Epidemiological, Clinical and Laboratory Features of Brucellosis: A Retrospective Evaluation of 175 Children

Background: Human brucellosis, a multi-organ system disease which may mimic other conditions, has a low incidence in childhood and the diagnosis may be easily missed. Brucellosis has become a major medical problem in some provinces of Iran. This study aimed to examine the epidemiology, clinical, and laboratory features, and treatment outcome of Brucellosis.
Materials and Methods: We retrieved and reviewed the records charts of all patients admitted to pediatric infectious diseases, Ghods Hospital from March 1995 to March 2004 with a clinical diagnosis of brucellosis whose brucella agglutination titer was 1:160 or greater in department. Information on age, gender, history of using unpasteurized milk or milk products, presenting symptoms and physical signs were extracted from the patients’ files. We also noted the result of routine laboratory tests, treatment given and outcome of treatment.
Results: Children under 12 years constituted the total brucellosis admissions. One hundred and seventy-five patients (107 males, 68 females with a M/F ratio of 1.6:1) had a diagnostic label of brucellosis and a brucella titer of 1:160. Eighty-seven patients (50%) were 1-6 years old, 86 (49%) were 7-12, while 2 patients were under 1. One hundred (57%) patients were from rural areas and 75 (43%) from cities. The admission for the disease was in summer in 76 patients (43%), followed by spring in 52(30%), winter in 24 (14%) and autumn (13%). One hundred and fourteen (65%) had history of using 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 patients, 157 cases (89.5%) had acute and 17 (9%) had chronic disease. 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 radiological changes in 20 (11%). The most common antibiotics used were cotrimoxazole + gentamycin in 83 (47.5%) and cotrimoxazole + rifampin in 72 (41%) cases.
Conclusion: Brucellosis presents in various ways and should be included in the differential diagnosis of arthritis in endemic countries. As symptoms, signs and first-line laboratory findings are not characteristic, agglutination tests, and if possible, blood culture should be performed in any child with prolonged fever. Treatment is effective, but prevention of the disease by educating high risk families is indicated.