Serpa Jose A, Knights Sheena, Farmakiotis Dimitrios, Campbell Judith
From the Departments of Medicine and Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, the Department of Medicine, Division of Infectious Diseases, University of Texas Southwestern, Dallas, and the Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
South Med J. 2018 Jun;111(6):324-327. doi: 10.14423/SMJ.0000000000000810.
Brucellosis is one of the most common zoonoses worldwide. Most cases in the United States occur among travelers or immigrants from endemic regions, mostly Central America. In this study, we aimed at describing and comparing the epidemiology and clinical presentation of brucellosis in pediatric and adult patients at two large tertiary care centers in Houston, Texas.
We identified patients diagnosed as having brucellosis between January 2000 and December 2009 by searching electronic medical records and reviewing microbiology records for positive cultures. Cases were defined as those with a positive blood culture for sp, a serum agglutination titer ≥1:80 (or both positive blood culture and serum agglutination titer ≥1:80), along with an epidemiologic risk factor and clinical presentation that is consistent with brucellosis.
Six adult and 12 pediatric cases were identified; 13 of 18 (72%) cases were immigrants, mostly from Central America. The median ages for adult and pediatric patients were 53 and 3 years old, respectively. Ingestion of unpasteurized milk products was frequently reported. Common clinical features included fever (83%), arthralgias or arthritis (67%), and hepatosplenomegaly (61%). Positive blood cultures were more frequently reported among children than adults (83% vs 33%, = 0.03). The most common laboratory finding was mildly elevated transaminases. Three adults (50%) but no children developed thrombocytopenia ( = 0.02). Relapsed infection was a frequent occurrence.
In the southern United States, brucellosis is an important consideration in the differential diagnosis of immigrants presenting with undifferentiated fever and joint complaints. A careful history often reveals an epidemiologic risk factor such as ingestion of unpasteurized dairy products.
布鲁氏菌病是全球最常见的人畜共患病之一。美国的大多数病例发生在旅行者或来自流行地区（主要是中美洲）的移民中。在本研究中，我们旨在描述和比较德克萨斯州休斯顿市两家大型三级医疗中心儿科和成年布鲁氏菌病患者的流行病学及临床表现。
通过检索电子病历并查阅微生物学记录中阳性培养结果，我们确定了2000年1月至2009年12月期间被诊断为布鲁氏菌病的患者。病例定义为血培养检出布鲁氏菌、血清凝集效价≥1:80（或血培养阳性且血清凝集效价≥1:80），同时伴有与布鲁氏菌病相符的流行病学危险因素及临床表现。
共确定6例成年病例和12例儿科病例；18例中的13例（72%）为移民，大多来自中美洲。成年和儿科患者的中位年龄分别为53岁和3岁。经常报告有摄入未杀菌乳制品的情况。常见临床特征包括发热（83%）、关节痛或关节炎（67%）以及肝脾肿大（61%）。儿童血培养阳性报告率高于成人（83%对33%，P = 0.03）。最常见的实验室检查结果是转氨酶轻度升高。3名成人（50%）出现血小板减少，而儿童无此情况（P = 0.02）。复发性感染很常见。
在美国南部，布鲁氏菌病是未分化发热和关节症状移民患者鉴别诊断中的重要考虑因素。详细的病史询问通常会揭示诸如摄入未杀菌乳制品等流行病学危险因素。
