Brucellosis in Children

Background: Brucellosis, a multisystem infection that may imitate other conditions, shows a low incidence during childhood and may be misdiagnosed. Brucellosis has become a major medical problem in a number of the provinces in Iran. Objectives: To study the epidemiology, clinical and laboratory features, and management of brucellosis. Patients and Methods: We reviewed the charts of all patients who were diagnosed with brucellosis and showed an agglutination titer of 1:160 or more for Brucella at the Department of Pediatric Infectious Diseases, Qods Hospital from March 1995 to March 2004. We collected information on the age, gender, history of unpasteurized milk or milk-product ingestion, presenting symptoms, and physical signs of the patients. We also collected results of routine laboratory tests, treatment, and treatment outcome. Results: Patients younger than 12 years of age constituted all cases of brucellosis admissions. One hundred seventy-five patients (107 male and 68 female, 1.6:1 ratio) were diagnosed with brucellosis and had a Brucella titer of 1:160 with an odds ratio (OR) of 1:160. Eighty-seven patients (50%) were 1-6 years of age, 86 patients (49%) were 7-12 years of age, and only 2 patients were 1 year of age. One hundred (57%) patients were from rural areas, and 75 (43%) were from cities. The most frequent seasons of disease occurrence were summer (76, 43%) and spring (52, 30%); there were fewer cases in winter (24, 14%) and autumn (23, 13%). One hundred fourteen cases (65%) had a history of consuming unpasteurized milk or milk products. The most frequent symptoms were arthralgia (79%) and fever (78%). The most common physical findings were fever (51%) and arthritis (26%). Of the cases, 157 (89.5%) were acute, and 17 (9%) were chronic. A normal white blood cell count was found in 123 cases (71%); anemia, in 33 (19%); increased erythrocyte sedimentation rate (ESR), in 92 (53%); positive C-reactive protein (CRP), in 85 (48%), and positive radiologic changes, in 20 (11%). The most common antibiotics used were cotrimoxazole plus gentamycin in 83 cases (47.5%) and cotrimoxazole plus rifampin in 72 cases (41%). Conclusions: Brucellosis presents in various ways and should be differentiated from arthritis in countries where Brucella is endemic. Symptoms, signs, and first-line laboratory findings are not distinguishing; accordingly, agglutination tests and, if possible, blood culture should be performed in any child with prolonged fever. Treatment is effective, but disease prevention by education of high-risk families is indicated.