Features of Childhood Brucellosis and the Diagnostic Role of Laboratory Markers in Hospitalization

Abstract

Objective: Human brucellosis is a systemic disease that mimics many diseases, and its diagnosis is extremely difficult in children. Childhood brucellosis may present with serious clinical pictures and cause complications. This study aimed to investigate the characteristics of childhood brucellosis and the diagnostic role of laboratory markers for hospitalization. Material and Methods: Sixty children aged between 0 and 18 years who were diagnosed with brucellosis between January 1, 2018 and December 31, 2019 were evaluated retrospectively. The demographic characteristics and clinical, microbiological, and other laboratory findings of brucellosis patients who were followed up as outpatient and inpatient were examined. Results: The median age of the patients was 9.3±4.3 years; 41.7% were girls and 58.3% were boys. Joint involvement was 83.3% of the patients. Total 33.3% patients were hospitalized. The median value of blood serum eosinophil counts was 60/μL (10-90/μL) in hospitalized patients and 110/ μL (55-205/μL) in outpatients (p=0.022). For blood eosinophil count cutoff level ≤ 90/μL (confidence interval [CI] 95%, 54.4-93.9), sensitivity was 78.95% (Cl 95%, 54.4-93.9) and specificity was 60%, (Cl 95%, 43.3-75.1). Conclusion: Childhood brucellosis remains an important public health problem for our country. Blood eosinophil levels may have a role in indicating the degree of disease and deciding hospitalization in childhood brucellosis. New studies with more patients are needed to understand this relationship better and to evaluate its specificity and sensitivity.

Keywords

• Brcellosis
• child
• blood eosinophil count

Çocukluk Çağı Bruselloz Özellikleri ve Hastaneye Yatışta Laboratuvar Belirteçlerinin Tanısal Rolü

Abstract

Amaç: İnsan brusellozu, birçok hastalığı taklit eden sistemik bir hastalıktır ve çocuklarda da teşhis edilmesi çok zor olabilmektedir. Çocukluk çağı brusellozu, ciddi klinik tablolarla karşımıza gelebilir ve komplikasyonlara neden olabilir. Bu çalışmada, çocukluk çağı bruselloz hastalarının özellikleri ile hastaneye yatışta laboratuvar belirteçlerin tanısal rolünün araştırılması amaçlandı. Gereç ve Yöntemler: Geriye dönük olarak 1 Ocak 2018 ile 31 Aralık 2019 tarihleri arasında bruselloz tanısı alan 0-18 yaş 60 çocuk hasta değerlendirildi. Ayaktan ve hastaneye yatış verilerek izlenen bruselloz hastalarının demografik özellikleri ve klinikleri ile mikrobiyolojik ve diğer laboratuvar bulguları incelendi. Bulgular: Hastaların yaş ortalaması, 9.3±4.3 yıldı ve %41,7’si kız, %58,3’ü erkek idi. Hastaların %83,3’ünde eklem tutulumu mevcuttu. Hastaların %33,3’ü yatırılarak izlendi. Kan serum eozinofil sayıları yatan hastalarda ortanca değeri 60/μL (10-90/μL) iken ayaktan hastalarda 110/μL (55-205/ μL) değerleri arasında idi (p=0,022). Kan eozinofil sayısı kesme seviyesi ≤90/μL için; (CI %95, 54,4-93,9) duyarlılık %78,95 (Cl %95, 54,4-93,9) ve özgüllük %60,00, (Cl %95,43,3-75,1) olarak bulundu. Sonuç: Çocukluk çağı brusellozu ülkemiz için önemli bir halk sağlığı sorunu olmaya devam etmektedir. Kan eozinofil düzeyleri, çocukluk çağı brusellozunda hastalık derecesini göstermede ve yatışa karar vermede bir role sahip olabilir ama bu ilişkinin daha iyi anlaşılması, özgüllük ve duyarlılığının değerlendirmesi için daha fazla sayıda hasta ile yeni çalışmalara ihtiyaç vardır.

