brucellosis at the Clinics and Departments in Bosnia and Herzegovina. In the majority of cases, the children were from rural parts of the country, 226 (91.87%);214 (87.04%) cases had direct contact with sick animals, sick family member or consumption of unpasteurized dairy products from farms where brucellosis had been already established. Male children predominated, 157 (63.82%). The most frequent clinical features in affected children were fever, 194 (78.86%) and joint pain, 158 (64.22%). The average duration of antimicrobial treatment was 42.85 ± 10.67 days. A total of 228 (92.68%) children were completely cured, while relapses occurred in 18 (7.32%) children. Since brucellosis is an endemic disease in Bosnia and Herzegovina, it is important that physicians in their daily practice consider brucellosis and establish proper diagnosis and therapy in children with prolonged fever, arthralgia, leukopenia and positive epidemiological data, especially in rural parts of the country.

Epidemiological, diagnostic, clinical, and therapeutic aspects of Brucella bacteremia in children in southern Israel: a 7-year retrospective study (2005-2011).

Data on the various aspects of brucellosis in children living in southern Israel are missing. Our aim was to study the epidemiological, microbiological, diagnostic, clinical, therapeutic and outcome features of brucellosis in children <19 years of age in southern Israel during 2005-2011. The study population included all patients hospitalized with a diagnosis of brucellosis, established according to a clinical presentation compatible with brucellosis+presence of Brucella bacteremia (BB). A total of 128 (50.8%) of 252 patients admitted with a diagnosis of brucellosis had BB (all with Brucella melitensis). All patients were of Muslim Bedouin ethnicity. The mean incidence of BB in southern Israel was 16 cases/100,000 Bedouin, with no significant changes during the study period. Overall duration of symptoms before diagnosis was 10.1±10.9 days. Fever at diagnosis was recorded in <20% of the patients. The most frequent symptoms were arthralgia (61.7%), weakness (32.8%), gastrointestinal disturbances (27.3%), myalgia (25%), and headache (18.8%). The main clinical findings included monoarthritis (36.7%), hepatosplenomegaly (25%), lymphadenopathy (17.2%), heart murmur (11.7%), and skin rash (9.4%), respectively. Anemia, leukopenia, thrombocytopenia, and pancytopenia were reported in 17.6%, 29.6%, 12.8%, and 2.3% of the patients, respectively. Twenty-nine (30.5%) patients with BB had serum agglutinin titers ≤1/160 (13, 13.7%%, had titers <1/160). Twenty-seven (93%) of the 29 patients aged 0-4 years were treated with gentamicin and trimethoprim-sulfamethoxazole; a total of 77 (60.2%) patients received gentamicin and doxycycline. Childhood brucellosis remains an important public health problem in southern Israel. BB was diagnosed in >50% of the children with brucellosis, and B. melitensis was identified in all cases. Arthralgia, weakness, and gastrointestinal complaints were the most common symptoms, and monoarthritis, hepatosplenomegaly, and lymphadenopathy were the most common clinical findings. A considerable number of patients with BB had undetectable/low serum agglutinin titers, suggesting insufficient reliability on serology alone in diagnosis of brucellosis.

Prevalence of Asymptomatic Brucellosis in Children 7 to 12 Years Old.

Background. Brucellosis is one of the most common diseases of humans and animals and its clinical manifestations differ from asymptomatic infection to chronic illness associated with recurrence of symptoms. This study aimed to evaluate the prevalence of brucellosis in asymptomatic children 7 to 12 years old in Kahak, Iran. Methods. In this study, 186 children 7 to 12 years old were evaluated. Demographic data and exposure to the brucellosis agent were recorded and blood samples for the Wright, Coombs, and 2ME tests were collected. All the study subjects were followed up for one year about the appearance of symptoms. Results. The mean age was 10 ± 1.72 years and 51% were boys. Family history was positive for brucellosis in 15% of children. A total of 8 children were brucellosis seropositive and, in subsequent follow-up, 6 of them showed the disease symptoms. Conclusion. This study showed that approximately 4.3% of children in endemic areas can have asymptomatic brucellosis and many of these children may be symptomatic in short term.

