Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
J Pediatric Infect Dis Soc. 2020 Dec 31;9(6):664-670. doi: 10.1093/jpids/piz092.
Data regarding risk factors of bacteremic brucellosis, and specifically recurrent bacteremia, are scarce. We assessed patients with childhood brucellosis, differentiating between those having culture-negative, single-bacteremic, and recurrent-bacteremic episodes.
The medical files of pediatric brucellosis patients, from 2005 through 2014, were reviewed retrospectively. Univariate and multivariate analyses were performed to compare demographic and clinical characteristics of culture-negative, single-bacteremic, and recurrent-bacteremic (≥30 days between positive cultures) episodes.
Of all 436 brucellosis cases, 22% were culture-negative, 72% were single-bacteremic, and 6% were recurrent-bacteremic. In a univariate analysis, single-bacteremic episodes were associated with fever (90% vs 65% and 40% in culture-negative and recurrent bacteremia, respectively) and elevated glutamic oxaloacetic transaminase (GOT) levels. Recurrent-bacteremic episodes were associated with anemia (26% vs 14% and 9% in single bacteremia and culture negative, respectively), elevated GOT, low immunoglobulin M (IgM) titers (56% vs 89% and 99%, respectively), and lower levels of adequate treatment (74% vs 94% and 86%, respectively). In multivariate analyses, single bacteremia was associated with fever (odds ratio [OR], 3.595, compared with culture negative), while recurrent bacteremia was inversely associated with IgM titers ≥1:160 (OR, 0.022 and 0.226 compared with culture negative and single bacteremia, respectively) and fever (OR, 0.108 compared with single bacteremia).
Brucellosis episodes are commonly complicated with bacteremia. Single-bacteremic episodes were associated with high-grade fever and elevated liver enzymes, possibly indicating high bacterial virulence. Recurrent-bacteremic episodes were associated with poor treatment at initial diagnosis, along with low rates of fever, low IgM titers, and high anemia rates, possibly indicating impaired host response. Physicians should consider treatment modifications for suspected recurrent-bacteremic brucellosis, including monitoring treatment adherence, and possibly administering prolonged treatment.
有关菌血症性布鲁氏菌病的风险因素，特别是复发性菌血症的相关数据较为匮乏。我们评估了患有儿童布鲁氏菌病的患者，将其分为培养阴性、单一菌血症和复发性菌血症（两次阳性培养之间间隔＞30 天）患者。
回顾性分析了 2005 年至 2014 年期间儿科布鲁氏菌病患者的病历。对培养阴性、单一菌血症和复发性菌血症（≥30 天之间阳性培养）患者的人口统计学和临床特征进行了单因素和多因素分析。
在所有 436 例布鲁氏菌病患者中，22%为培养阴性，72%为单一菌血症，6%为复发性菌血症。单因素分析显示，单一菌血症患者有发热（90%比 65%和 40%，分别为培养阴性和复发性菌血症）和谷草转氨酶（GOT）升高。复发性菌血症患者有贫血（26%比 14%和 9%，分别为单一菌血症和培养阴性）、GOT 升高、免疫球蛋白 M（IgM）滴度低（56%比 89%和 99%，分别为单一菌血症和培养阴性）和治疗不充分（74%比 94%和 86%，分别为单一菌血症和培养阴性）。多因素分析显示，单一菌血症与发热相关（与培养阴性相比，比值比 [OR] 3.595），而复发性菌血症与 IgM 滴度≥1：160 呈负相关（与培养阴性和单一菌血症相比，OR 分别为 0.022 和 0.226）和发热（与单一菌血症相比，OR 为 0.108）。
布鲁氏菌病常伴有菌血症。单一菌血症患者有高热和肝酶升高，可能提示细菌毒力较高。复发性菌血症与初始诊断时治疗不充分、发热发生率低、IgM 滴度低和贫血发生率高有关，可能提示宿主反应受损。对于疑似复发性菌血症布鲁氏菌病，医生应考虑调整治疗方案，包括监测治疗依从性，并可能需要延长治疗时间。
