From the The Pediatric Infectious Disease Unit.
The Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel.
Pediatr Infect Dis J. 2018 Jun;37(6):586-591. doi: 10.1097/INF.0000000000001900.
Brucellosis is a common zoonosis in the Bedouin population of southern Israel. Limited data exist for the rate and risk factors of hematologic complication of brucellosis in children. We assessed anemia, leukopenia, thrombocytopenia and pancytopenia in childhood brucellosis in southern Israel.
Our medical center is the sole hospital in southern Israel. All medical files of brucellosis, 2005-2014, identified through positive blood cultures or International Classification of Diseases 9th revision coding with positive serology, were reviewed retrospectively.
Overall, 511 brucellosis episodes were identified; 42% (N = 214) with ≥1 cytopenia, including 13% (N = 68) anemia, 28% (N = 144) leukopenia, 14% (N = 74) thrombocytopenia and 2% (N = 9) pancytopenia. Overall, 99.8% of episodes were in Bedouin children and 70% in males. In 79% of episodes, blood culture was positive for Brucella melitensis. Acute infections comprised 84% of all episodes. In univariate analysis, older age (10.49 ± 4.81 vs. 9.25 ± 4.89 years), fever (92% vs. 78%), positive blood culture (84% vs. 75%) and IgM ≥1:640 levels (50% vs. 39%) were associated with cytopenia. In contrast, arthralgia was associated with noncytopenic episodes. In multivariate analyses, older age (odds ratio = 1.063) and fever (odds ratio = 3.127) were associated with cytopenia.
Brucellosis is commonly presented with cytopenia, especially in bacteremic episodes with fever. However, pancytopenia is uncommon and its finding should alert the physician to look for other possible etiologies.
布鲁氏菌病是以色列南部贝都因人中的一种常见人畜共患病。有关儿童布鲁氏菌病血液学并发症的发生率和危险因素的数据有限。我们评估了以色列南部儿童布鲁氏菌病中的贫血、白细胞减少症、血小板减少症和全血细胞减少症。
我们的医疗中心是以色列南部唯一的一家医院。通过阳性血培养或国际疾病分类第 9 版编码和阳性血清学鉴定，回顾性分析了 2005 年至 2014 年期间所有的布鲁氏菌病病历。
共有 511 例布鲁氏菌病发作，其中 42%（N=214）有≥1种细胞减少症，包括 13%（N=68）贫血、28%（N=144）白细胞减少症、14%（N=74）血小板减少症和 2%（N=9）全血细胞减少症。总体而言，99.8%的病例发生在贝都因儿童中，70%的病例发生在男性中。79%的病例血培养阳性为布鲁氏菌属 melitensis。急性感染占所有病例的 84%。在单因素分析中，年龄较大（10.49±4.81 岁比 9.25±4.89 岁）、发热（92%比 78%）、阳性血培养（84%比 75%）和 IgM≥1:640 水平（50%比 39%）与细胞减少症相关。相比之下，关节炎与非细胞减少症发作相关。多因素分析中，年龄较大（比值比=1.063）和发热（比值比=3.127）与细胞减少症相关。
布鲁氏菌病常伴有细胞减少症，尤其是在发热的菌血症发作时。然而，全血细胞减少症并不常见，其发现应提醒医生寻找其他可能的病因。