Seroprevalence of brucellosis among children in the Middle Anatolia Region of Turkey.

Brucellosis is an important public-health problem in Turkey. Children may constitute 20 to 30% of all brucellosis cases in the world, especially in the endemic regions. Data on the seroprevalence of brucellosis in childhood are very limited. In this study, we aimed to evaluate the seroprevalence of brucellosis among a child population. One thousand one hundred and ten subjects were included in the study. Blood samples were collected and tested with Rose Bengal (RB) and standard tube agglutination test (SAT). RB test results were positive for 6 patients, and SAT was negative for all patients. Our findings suggest that seroprevalence of brucellosis is decreasing in Middle Anatolia due to a new cattle vaccination and eradication programme which was initiated in 2009.

Brucellosis in children

In Saudi Arabia, brucellosis is an endemic zoonotic disease. Although it is believed that children are not commonly involved, a number of reports from endemic areas exhibited a high percentage of pediatric patients (20-30% of affected patients). Clinical manifestations of childhood brucellosis are varied and range from minimal symptoms to extreme morbidity and occasional fatality. Asymptomatic infections are also not uncommon. The fact that brucellosis is endemic in the Kingdom became clear in the early 1980s. Several reasons have been consid-ered, but the most prominent of them is the increase in the importation of animals from areas where brucellosis is endemic, especially some African countries. Consumption of raw milk and, to a lesser extent, contact with infected animals or their products are the primary routes of infection. The consumption of fresh, unpasteurized milk from camels is a traditional practice, and people believe that boiling the milk removes nutritional value.

Clinical Manifestations, Laboratory Findings, and Therapeutic Regimen in Hospitalized Children with Brucellosis in an Iranian Referral Children Medical Centre

Brucellosis is considered a known widespread zoonotic disease and is endemic in Mediterranean region, like Iran. This study reviewed the clinical manifestations, laboratory findings, and therapeutic regimen in childhood brucellosis in Iran. In this retrospective study, we reviewed hospital-records of 34 consecutive children with a confirmed diagnosis of brucellosis among a total number of 10,864 patients admitted to Children's Medical Center, Tehran, Iran, between 2002 and 2010. Among the patients diagnosed with brucellosis, 22 (65%) were admitted during spring and summer. Clinical findings of these patients at admission were arthritis, splenomegaly, hepatomegaly, lymphadenopathy, maculopapular skin rashes, and fever. Anaemia (53%) and leukopenia (33%) were the most common findings in the children. Only one patient had presented with leukocytosis. Four children (12%) were thrombocytopenic, and none of patients had pancytopenia. Blood cultures were positive in 5 patients (23%). Only one patient underwent bone-marrow aspiration and had positive culture for Brucella spp. Positive titres were found in 33 cases (97%) in Wright test, 23 cases (96%) in Coombs test, and 16 patients (72.7%) in 2ME (2-Mercaptoethanol) test. In one case, Wright and Coombs test titres were below 1:80 while Brucella spp. were isolated from blood at the same time. It is concluded, prolonged fever with joint involvement and organomegaly may increase possibility of infection with Brucella spp. Appropriate treatment regimen by more tolerable oral drugs, with a duration of at least 8 weeks, is recommended.

