Brucellosis in Saudi Children: Presentation, Complications, and Treatment Outcome

Abstract

Background Brucellosis, an endemic disease in Saudi Arabia, has an infection rate of 70 per 100,000 people, with a varying morbidity rate in different parts of the country. The aim of this study was to assess the epidemiological and clinical features, laboratory findings, treatment modalities, complications, and outcomes in children with brucellosis. Materials and methods The medical records of 153 patients attending King Abdullah Specialist Children’s Hospital in Riyadh, Saudi Arabia, from January 2015 to January 2019 were reviewed retrospectively. Demographic data, laboratory test results, serum agglutination test titer, and the results of the blood cultures were obtained. The diagnosis of brucellosis was based on compatible signs and symptoms with a positive serology titer of ≥1:160 or a blood culture positive for Brucella species. Results The majority of the sample (69.6%, n=107) were males, with a mean age of 7.75 ± 3.28 years. Ingestion of unpasteurized camel dairy products was the most frequent transmission risk factor. The most prevalent presenting symptoms were constitutional and musculoskeletal symptoms. Six patients (3.9%) had complicated brucellosis, with neurobrucellosis diagnosed in three cases. Hospitalization for brucellosis was required in 15% of the patients. The majority (99.35%, n=152) of the patients had a serum agglutination test (SAT) titer of ≥1:160. A blood culture was positive in 52 (34%) of the 111 patients tested. The most frequently prescribed regimen was rifampicin + co-trimoxazole in 81 (52.9%) patients. Relapse occurred in a small proportion (4.6%, n=7), and the majority (95.4%, n=146) had a complete remission. Conclusions The main route of transmission was the ingestion of unpasteurized dairy products. Brucellosis had a wide range of clinical presentation, involving multiple organ systems. Neurobrucellosis was the most frequent complication. The SAT was the most useful and reliable test for the diagnosis of brucellosis. Most patients were successfully treated with rifampicin and co-trimoxazole for six weeks.

Brucellosis causing bone marrow aplasia in an 11-year-old patient with complete recovery after treatment

“…Brucellosis is an endemic zoonotic disease in most countries of the MENA region. For example, in Saudi Arabi, the incidence of brucellosis is estimated to be 70 per 100,000 people/year [6] . Up to 30% of the reported cases are children [7] .…”

Survival benefit from paediatric transplantation in brucellosis-infected patients listed for heart transplantation

“…Qasim et al's study included 153 Saudi children with Brucella, 80% of them had fever and mild symptoms. 8 Moreover, Ghaly et al reported that 24% of children with Fever of Unknown Origin in Egypt are caused by brucellosis. Therefore, it is recommended that in the evaluation of patients transplanted with unknown fever, even if the symptoms do not imply brucellosis, we should think about this disease and perform the necessary tests.…”

“…In this regard, Qasim et al obtained a positive blood culture in 34% of children with Brucella. 8 Since diagnosis is confirmed by obtaining the germ of the causative agent, it is necessary to perform blood culture in all patients and, if possible, bone marrow culture and keep the sample for a long time (at least 30 days) or use BACTEC medium, if appropriate.…”

A Case of Seronegative Pediatric Neurobrucellosis Presenting With Ataxia

“…Triple therapy with IV ceftriaxone, doxycycline, and rifampicin showed an excellent response and clinical improvement. The presented case was part of a retrospective cohort study that aimed to describe the clinical presentations and treatment strategies of brucellosis among Saudi children [ 8 ].…”