Childhood Brucellosis Research Articles

Childhood brucellosis is still a severe problem in the eastern region of Turkey.

Childhood brucellosis is still a severe problem in the eastern region of Turkey.

Interleukin-3 and Interleukin-4 in Childhood Brucellosis

The Th1/Th2 cytokine balance seems to be involved in the susceptibility or resistance to Brucella infection, however the precise role of interleukins in human brucellosis has not been thoroughly explored. The serum levels of interleukin-3 (IL-3) and interleukin-4 (IL-4) were measured by enzyme-linked immunosorbent assay (Quantikines, R&D Systems) in five children hospitalized for brucellosis and in a control group comprising ten children who were residents of the same area. IL-4 levels were significantly increased during both the acute phase (p = 0.0036) and convalescence (p = 0.026) as compared to controls. IL-3 levels were mildly increased during the acute phase (p = 0.026) without any significant difference noted during convalescence (p = 0.271) as compared to controls. Both IL-3 and IL-4 levels were neither related to hemoglobin values, nor to red and white blood cell, neutrophil, lymphocyte and platelet counts. Serum IL-4 levels are increased in hospitalized children with symptomatic brucellosis, a finding suggestive of a Th2 response leading to severe infection.

Brucellose ostéoarticulaire et signes dˈauto-immunité

We report two cases of osteoarticular brucellosis in childhood, which illustrate the diagnostic difficulties in non-endemic areas. Case report. – A 12-year-old boy was admitted for a unilateral sacroiliitis for which the brucellosis origin was established by serological and blood cultures (without fever). Autoimmunity was detected and disappeared following the treatment of the affection. A six-year-old girl was admitted for a monoarthritis of the left ankle (with fever) for which the brucellosis origin was also established by serology and blood cultures. Comments. – The above cases underline the importance of knowing the atypical varieties of brucellosis. The brucellosis serologies need to take part in the etiological workup of an infectious osteoarthritis when a classic infectious cause cannot be proved. Blood cultures on a specific medium are essential to carry out, even in the case of apyrexia. Finally, the possibility of autoimmunity signs for the brucellosis has to be known to avoid orientating the diagnosis towards an autoimmune systemic disease.

Brucellosis in Saudi Arabia: Past, Present and Future

Brucellosis in Saudi Arabia: Past, Present and Future

Paediatric neurobrucellosis: case report and literature review

Neurological complications are rare in childhood brucellosis: there are only 33 reported cases. In children, neurobrucellosis is usually of acute presentation involving the central nervous system. We report our experience with an 8-year-old boy with brucella meningitis who demonstrated a Jarisch-Herxheimer-like reaction, i.e. initial clinical deterioration following the commencement of antibrucella treatment, associated with increased pleocytosis and shift from lymphocytic to polymorphic predominance and an already increased CSF lactate. These CSF findings have not been previously described. The patient recovered completely after 3 months' therapy consisting of rifampicin, doxycycline and gentamicin. Paediatric neurobrucellosis therapy should be a combination of three antibrucella antibiotic that include an aminoglycoside; for a period of 8-12 weeks, steroids may be added to treat complications. The prognosis of neurobrucellosis in children is usually good.

Childhood brucellosis in north-western Greece: A retrospective analysis

Childhood brucellosis in north-western Greece: A retrospective analysis

Childhood brucellosis in Israel.

Brucellosis has become a major medical problem in Israel particularly in the Muslim Arab population. Eighty-eight children with acute brucellosis are described. Sixty-seven were studied retrospectively during 1987 through 1988, and 21 children were studied prospectively during 1989 through 1992. Epidemiologic, clinical and laboratory features were evaluated, and the outcome of 4 antimicrobial regimens are compared. Although the clinical manifestation varied, the classical triad of fever (91%), arthralgia or arthritis (83%) and hepato- and/or splenomegaly (63%) characterized most patients. Sixty-one percent of the children had elevated liver enzymes. Brucella melitensis was isolated from 61% of blood cultures. The relapse rate in patients who were treated with monotherapy (doxycycline) was 43% compared with 14% with regimens of combined therapy with rifampin and doxycycline, streptomycin and doxycycline or rifampin and trimethoprim-sulfamethoxazole (P < 0.049). Eleven children (33%) who were treated for 3 weeks had relapse compared with 1 patient (3.5%) treated for 4 weeks or longer. The total relapse or reinfection rate was 20%. All patients with relapse recovered after a second course of antibiotic therapy. During the 2 years of follow-up one child progressed to chronic osteomyelitis. Combination therapy and extending treatment for 4 weeks or longer gave significantly better results than monotherapy or shorter courses of therapy and resulted in fewer relapses.