Relapsing Brucellosis After Liver Transplantation in a Child

Brucellosis is still an important infectious disease worldwide, especially in the Mediterranean area and in developing countries (1). The treatment of brucellosis is challenging because of relatively high rates of relapse and treatment failure. Obviously, relapse occurs more frequently within the first year if the full course of treatment is not completed (2). It is hypothesized that immunocompromised patients and organ transplant recipients have an increased rate of relapse (3). The hepatotoxicity of drugs used for brucellosis therapy and the drug interactions with immunosuppressive agents are important considerations in the treatment of brucellosis in immunocompromised patients and organ transplant recipients. No guidelines exist in the literature concerning the appropriate regimen and duration of therapy for brucellosis/relapsebrucellosis in these populations. In this report, we describe a child with relapsing brucellosis after liver transplantation, who was treated with two different courses of trimethoprim sulfamethoxazole (TMP-SMZ) and rifampin. A 7-year-old girl with fulminant hepatitis due to Wilson’s disease who had undergone liver transplantation 2 years ago presented to us with a fever that had lasted for more than 2 weeks. Due to the fact that the patient lives in a rural area and had consumed unpasteurized fresh cheese, she was evaluated forbrucellosis. The standard tube agglutination test and immunocapture test were positive at a titer of 1:640. The patientdid not have a history of brucellosis or similar symptoms before transplantation and the donor (mother) had no clinical or serologic evidence of brucellosis. Therefore, we postulated that the immunosuppressive therapy (tacrolimus and mycophenolate mofetil) was the predisposing factor for this infectious disease. The patient was treated with TMP-SMZ and rifampin. After treatment, her clinical and laboratory findings improved dramatically. Tacrolimus levels decreased because of increased cytochrome P450 activity due to rifampin. To prevent acute cellular rejection, the tacrolimus dosage was tripled to maintain normal drug blood levels. TMP-SMZ and rifampin were given for 12 weeks. Brucella serology was negative 4 months after treatment. One year later, the patient was evaluated for another fever of unknown origin. Although the patient was not in contact with infected animals or contaminated milk or milk products, her standard tube agglutination test and immunocapture titers were 1:320 and 1:160, respectively. TMP-SMZ and rifampin therapy were started. The patient’s response to therapy was excellent. Despite the fourfold increase in the dose of tacrolimus, normal blood levels of the drug were not achieved. To prevent acute cellular rejection during brucellosis treatment, mycophenolate mofetil, which had been previously discontinued, was restarted. Antibiotic therapy was used for a periodof 6 months to treat the brucellosis relapse. Despite fluctuations in immunosuppressive therapy, rejection and drug-induced hepatotoxicity were not observed. Antibiotic therapy was successful with no recurrence of infection during 3 years of follow-up. In conclusion, we believe that TMP-SMZ and rifampin therapy seem to be effective and reliable for the treatment of brucellosis in children after liver transplantation and that the length of treatment should be extended compared with that given in nonimmunosuppressed individuals. Ali Islek 1 Ersin Sayar1 Aygen Yilmaz1 Filiz Günseren2 Reha Artan1 1 Department of Pediatric Gastroenterology Akdeniz University Faculty of Medicine Antalya, Turkey 2 Department of Infectious Diseases and Clinical Microbiology Akdeniz University Faculty of Medicine Antalya, Turkey

Childhood Brucellosis in Southeastern Region of Turkey: A retrospective analysis

Childhood Brucellosis in Southeastern Region of Turkey: A retrospective analysis

Update on Childhood Brucellosis

In endemic regions of brucellosis, childhood brucellosis includes up to one-third of all cases of human brucellosis. The main source of infection in children is consumption of unpasteurized dairy products and traditional local foods containing dairy products. The older boys are more involved in animal care. Boys are more commonly infected than girls. Common symptoms and signs include fever, arthralgia, sweating, peripheral arthritis and splenomegaly. Peripheral arthritis especially monoarthritis is more common and the most commonly affected joints are hip and knee. All organs may involve during the course of the disease. Isolation of Brucella spp. from the blood, bone marrow or other tissue fluids is the hallmark of diagnosis. Serologic tests are the main tools of diagnosis of brucellosis in endemic regions. Standard agglutination test (SAT) with titers >1:160 and the 2-mercaptoethanol (2ME) test ≥1:80 are suggestive of active infection. Children older than 8 years should be treated with doxycycline for 45 days or 8 weeks plus gentamicin for 7 or 5 days respectively or doxycycline for 45 days and streptomycin for 14 days. Also doxycycline plus rifampin or cotrimoxazole plus rifampin for 45 days may be alternative regimens. Cotrimoxazole plus rifampin for six weeks is the regimen of choice for the treatment of patients younger than 8 years old. Gentamicin for 5 days plus cotrimoxazole for six weeks may be a suitable alternative regimen. The article presented few of the patents associated with Brucellosis. Keywords: Brucellosis, children, epidemiology, clinical manifestation, treatment, patent, peritonitis, endocarditis, lymphopenia, hrombocytopenia

