Brucellosis Outbreak in Children and Adults in Two Areas in Israel

Abstract

Abstract. Two parallel outbreaks of Brucella melitensis infection occurred in 2014 in two geographical areas in Israel. In two medical centers in northern Israel and one medical center in Jerusalem, 102 patients (58 children, 47 adults) were diagnosed with brucellosis. Most patients (N = 76, 72%) were Muslim Arabs, 28 (27%) were Druze, and one was Jewish. The source of infection was often traced to cheese from the Palestinian Authority. Biovar-1 was evident in 98% in northern Israel but only in 42% in Jerusalem. Most common manifestations were fever (82%) and osteoarticular symptoms (49%). The major differences between the geographic areas were ethnicity and duration until diagnosis. Compared with adults, children had higher rates of hospitalization (93% versus 64%, P = 0.001), osteoarticular symptoms (60% versus 36%, P = 0.05), elevated alanine aminotransferase (12% versus 0%, P = 0.01), and lower C-reactive protein (2.28 ± 2.08 versus 5.57 ± 6.3l mg/dL, P = 0.001). Two unrelated brucellosis outbreaks occurred in 2014 in two different geographic areas of Israel and were limited to sections of the Arab and Druze populations. Most of the demographic and clinical aspects of patients were not affected by geographic variability. Clinical and laboratory differences were found between children and adults emphasizing the nonuniformity of the disease in different age groups. Effective control of unpasteurized dairy foods, health education programs, and improved regional cooperation are required to control brucellosis in Israel.

A Systematic Review and Meta-Analysis of Epidemiology and Clinical Manifestations of Human Brucellosis in China

“…Some scholars reported that enlarged lymph nodes, spleen and liver, skin rashes, pharyngitis [ 89 ], and hematological and respiratory complications were more frequently observed in children than in adults [ 90 ]. Children had higher rates of hepatitis, osteoarticular manifestations [ 91 ], and lower rates of meningitis, endocarditis, spondylitis, and the progression to chronicity [ 92 ]. In the study, we found clinical differences between children and adults.…”

Otolaryngology/head and neck region manifestations of Brucella

“…As in other investigations, the most common manifestation was fever, followed by osteoarticular symptoms, which were more pronounced in the pediatric group (required a longer hospitalization). No head or neck manifestations were reported in this study …”

“…No head or neck manifestations were reported in this study. 20 Searching all English-language papers for additional brucellosis cases involving predominantly the otolaryngology/head and neck region revealed one case of Brucellainduced suppurative parotitis and a case of neurobrucellosis complicated by vestibulocochlear nerve palsy. 21…”

A rare complication of brucella in adolescence: Epididymoorchitis

“…Long-term combined antibiotic therapy prevents relapses. The combined treatment of doxycycline-rifampicin or doxycycline-streptomycin for six to eight weeks is the first choice in epididymoorchitis (2,19). Surgical drainage and rarely orchiectomy may be required in patients with testicular abscess (20).…”