Childhood brucellosis in north-western Greece: a retrospective analysis.

Fifty-two cases of childhood brucellosis which occurred in north-western Greece during the 15-year period 1979-1993, are reviewed. It is believed that they represent very closely the total incidence of the disease in the region which has a population of 100,000 children aged 0-14 years old. Brucellosis-affected children were almost exclusively from goat- or shepherd families and of both sexes and all age groups. A broad spectrum of clinical manifestations ranging from malaise only to brain abscess was observed. Fever and arthralgia were the most common manifestations followed by malaise, myalgia, sweating, rash, cough, and gastro-intestinal, cardiac and CNS involvement. Splenomegaly was found more often than hepatomegaly and lymphadenopathy. Laboratory findings included anaemia, leukopenia, neutropenia, lymphocytopenia, monocytosis, eosinophilia, thrombocytopenia and pancytopenia. Leukocytosis and lymphocytosis were extremely rare and ESR and serum C-reactive protein levels were mildly elevated. All patients had positive Rose Bengal slide agglutination tests and standard tube agglutination titres of 1:160 or more. When performed, blood culture was often diagnostic. The children were treated with streptomycin for 2 weeks plus either tetracyclines or trimethoprim-sulphamethoxazole for 3 weeks. Treatment was well tolerated. Relapse was observed in one case. Brucellosis nowadays affects children in an occupational pattern. As symptoms, signs and first-line laboratory findings are not characteristic, agglutination tests and blood culture should be performed in any child with prolonged fever. Treatment is effective, but prevention of the disease by animal testing and education of high risk families is indicated.

Acute focal bacterial nephritis in childhood brucellosis

Brucellosis is an infectious disease transmitted from various animal hosts to man. In children the most common route of infection is unpasteurized milk or milk products. Brucellosis affects the urinary tract uncommonly, most frequently causing orchioepididymitis. We report the case of a 4-year-old boy with brucellosis who developed acute focal bacterial nephritis (AFBN), documented by sonography, gallium scan, and computed tomography. After appropriate treatment his symptoms and his sonographic abnormality resolved completely. To the best of our knowledge, this is the first report of the association of AFBN and brucellosis.

Acute thrombocytopenic purpura in childhood brucellosis

Two children who presented with fever, thrombocytopenic purpura and mucosal haemorrhages proved to have brucellosis. Large platelets in the peripheral smear and megakaryocytic hyperplasia in the bone marrow suggested increased peripheral destruction as the primary mechanism of the thrombocytopenia. There was a prompt clinical and haematological response to specific anti-brucella chemotherapy. The nature of this association and its implications for brucella-endemic areas are discussed.

Brucellosis in Children of Faifa - Gizan, Southwest of Saudi Arabia: A Review of 32 Cases

Brucellosis in Children of Faifa - Gizan, Southwest of Saudi Arabia: A Review of 32 Cases

Hip involvement in childhood brucellosis

We reviewed 190 children with brucellosis admitted over a 7.8-year period. Seventy of these had articular involvement (36%) and the most common site was the hip (18%). All but one patient had unilateral infection. The hip was the only joint infected in 20 patients (57%). The next most common articular site was the knee. All patients had painful limitation of movement and this was the only articular sign in 28 (80%). Extra-articular signs included fever and hepatosplenomegaly. Brucella infection should be considered in every child from an endemic area who presents with fever and joint symptoms. The insidious onset and a normal or low leucocyte count help the differentiation from acute septic arthritis. Children with hip involvement had a slower response to treatment, longer hospital stays and a higher incidence of complications and relapse than those without. Complications included dislocation (n = 4) and avascular necrosis of the femoral head (n = 1). Treatment by combination chemotherapy for 6 to 12 weeks usually achieves cure and prevents relapse. A multidisciplinary team approach to management is recommended.

Hematologic manifestations of brucellosis in children.

Hematologic manifestations of brucellosis in children.