A Case of Underdiagnosed Brucella Meningitis Presented With Hearing Loss

Abstract: Brucellosis is a widespread zoonosis in many parts of theworld. Neurologic complications including meningitis, meningoencepha-litis, brain abscess, myelitis, radiculoneuritis, peripheral and cranial neu-ropathies,andpsychiatricmanifestationsarerarelyencountered,especiallyin children. In this report, we present a 13-year-old adolescent boy withchronic Brucella meningitis and hearing loss who was given anti-brucellosis treatment for 6 months and subsequently underwent cochlearimplantation.Key Words: chronic Brucella meningitis, child, hearing loss,cochlear implantation(Infect Dis Clin Pract 2013;21: 136Y138) B rucellosis is a multisystemic disease with nonspecific man-ifestations caused by gram-negative bacteria, Brucella spe-cies.Brucellosisremainsapublichealthprobleminmostcountriesof the Mediterranean, including Turkey, and in the Balkans, theMiddleEast,andCentralandSouthAmerica. 1 Neurobrucellosisis a rare complication of brucellosis in children. The mostcommon presentations of neurobrucellosis are meningitis andmeningoencephalitis.Cranialnerveinvolvementsareamongthemajor complications of neurobrucellosis.

Update on Childhood Brucellosis

In endemic regions of brucellosis, childhood brucellosis includes up to one-third of all cases of human brucellosis. The main source of infection in children is consumption of unpasteurized dairy products and traditional local foods containing dairy products. The older boys are more involved in animal care. Boys are more commonly infected than girls. Common symptoms and signs include fever, arthralgia, sweating, peripheral arthritis and splenomegaly. Peripheral arthritis especially monoarthritis is more common and the most commonly affected joints are hip and knee. All organs may involve during the course of the disease. Isolation of Brucella spp. from the blood, bone marrow or other tissue fluids is the hallmark of diagnosis. Serologic tests are the main tools of diagnosis of brucellosis in endemic regions. Standard agglutination test (SAT) with titers > 1:160 and the 2-mercaptoethanol (2ME) test ≥ 1:80 are suggestive of active infection. Children older than 8 years should be treated with doxycycline for 45 days or 8 weeks plus gentamicin for 7 or 5 days respectively or doxycycline for 45 days and streptomycin for 14 days. Also doxycycline plus rifampin or cotrimoxazole plus rifampin for 45 days may be alternative regimens. Cotrimoxazole plus rifampin for six weeks is the regimen of choice for the treatment of patients younger than 8 years old. Gentamicin for 5 days plus cotrimoxazole for six weeks may be a suitable alternative regimen. The article presented few of the patents associated with Brucellosis.

The evaluation of brucellosis in children in an endemic region of Turkey, Van

Brucellosis is an important infectious disease especially endemic in Eastern and Southeastern Turkey. In this study, we aimed to evaluate the clinical, laboratory and treatment results of Brucellosis in children. Children with nonspecific findings suggestive of Brucellosis were included from September 2010 to February 2011 from the outpatient clinic. The symptoms, physical findings and laboratory values are analyzed in 43 children who were diagnosed as Brucellosis.The mean age of children was 9.3 years (range: 4-13 years), 51%n:22) were male. Most common complaint was fatigue (100%), myalgia (100%) and weight loss (86%). Arthritis (48%), lymphadenopathy (6%), and splenomegaly (13%) has been identified. Laboratory values revealed high sedimentation rates (51%), high AST/ALT (65%), high CRP levels (72%). Brucella agglutination test was positive in all of the patients. Brucella was identified in 6% of blood cultures. All of the patients were treated with antibiotics of least two-drug combination. The relapse rate was 11% (n=5) and no mortality was observed. Brucellosis is an important health issue, especially in endemic regions, necessitating preventive measures and effective treatment.

