Epidemiologic, clinical, and laboratory characteristics of childhood brucellosis : A study in an Iranian children's referral hospital.

BACKGROUND

Brucellosis is endemic in Iran. Children constitute 20-25% of cases. We determined clinical, laboratory, and epidemiologic characteristics of pediatric brucellosis patients hospitalized at the Children's Medical Center from May 2011 to December 2016.

METHODS

Medical records were reviewed retrospectively. For each patient, a questionnaire was provided containing demographic characteristics (sex, age, nationality, date of admission, city of residence, history of ingestion of unpasteurized dairy products, family history of brucellosis, history of contact with suspicious animals) and clinical information (signs and symptoms, laboratory findings, history of disease relapse, treatment).

RESULTS

Included were 43 patients diagnosed with brucellosis (26 males, 60.5%; age 1-13 years, mean ± SD: 7.02 ± 3.5). A history of ingestion of raw or unpasteurized dairy products was present in 88% (N = 38) and 11 patients (26%) had had contact with a suspicious animal. Highest frequencies of brucellosis were recorded in 2013 (N = 10, 23%) and 2015 (N = 11, 26%). Most cases were admitted in the summer (N = 14, 33%) and spring (N = 12, 28%). Fever (N = 39, 91%), arthralgia (N = 33, 77%), and malaise (N = 33, 77%) were the main complaints. Anemia (65%), lymphocytosis (51%), and elevated erythrocyte sedimentation rate (86%) and C‑reactive protein (67%) were the most prominent blood anomalies. Blood culture was positive in 30% (N = 11/37), bone marrow culture in 31% (N = 4/11). A positive Wright, Coombs Wright, and 2 ME test was observed in 67% (N = 29), 92% (N = 34/37), and 85% (N = 34/40) of cases, respectively. Median length of antibiotic therapy was 12 weeks (2-24 weeks). The most frequent drug regimen was combined trimethoprim-sulfamethoxazole and rifampicin (N = 24, 56%). Relapse occurred in 9 patients (21%), there were no deaths.

CONCLUSIONS

Physicians should be aware of the manifestations, diagnosis, and treatment protocols of childhood brucellosis. Control programs and preventive measures, e.g., regular examination of domestic animals, mass vaccination of livestock, slaughter of infected animals, control of animal trade and migration, pasteurization of milk and milk products, training and increased public awareness of the dangers of consumption of unpasteurized dairy products, are highly recommended.