Brucellosis in Children of Zulfi (Riyadh) Area: Some Differences in Observations and Management

Brucellosis in Children of Zulfi (Riyadh) Area: Some Differences in Observations and Management

Reply

Letters to the EditorReply Ghulam Nabi and MD Nisar A. MirFRCP, DCH Ghulam Nabi Department of Pediatrics, Civil Hospital, P.O. Box 737, Khamis Mushyat, Saudi Arabia Department of Pediatrics, Civil Hospital, P.O. Box 737, Khamis Mushyat, Saudi Arabia Search for more papers by this author and Nisar A. Mir Department of Child Health, College of Medicine, King Saud University - Abha Branch, Abha, Saudi Arabia Search for more papers by this author Published Online:1 May 1993https://doi.org/10.5144/0256-4947.1993.313SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: We are grateful to the authors for highlighting a differing clinical presentation of childhood brucellosis in the Zulfi region of Riyadh. Our hospital, being a referral one, caters to a population which is spread over a vast terrain and a majority of our patients are from the Tihama region; this may partly explain the reason for our uniform policy regarding hospitalization of these patients. Second, we believe that brucellosis is a multisystem disease with complications ranging from meningitis to carditis, arthritis, and anemia [1]. In our study, 34% of our patients were anemic and half of them required blood transfusion. Also the presence of other disorders such as malaria should be ruled out [2]. The majority of our patients were less than eight years of age; hence, tetracycline could not be used. The oral route is preferable whenever possible in the pediatric population. There is poor compliance when treatment is being given on an outpatient basis. As has been shown by other investigators [3], we have found that rifampicin is a safe and effective drug with minimum side effects and we discontinued our earlier practice of using streptomycin. In addition, streptomycin-induced ototoxicity in children is a reminder to the clinicians to watch for vertigo, ataxia, and hearing impairment, all of which are dose-dependent with cumulative effect with prolonged use.ARTICLE REFERENCES:1. Al Freihi HM, Al Mohaya S, Al Mohsin MFA, et al.. Brucellosis in Saudi Arabia: diverse manifestations of important cause of a pyrexial illness. Ann Saudi Med. 1986; 6(2):95–9. Google Scholar2. Chowdhury MAK, Nabi G. Visceral leishmaniasis (Kala Azar) in southern Saudi Arabia. Saudi Med J. 1989; 10(4):328. Google Scholar3. Llorens Terol J, Busquets RM. Brucellosis treated with rifampicin. Arch Dis Child. 1980; 55:486–8. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 13, Issue 3May 1993 Metrics History Published online1 May 1993 InformationCopyright © 1993, Annals of Saudi MedicinePDF download

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

Letters to the EditorBrucellosis in Pediatric Patients: A Review of 114 Cases from Asir Region AKM Harunur RashidMRCP(UK), DCH AKM Harunur Rashid Consultant Pediatrician, Suleimania Children's Hospital, P.O. Box 59046, Riyadh 11525, Saudi Arabia Search for more papers by this author Published Online:1 Mar 1993https://doi.org/10.5144/0256-4947.1993.204aSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor. I read with interest the report on brucellosis in children by Nabi and Mir [1]. The objective of the study was to highlight brucellosis as a major cause of morbidity in the pediatric population of the Asir region. The authors mentioned paucity of data on its clinical pattern in Saudi children. This is true; however, they could have quoted two additional reports published from Saudi Arabia [2,3].In our study of brucellosis in children in Gurayat, a small peripheral town in the northwestern region of Saudi Arabia, a total of 55 children were diagnosed over a period of one year from March 1988 to February 1989. A total of 23 cases were admitted to Gurayat General Hospital and comprised 1.4% of a total of 1672 pediatric admissions. An additional 32 children were diagnosed and treated in the outpatient clinic of the hospital during the same period. Thirty-one (56%) patients were male, all were Saudi nationals, mean age was 5.94 years (range 5 months to 12 years, median 6 years), and 26 (47%) were younger than five years of age (Table 1).Table 1. Age distribution.Table 1. Age distribution.Brucellosis prevailed throughout the year, with 41 (75%) cases diagnosed during the summer months from March to August. All but one patient presented with unexplained fever for more than one week, 18 (32%) had arthralgia or arthritis. All the patients had a history of raw milk ingestion or close contact with sheep, goats, camels, or contact with infected family members. As in the previous studies, B. melitensis was the major pathogen on serological examination [1–3]. All the patients were treated with a combination of Septrin (trimethoprim) 7-10 mg/kg/day, sulfamethoxazole 30-50 mg/kg/day, and rifampicin 20 mg/kg/day. Duration of treatment was 4-6 weeks, with a longer duration being given to children with severe disease with or without arthritis. One child was given added injections of streptomycin for an initial period of two weeks. No child had any neurological or cardiac complications or death. One child required repeat admission because of relapse. Frequently, more than one family member was affected. In one family, six children were affected. One child presented four months following diagnosis in the other five siblings. I concur with the authors that rifampicin and trimethoprim are an encouraging combination therapy. In Gurayat there are 20,000 children, 40% of a total population of 50,000. This gives an annual incidence of 2.75/1000 children. Up to 20 or more cases may occur for each reported case [4], making the actual prevalence higher in this region.Brucellosis is a preventable disease and in view of the magnitude of the problem in children, there is an urgent need for an effective control program. There is agreement that control of human brucellosis is through the control of it in animals. It has been found that widespread vaccination of sheep and goats has proven to be very effective in reducing human brucellosis. It is the veterinarian's responsibility to accept the challenge to control animal brucellosis, which in turn will control the disease in humans [5].ARTICLE REFERENCES:1. Nabi G, Mir NA. "Brucellosis in pediatric patients: a review of 114 cases from Asir Region" . Ann Saudi Med. 1992; 12 (3): 286–8. Google Scholar2. Al-Marshady AR, Harland PSEG. "Brucellosis in children" . Ann Saudi Med. 1986 (suppl) 25; (6): 25–7. Google Scholar3. Al-Eissa YA, Kambal AM, Al-Nasser MN, et al. "Childhood brucellosis: a study of 102 cases" . Pediatr Infect Dis J. 1990; (9): 74–9. Google Scholar4. Wise RL. "Brucellosis in the United States" . JAMA. 1980; 244: 2318–22. Google Scholar5. Nicoletti P. "The control of brucellosis-A veterinary responsibility" . Saudi Med J. 1992; 13 (1): 10–3. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byOpawoye A (2019) Brucellosis in Saudi Arabia: Past, Present and Future, Annals of Saudi Medicine , 20:5-6, (492-492), Online publication date: 1-Sep-2000.Opawoye A (1994) Brucellosis in Children of Faifa - Gizan, Southwest of Saudi Arabia: A Review of 32 Cases, Annals of Saudi Medicine , 14:5, (426-427), Online publication date: 1-Sep-1994. Volume 13, Issue 2March 1993 Metrics History Published online1 March 1993 InformationCopyright © 1993, Annals of Saudi MedicinePDF download