840 Neurobrucellosis in Childhood: Four New Cases and a Review of the Literature

Background and AimsNeurobrucellosis accounts for < 1% of cases of brucellosis in children and has a broad range of clinical manifestations. In this report we describe our experience regarding the...

Brucellosis in Children

Brucellosis in Children

Brucellosis in Children

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.

Retrospective clinical and laboratory evaluation of children with brucellosis

Acute brucellosis is a zoonotic disease seen in childhood, with non-specific complaints and clinical findings that can affect the locomotor, gastrointestinal, genitourinary, hematologic, cardiovascular, respiratory, and central nervous systems. Particularly in endemic regions, it occurs as a result of consumption of unpasteurized milk and dairy products. In this study, clinical and laboratory findings of children with acute brucellosis are presented. Data for 147 patients, aged 2-16 years, were evaluated retrospectively. The most frequent complaints and clinical findings were abdominal pain and fever. Other complaints and clinical findings included arthralgia, myalgia, loss of appetite, weakness, sweating, fatigue, headache, arthritis, hepatomegaly, and splenomegaly. Anemia was the most frequent hematological abnormality detected; other abnormalities included leukopenia, thrombocytopenia, and pancytopenia. Childhood brucellosis can cause non-specific complaints and particularly anemia and leukopenia as hematological abnormalities. It is easily treated, however, with appropriate antibiotics.

A multicenter retrospective study of childhood brucellosis in Chicago, Illinois from 1986 to 2008

To determine risk factors in children for the acquisition of Brucella, clinical presentation, treatment, and disease outcomes. A retrospective multicenter chart review was undertaken of children identified with brucellosis from 1986 to 2008 at three tertiary care centers in Chicago, Illinois, USA. The charts were reviewed for data regarding risk factors for acquisition, clinical presentation, and outcomes. Twenty-one charts were available for review. The median age was 6.5 years (range 2-14 years); 62% were female. Ethnic background was 67% Hispanic and 24% Arabic. Risk factors included travel to an endemic area (86%), particularly Mexico, and consumption of unpasteurized milk products (76%). Common findings included fever (95%), bacteremia (86%), elevated liver transaminases (80%), constitutional symptoms (76%), splenomegaly (60%), and hepatomegaly (55%). Relapse occurred in three of six subjects started on single drug treatment, but in only one of 15 subjects who started on two or more drugs (p=0.053). No relapses occurred in children whose initial therapy included rifampin or those administered three-drug regimens. Brucella is an infrequent pathogen but should be considered in children with compatible epidemiologic and clinical characteristics. Blood cultures should be obtained, and initial therapy with two or more drugs may decrease the risk of relapse.

Clinical and laboratory features, complications and treatment outcome of brucellosis in childhood and review of the literature

Brucellosis, whether in an endemic region or not, remains a diagnostic puzzle due to occasional misleading unusual presentations and non-specific symptoms. The aim of this study was to evaluate the clinical and laboratory findings, complications and treatment outcome of brucellosis in children in southeastern Anatolia, Turkey. This study focuses on the frequency of clinical and laboratory findings and complications in cases with brucellosis. Of 22 patients, 8 (36.3%) were female and 14 (63.7%) were male. Fever, malaise, lack of appetite, arthralgia, and night sweating were the main presenting symptoms overall. Hematologic complications (n=13, 59.1%) were most common, followed by skeletal (n=7, 31.8%) and cutaneous system (n=1, 4.5%). Brucellosis may affect any organ system and imitate a variety of clinical entities. Diagnosis of brucellosis should be considered whenever there is a febrile illness associated with rheumatological complaints. Consequently, early recognition of the infection, prolonged antibiotic treatment and careful long-term follow-up should improve the patient outcome.

Unusual clinical presentations of brucellosis in childhood

Unusual clinical presentations of brucellosis in childhood