Citak Elvan Caglar, Citak Funda Erkasar, Tanyeri Bilge, Arman Dilek
Departments of Pediatric Oncology, Gazi University, Ankara, Turkey.
J Pediatr Hematol Oncol. 2010 Mar;32(2):137-40. doi: 10.1097/MPH.0b013e3181ced382.
Brucellosis continues to be an important cause of fever in underdeveloped countries and in the rural areas of developed world. It is a multisystemic disease, associated with a wide variety of symptoms. A wide variety of symptoms, including hematologic abnormalities, such as anemia, thrombocytopenia, pancytopenia, dissemine intravascular coagulation, and leucopenia could be seen. The aim of the study is to review the hematologic findings of brucellosis in childhood.
In this short study, the records of 146 children with brucellosis were evaluated for hematologic manifestation retrospectively. Among them, 9 patients had pancytopenia and 5 had brucella-induced immune thrombocytopenia and were identified in a 5-year period between June 2004 and July 2009.
Eight of the 9 patients with pancytopenia had Brucella melitensis isolated from blood cultures and/or bone marrow cultures, and all 9 patients had Brucella agglutination titers of at least 1:320. All patients with immune thrombocytopenia blood cultures were positive for Brucella. Except 1 patient the pancytopenia in these patients regressed completely and their peripheral blood counts returned to normal after treatment of Brucella infection. One patient was not responding to the brucella treatment and underwent allogeneic hematopoietic stem cell transplantation. All patients with brucella-induced immune thrombocytic purpura were symptomatic and had severe thrombocytopenia, they were placed on intravenous gamma globulin for 2 days. Between day 3 and day 5 platelet counts increased in these patients.
Brucellosis should be considered as a possible diagnosis among patients with pancytopenia and immune thrombocytopenic purpura in endemic regions.
布鲁氏菌病仍是欠发达国家以及发达国家农村地区发热的重要原因。它是一种多系统疾病，伴有多种症状。可见多种症状，包括血液学异常，如贫血、血小板减少、全血细胞减少、弥散性血管内凝血和白细胞减少。本研究的目的是回顾是回顾儿童布鲁氏菌病的血液学表现。
在这项简短的研究中，对146例布鲁氏菌病患儿的记录进行回顾性评估，以观察其血液学表现。其中，9例患儿出现全血细胞减少，5例患儿出现布鲁氏菌诱导的免疫性血小板减少，这些病例是在2004年6月至2009年7月的5年期间确诊的。
9例全血细胞减少患儿中有8例血培养和/或骨髓培养分离出羊种布鲁氏菌，所有9例患儿布鲁氏菌凝集效价至少为1:320。所有免疫性血小板减少患儿的血培养布鲁氏菌均呈阳性。除1例患儿外，这些患儿的全血细胞减少在布鲁氏菌感染治疗后完全消退，外周血细胞计数恢复正常。1例患儿对布鲁氏菌治疗无反应，接受了异基因造血干细胞移植。所有布鲁氏菌诱导的免疫性血小板减少性紫癜患儿均有症状且血小板严重减少，他们接受了2天的静脉注射丙种球蛋白治疗。在第3天至第5天，这些患儿的血小板计数有所增加。
在流行地区，全血细胞减少和免疫性血小板减少性紫癜患者应考虑布鲁氏菌病的可能诊断。
