University Clinic for Infectious Diseases and Febrile Conditions, Skopje, Republic of Macedonia.
Pediatr Infect Dis J. 2013 Aug;32(8):815-9. doi: 10.1097/INF.0b013e31828e9d15.
To describe the main clinical and laboratory characteristics, frequency and distribution of osteoarticular involvement, therapeutic options and outcome in children with osteoarticular brucellosis.
This descriptive study includes 133 pediatric patients with osteoarticular brucellosis who were treated at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia, during the period between 1989 and 2011. Brucellosis was presumptively diagnosed on the basis of clinical signs and confirmed by the detection of specific antibodies at significant titers.
The median age of patients was 9 years (range, 2-14 years) and 63.9% were males. Family history of brucellosis was present in 54.1%. The dominant clinical symptoms were arthralgia and fever in 77.4% and 73.7%, respectively, and the dominant sign was hepatomegaly in 73.7% of patients. The main laboratory abnormalities were elevated C-reactive protein (81.0%) and circulating immunocomplexes (80.7%). In 71.4% of patients, the osteoarticular involvement was monoarticular. Hip arthritis was present in 49.6%, followed by the knee in 30.1%. Various therapeutic regimens with a duration of 6 weeks were used. In 87 patients during a follow-up of at least 6 months, relapse occurred in 13.8%.
Osteoarticular involvement is frequent in children with brucellosis. It is most often manifested with monoarthritis of the large weight-bearing joints. Brucellosis should be included in the differential diagnosis of childhood arthritis in endemic countries, especially in the presence of family history, contact with infected animals or ingestion of unpasteurized food products, fever and hepatomegaly.
描述儿童布鲁氏菌性骨关节病的主要临床和实验室特征、骨关节受累的频率和分布、治疗选择和结果。
本描述性研究纳入了 1989 年至 2011 年期间在马其顿斯科普里传染病和发热疾病大学诊所治疗的 133 例儿童布鲁氏菌性骨关节病患者。基于临床体征推测布鲁氏菌病，通过检测特异性抗体的显著滴度进行确诊。
患者的中位年龄为 9 岁（范围 2-14 岁），63.9%为男性。54.1%的患者有布鲁氏菌病家族史。主要临床症状分别为 77.4%的关节痛和 73.7%的发热，73.7%的患者主要体征为肝肿大。主要实验室异常为 C 反应蛋白升高（81.0%）和循环免疫复合物升高（80.7%）。71.4%的患者骨关节受累为单关节炎。髋关节受累占 49.6%，其次是膝关节受累（30.1%）。使用了持续 6 周的各种治疗方案。在至少 6 个月的随访中，87 例患者中有 13.8%复发。
儿童布鲁氏菌病常发生骨关节受累。最常见的表现为大承重关节的单关节炎。在流行国家，尤其是存在家族史、接触受感染动物或摄入未经巴氏消毒的食品、发热和肝肿大的情况下，应将布鲁氏菌病纳入儿童关节炎的鉴别诊断。
