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

Abstract

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.

Investigation of the Sensitivity and Specificity of Laboratory Tests Used in Differential Diagnosis of Childhood Brucellosis

“…Clinical manifestations of brucellosis may range from nonspecific symptoms such as long-term fever, fatigue, and malaise to local organ involvement such as arthritis and neurobrucellosis [21]. Therefore, many studies have been carried out to determine the laboratory parameters, which will support clinical findings.…”

Comparison of Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) and Agglutination Assays in Diagnosis of Brucellosis in Golestan Province, North of Iran

“…Brucellosis is a significant zoonotic infection and a global public health concern [1]. This disease is transmitted to humans in various ways, including the consumption of contaminated dairy products and direct contact with infected animals, placental membranes, and aborted fetuses [2]. The clinical symptoms of this disease, although non-specific, are classified into acute, subacute, and chronic.…”

“…This infection may have a variety of clinical presentations, including chills, fever, sweating, malaise, myalgia, and even arthralgia, which overlap a wide range of diseases, such as tuberculosis, enteric (typhoid) fever, and viral infections. Therefore, the application of an accurate and reliable laboratory diagnostic technique is necessary to identify the causative agent [2].…”

Brucella-induced Thrombocytopenia and Bleeding

“…Hematological problems may occur and are most common in children with brucella infection, but sometimes occur in adults as well. Several blood disorders have been reported in brucellosis, including hemolytic anemia [3], thrombocytopenia, leukopenia [4], leukocytosis [5], thrombocytosis [6], and pancytopenia [7]. Mild anemia and leukopenia are the most common complications of acute infection.…”