Haematological manifestations of childhood brucellosis.

Very few data on the frequency and diversity of haematological abnormalities occurring in brucellosis in children have been reported. In the present study 110 children (56 boys and 54 girls; age range, 2 months to 14 years) with proven brucellosis were investigated to determine the haematological changes during the active course of this infection. Anaemia was detected in 48 (44%) patients, of whom four had evidence of haemolysis. Leukopenia occurred in 33% of the cases, with neutropenia and/or lymphopenia being the most striking features encountered. Thrombocytopenia was found in six (5%) patients and pancytopenia in 15 (14%) patients, of whom one developed disseminated intravascular coagulation. Clinically detectable bleeding occurred in five (4.5%) patients whose platelet counts were significantly low. Hypersplenism, haemophagocytosis and granulomatous lesions of the bone marrow appear to play a fundamental role in producing these abnormalities of the peripheral blood. Brucellosis may be considered in patients whose blood picture reveals haemolytic anaemia, leukopenia, thrombocytopenia or pancytopenia, particularly when the disease is epidemiologically suspected.

Childhood Brucellosis: Experience in Tathleeth

Childhood Brucellosis: Experience in Tathleeth

Childhood brucellosis in southwestern Saudi Arabia: a 5-year experience.

One-hundred-and-fifty-seven children admitted with brucellosis at Abha, Saudi Arabia, were studied prospectively. Ninety-two per cent gave a history of animal contact, usually with sheep or goats, or ingesting raw milk, milk products, or raw liver. Three-quarters of the patients had an acute or subacute presentation with diverse symptomatology: fever (100 per cent), malaise (91 per cent), anorexia (68 per cent), cough (20 per cent), abdominal symptoms (20 per cent), arthralgia (25 per cent). Hepatomegaly (31 per cent), splenomegaly (55 per cent), and lymphadenopathy (18 per cent) were common findings. Organ complications were rare except for arthritis (36 per cent) which usually presented as a peripheral oligoarthritis involving the hips and knees. All patients had significant agglutination titres; B. melitensis was grown from the blood in 7 of 16 (44 per cent) patients. Haematological variations were common, but non-specific: anaemia (64 per cent), thrombocytopenia (28 per cent), leucopenia (38 per cent), leucocytosis (12 per cent), and elevated erythrocyte sedimentation rate (81 per cent). Varying combinations of rifampicin, co-trimoxazole, tetracycline, and streptomycin resulted in a prompt pyrexial response (mean: 3.8 days), and a slower response in the arthropathy and hepatosplenomegaly. Relapses were related to poor compliance, use of a single drug or a shorter duration of chemotherapy. Brucellosis is a common childhood problem in southwestern Saudi Arabia as in other parts of the country and the Middle East. It should be considered in every child from an endemic area presenting with a febrile illness and a history of animal contact.

