An Analysis of Children with Brucellosis Associated with Pancytopenia

Abstract

Brucellosis produces a variety of nonspecific hematologic abnormalities. Hematologic complications of mild anemia and leukopenia have been frequently associated with acute brucellosis, but pancytopenia is less frequently seen. In this study, records of children with brucellosis aged under or equal to 16 years, admitted to Yuzuncu Yil University Hospital between 2004 and 2010, were analyzed retrospectively. Over this time period, 187 patients with brucellosis were diagnosed. Twenty-five (13.3%) of 187 patients had pancytopenia during admission to hospital. The diagnosis of brucellosis was confirmed by standard tube agglutination test in all patients; titers were 1:320 in 1 patient and 1:1280 in 24 patients. Blood culture was positive for Brucella melitensis in 3 patients (12%). Fever was the most common manifestation, followed by malaise, anorexia, sweating, and weight loss. Fever and splenomegaly were the common signs in most patients. In addition, arthritis was observed in 5 patients, and epistaxis, headache, and abdominal pain were observed in 3 patients. The common bone marrow aspiration findings consisted of increased megakaryocytes and hyperplasia of erythroid series, with a shift to the left of the granulocytic series. Histiocytic hyperplasia was observed in the bone marrow smear of 2 patients. Mild hemophagocytosis was observed in the bone marrow of 3 patients. All patients recovered completely, and their peripheral blood counts returned to normal by 2 to 6 weeks after antibiotic treatment of brucellosis. In conclusion, the authors would like to emphasize that brucellosis should be considered in the differential diagnosis of children with pancytopenia.

Bruselloz Tanılı 94 Çocuk Hastanın Retrospektif Olarak Değerlendirilmesi

“…Bizim çalışmamızda ise hastaların başvuru esnasında AST ve ALT ortanca değerleri normal sınırlarda saptanmış olup, transaminaz yüksekliği olan 2 hastaya hepatit tanısı konulmuştur. Brusellozlu olgularda laboratuvar bulgularına anemi, lökopeni, trombositopeni veya pansitopeni gibi hematolojik bulgular da eşlik edebilmektedir (23,24). Bizim çalışmamızda da hastaların %7.4'ünde lökopeni, % 3.1'inde anemi, %1'inde anemi ve lökopeni, % 2.1'inde pansitopeni saptanmıştır.…”

Human brucellosis in Turkey: different clinical presentations

“…Brucellosis may cause nonspecific symptoms such sweating, weakness, and loss of appetite [24]. In studies analyzing the symptoms of brucellosis, fever (59%-91.8%), sweating (15%-92.9%), back pain (28%-61%), headache (5%-64%), loss of appetite (1%-73%), joint pain (34%-84%), myalgia (12%-60%), and weakness (35%-80%) have been reported [25][26][27][28][29].…”

Secondary hemophagocytic lymphohistiocytosis in children with brucellosis: report of three cases

“…The incidence of pancytopenia with brucellosis varies from 3% to 21% in published studies [10]. In the literature, reports related to brucellosis, cytopenia, and hemophagocytosis are limited [5,6,11,12]. We found only one case report describing a child with Brucellaassociated HLH [7].…”

“…Pancytopenia is not a common findings in children with brucellosis, whereas anemia and leukopenia are the most common hematological findings in brucellosis [5]. Moreover, Brucellaassociated HLH has been rarely reported in the literature, and the mechanisms of sHLH have not been as well understood in brucellosis as they have been in many other bacterial infections [5][6][7] Regardless of the etiologic cause, cytokine storm and excessive macrophage activation induce hemophagocytosis in primary and secondary HLH.…”