Rush University Medical Center, 1653 West Congress Parkway, Suite 736 Murdock, Chicago, IL 60612, USA.
Int J Infect Dis. 2011 Dec;15(12):e812-7. doi: 10.1016/j.ijid.2011.08.002. Epub 2011 Sep 3.
To determine risk factors in children for the acquisition of Brucella, clinical presentation, treatment, and disease outcomes.
A retrospective multicenter chart review was undertaken of children identified with brucellosis from 1986 to 2008 at three tertiary care centers in Chicago, Illinois, USA. The charts were reviewed for data regarding risk factors for acquisition, clinical presentation, and outcomes.
Twenty-one charts were available for review. The median age was 6.5 years (range 2-14 years); 62% were female. Ethnic background was 67% Hispanic and 24% Arabic. Risk factors included travel to an endemic area (86%), particularly Mexico, and consumption of unpasteurized milk products (76%). Common findings included fever (95%), bacteremia (86%), elevated liver transaminases (80%), constitutional symptoms (76%), splenomegaly (60%), and hepatomegaly (55%). Relapse occurred in three of six subjects started on single drug treatment, but in only one of 15 subjects who started on two or more drugs (p=0.053). No relapses occurred in children whose initial therapy included rifampin or those administered three-drug regimens.
Brucella is an infrequent pathogen but should be considered in children with compatible epidemiologic and clinical characteristics. Blood cultures should be obtained, and initial therapy with two or more drugs may decrease the risk of relapse.
确定儿童感染布鲁氏菌的危险因素、临床表现、治疗方法和疾病结局。
对美国伊利诺伊州芝加哥的三家三级护理中心 1986 年至 2008 年间确诊为布鲁氏菌病的儿童进行回顾性多中心病历回顾。对病历进行了有关发病因素、临床表现和结局的数据回顾。
共 21 份病历可用于审查。中位年龄为 6.5 岁（范围 2-14 岁）；62%为女性。种族背景为 67%西班牙裔和 24%阿拉伯裔。危险因素包括前往流行地区（86%），特别是墨西哥，以及食用未经巴氏消毒的奶制品（76%）。常见的发现包括发热（95%）、菌血症（86%）、肝转氨酶升高（80%）、全身症状（76%）、脾肿大（60%）和肝肿大（55%）。在接受单一药物治疗的 6 例患者中，有 3 例出现复发，但在接受 2 种或以上药物治疗的 15 例患者中，仅 1 例复发（p=0.053）。在初始治疗包括利福平或使用三联药物方案的儿童中，未发生复发。
布鲁氏菌是一种罕见的病原体，但在具有符合流行病学和临床特征的儿童中应考虑。应获取血培养，并使用两种或更多种药物进行初始治疗，可能会降低复发的风险。
