Hematologic Indices, Inflammatory Markers, Symptoms and Routine Diagnostic Tests in Childhood Brucellosis

Background Brucellosis is endemic in Iran, and is seen in all age groups, including children. Its diagnosis in childhood needs a high index of suspicion. The diagnostic methods currently in use need evaluation for analytical performance. Objective The present study tries to evaluate the hematological indices, serologic markers of inflammation and symptoms in patients suspected of brucellosis. Furthermore, the results of three routine methods are compared: PCR, blood culture and Wright agglutination test. Methods Symptoms of patients were asked by questionnaire in 48 children. Hematological indices of the CBC test as well as results of CRP, ESR, blood culture, Wright test and PCR were also recorded. Analytical performance of those 3 tests was calculated. Results Nine out of 48 patients were positive for brucellosis by PCR, seven of which being positive for Wright test and 2 for culture. Fever and arthralgia were seen in 88.8% and 77.7% of PCRpositive cases, respectively. According to hematological findings 3 of PCR-positive patients (33.3%) had anemia and 2 (22.2%) showed leukopenia. Elevation of ESR was observed in 5 (55.5%), and CRP was positive in 7 such cases (77.7%). Conclusions Clinical symptoms, CBC parameters and laboratory markers of systemic inflammation cannot be considered reliable criteria for diagnosis of childhood brucellosis. We suggest usage of PCR rather than blood culture and Wright test for diagnosis in suspected pediatric cases, due to low sensitivity of both culture and Wright test.