Speciation and Biotyping of Brucella

Letters to the EditorSpeciation and Biotyping of Brucella Kevin K. Smith and RT(CSLT) S.M. HussainQadri, PhD, Diplomate ABMM, FAAM, FRCPath Kevin K. Smith Section of Microbiology, Department of Pathology and Laboratory Medicine (MBC-10), King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia Search for more papers by this author and S.M. Hussain Section of Microbiology, Department of Pathology and Laboratory Medicine (MBC-10), King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia Search for more papers by this author Published Online:1 May 1992https://doi.org/10.5144/0256-4947.1992.325SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: With reference to a recent letter to the editor by Eltigani et al [1], we concur that speciation and biotyping of Brucella provides an excellent tool in understanding the epidemiology of brucellosis. However, their contention that “no significant work has been done to identify the species and biotypes responsible. The only published work was that of Corbel…” is not completely justified. Several investigators have reported their findings on the incidence of Brucella species and biotypes both in man and animals. Our cursory survey of literature, which we feel is far from complete, showed that of 527 cases of brucella cultured from humans in the last eight years, 517 (98%) were identified as B. melitensis and the rest as B. abortus[1–7]. Madkour [8] reported a moderate distribution of B. melitensis and B. abortus in animals and an understandable absence of B. suis.Although Corbel [9] has found all three biotypes of B. melitensis, Qadri et al [2] reported that 64% of their 153 B. melitensis isolates from a major tertiary care center in Riyadh were biotype 1 and the rest biotype 3. Recently, Bilal et al [3] found that all the 70 isolates from the Asir region were biotype 3. Distribution of biotypes of B. melitensis, including those reported by Eltigani et al [1], is shown in Table 1.Table 1. Biotypes of Brucella melitensis.Table 1. Biotypes of Brucella melitensis.Since biotype 1 is more common in African countries, its high prevalence in Saudi Arabia may be due to the import of animals from these countries for slaughter as well as breeding purposes. Biotype 3 is usually associated with nomadic herds and its second highest incidence reflects the nomadic heritage in the Kingdom.Although several reports from the Central region of the Kingdom have dealt with speciation and biotyping, there are gaps in their prevalence from other parts of the Kingdom. We agree with Eltigani et al [1] on the need for further studies that may aid in the discovery and clarification of epidemiological linkages. Unfortunately, in the countries most affected by brucellosis, including Saudi Arabia, biotyping has not been performed to such a level so as to provide worthwile epidemiological evaluation.ARTICLE REFERENCES:1. Eltigani MME, Al-Orainey IO, El-Nageed SS, Kambal AMM. "Biotyping of Brucella isolates" . Ann Saudi Med. 1991; 11(2):238–9. Google Scholar2. Qadri SMH, Akhtar M, Ueno Y, Al-Sibai MB. "Susceptibility of Brucella melitensis to fluoroquinones" . Drugs Exptl Clin Res. 1989; 10:483–5. Google Scholar3. Bilal NE, Jamjoom GA, Bobo RA, et al.. "Brucellosis in the Asir Region of Saudi Arabia" . Saudi Med J. 1991; 12:37–41. Google Scholar4. Al-Eissa YA, Kambal AM, Al-Nasser MN, et al.. "Childhood brucellosis: a study of 102 cases" . Pediatr Infect Dis J. 1990; 9:74–9. Google Scholar5. Madkour MM, Rahman A, Mohamed E, et al.. "Brucellosis in Saudi Arabia" . Saudi Med J. 1985; 6:324–32. Google Scholar6. Kambal AM, Mahgoub ES, Jamjoom GA, Cowdhury MN. "Brucellosis in Riyadh, Saudi Arabia: a microbiological and clinical study" . Tran R Soc Trop Med Hyg. 1983; 77:820–4. Google Scholar7. Kiel FW, Khan MY. "Analysis of 506 consecutive positive serologic tests for brucellosis in Saudi Arabia" . J Clin Microbiol. 1987; 25:1384–7. Google Scholar8. Madkour MM. Brucellosis. London: Butterworths, 1989;16–20. Google Scholar9. Corbel MJ. "Advances in the development of a reliable phage typing system for smooth and non-smooth brucella isolates" . Ann Inst Pasteur Microbiol. 1987; 138:69–144. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 12, Issue 3May 1992 Metrics History Published online1 May 1992 InformationCopyright © 1992, Annals of Saudi MedicinePDF download