Fruchtman Yariv, Segev Renana Wilkof, Golan Avivit Asher, Dalem Yael, Tailakh Muhammad Abu, Novak Victor, Peled Nehama, Craiu Mihai, Leibovitz Eugene
1 Pediatric Emergency Medicine Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva, Israel .
Vector Borne Zoonotic Dis. 2015 Mar;15(3):195-201. doi: 10.1089/vbz.2014.1726.
Data on the various aspects of brucellosis in children living in southern Israel are missing.
Our aim was to study the epidemiological, microbiological, diagnostic, clinical, therapeutic and outcome features of brucellosis in children <19 years of age in southern Israel during 2005-2011.
The study population included all patients hospitalized with a diagnosis of brucellosis, established according to a clinical presentation compatible with brucellosis+presence of Brucella bacteremia (BB).
A total of 128 (50.8%) of 252 patients admitted with a diagnosis of brucellosis had BB (all with Brucella melitensis). All patients were of Muslim Bedouin ethnicity. The mean incidence of BB in southern Israel was 16 cases/100,000 Bedouin, with no significant changes during the study period. Overall duration of symptoms before diagnosis was 10.1±10.9 days. Fever at diagnosis was recorded in <20% of the patients. The most frequent symptoms were arthralgia (61.7%), weakness (32.8%), gastrointestinal disturbances (27.3%), myalgia (25%), and headache (18.8%). The main clinical findings included monoarthritis (36.7%), hepatosplenomegaly (25%), lymphadenopathy (17.2%), heart murmur (11.7%), and skin rash (9.4%), respectively. Anemia, leukopenia, thrombocytopenia, and pancytopenia were reported in 17.6%, 29.6%, 12.8%, and 2.3% of the patients, respectively. Twenty-nine (30.5%) patients with BB had serum agglutinin titers ≤1/160 (13, 13.7%%, had titers <1/160). Twenty-seven (93%) of the 29 patients aged 0-4 years were treated with gentamicin and trimethoprim-sulfamethoxazole; a total of 77 (60.2%) patients received gentamicin and doxycycline.
Childhood brucellosis remains an important public health problem in southern Israel. BB was diagnosed in >50% of the children with brucellosis, and B. melitensis was identified in all cases. Arthralgia, weakness, and gastrointestinal complaints were the most common symptoms, and monoarthritis, hepatosplenomegaly, and lymphadenopathy were the most common clinical findings. A considerable number of patients with BB had undetectable/low serum agglutinin titers, suggesting insufficient reliability on serology alone in diagnosis of brucellosis.
关于生活在以色列南部儿童布鲁氏菌病各方面的数据缺失。
我们的目的是研究2005年至2011年期间以色列南部19岁以下儿童布鲁氏菌病的流行病学、微生物学、诊断、临床、治疗及转归特征。
研究人群包括所有因布鲁氏菌病诊断而住院的患者，诊断依据为与布鲁氏菌病相符的临床表现+布鲁氏菌菌血症（BB）的存在。
252例诊断为布鲁氏菌病的住院患者中，共有128例（50.8%）存在BB（均为羊种布鲁氏菌）。所有患者均为穆斯林贝都因族裔。以色列南部BB的平均发病率为每10万贝都因人中有16例，在研究期间无显著变化。诊断前症状的总体持续时间为10.1±10.9天。诊断时发热的患者不到20%。最常见的症状为关节痛（61.7%）、乏力（32.8%）、胃肠道不适（27.3%）、肌痛（25%）和头痛（18.8%）。主要临床体征分别为单关节炎（36.7%）、肝脾肿大（25%）、淋巴结病（17.2%）、心脏杂音（11.7%）和皮疹（9.4%）。分别有17.6%、29.6%、12.8%和2.3%的患者报告有贫血、白细胞减少、血小板减少和全血细胞减少。29例（30.5%）有BB的患者血清凝集素滴度≤1/160（13例，13.7%，滴度<1/160）。29例0至4岁的患者中有27例（93%）接受庆大霉素和甲氧苄啶-磺胺甲恶唑治疗；共有77例（60.2%）患者接受庆大霉素和多西环素治疗。
儿童布鲁氏菌病在以色列南部仍然是一个重要的公共卫生问题。超过50%的布鲁氏菌病患儿诊断出有BB，所有病例均鉴定为羊种布鲁氏菌。关节痛、乏力和胃肠道不适是最常见的症状，单关节炎、肝脾肿大和淋巴结病是最常见的临床体征。相当数量有BB的患者血清凝集素滴度检测不到/较低，提示仅依靠血清学诊断布鲁氏菌病的可靠性不足。