Keywords

• Bruselloz
• çocuk
• kan eozinofil sayısı

References

1. 1. Bukhari EE. Pediatric brucellosis. An update review for the new millennium. Saudi Med J 2018 Apr;39(4):336-41.
2. 2. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med 2005 Jun 2;352(22):2325-36.
3. 3. CDC. Brucellosıs reference guıde: Exposures, testıng, and preventıon. 2017 [cited 2020]; Available from: https://www.cdc. gov/brucellosis/pdf/brucellosi-reference-guide.pdf.
4. 4. Downes KJ. Brucella. In: Robert M. Klıegman M, Joseph W. St Geme III M, Nathan J. Blum M, Samır S. Shah M, MSCE, Robert C. Tasker M, MD, Karen M. Wılson M, MPH, et al., editors. Nelson Texbook of Pediatrics. 21 ed. p. 6199-206.
5. 5. Hanefi C. Gul, Erdem H. Brucellosis ( Brucella Species). In: John E. Bennett MD, Raphael Dolin MD, MD MJB, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, . 9 ed2020. p. 2753-8.e2.
6. 6. Seleem MN, Boyle SM, Sriranganathan N. Brucellosis: a reemerging zoonosis. Vet Microbiol 2010 Jan 27;140(3-4):392-8.
7. 7. Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis 2006 Feb;6(2):91-9.
8. 8. T.C. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, Türkiye Bruselloz İstatistik Verileri. 2017 [cited 2020]; Available from: hsgm.saglik.gov.tr/tr/zoonotikvektorel-bruselloz/istatistik.

9. 9. Young EJ. Brucellosis. In: James D. Cherry MD M, Gail J. Harrison MD, Sheldon L. Kaplan MD, William J. Steinbach MD, Peter J. Hotez MD P, editors. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 8 ed2019. p. 1156-9.e3.
10. 10. Erdem H, Elaldi N, Ak O, Gulsun S, Tekin R, Ulug M, et al. Genitourinary brucellosis: results of a multicentric study. Clinical microbiology and infection: The official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2014 Nov;20(11):O847-53.
11. 11. Klinik, Bakteriyoloji, Tanı, Standartları, Çalışma, Grubu. Brusellozun Mikrobiolojik tanısı. 2015 [cited 2020]; Available from: https:// hsgm.saglik.gov.tr/depo/birimler/Mikrobiyoloji_Referans_ Laboratuvarlari_ve_Biyolojik_Urunler_DB/rehberler/UMS_ LabTaniRehberi_Cilt_1.pdf.
12. 12. CDC. Brucellosis-Serology. 2012 [cited 2020]; Available from: https://www.cdc.gov/brucellosis/clinicians/serology.html.
13. 13. al-Eissa Y, al-Zamil F, al-Mugeiren M, al-Rasheed S, al-Sanie A, al- Mazyad A. Childhood brucellosis: a deceptive infectious disease. Scand J Infect Dis 1991;23(2):129-33.
14. 14. Kazanasmaz H, Geter S. Investigation of the sensitivity and specificity of laboratory tests used in differential diagnosis of childhood brucellosis. Cureus. 2020 Jan 23;12(1):e6756.
15. 15. Arapovic J, Spicic S, Ostojic M, Duvnjak S, Arapovic M, Nikolic J, et al. Epidemiological, clinical and molecular characterization of human brucellosis in Bosnia and Herzegovina - An ongoing brucellosis outbreak. Acta Med Acad 2018 May;47(1):50-60.
16. 16. Olt S, Ergenc H, Acikgoz SB. Predictive contribution of neutrophil/ lymphocyte ratio in diagnosis of brucellosis. Biomed Res Int 2015;2015:210502.
17. 17. Bozdemir ŞE, Altıntop YA, Uytun S, Aslaner H, Torun YA. Diagnostic role of mean platelet volume and neutrophil to lymphocyte ratio in childhood brucellosis. Korean J Intern Med 2017 Nov;32(6):1075-81.
18. 18. Aypak A, Aypak C, Bayram Y. Hematological findings in children with brucellosis. Pediatr Int 2015 Dec;57(6):1108-11.
19. 19. Tanir G, Tufekci SB, Tuygun N. Presentation, complications, and treatment outcome of brucellosis in Turkish children. Pediatr Int 2009 Feb;51(1):114-9.
20. 20. Citak EC, Citak FE, Tanyeri B, Arman D. Hematologic manifestations of brucellosis in children: 5 years experience of an anatolian center. J Pediatr Hematol Oncol 2010 Mar;32(2):137-40.
21. 21. Okan DH, Gökmen Z, Seyit B, Yuksel K, Cevdet Z, Deniz A. Mean platelet volume in brucellosis: correlation between brucella standard serum agglutination test results, platelet count, and C-reactive protein. Afr Health Sci 2014 Dec;14(4):797-801.
22. 22. Küçükbayrak A, Taş T, Tosun M, Aktaş G, Alçelik A, Necati Hakyemez I, et al. Could thrombocyte parameters be an inflammatory marker in the brucellosis? Med Glas (Zenica) 2013 Feb;10(1):35-9.
23. 23. Aktar F, Tekin R, Bektas MS, Güneş A, Köşker M, Ertuğrul S, et al. Diagnostic role of inflammatory markers in pediatric Brucella arthritis. Ital J Pediatr 2016 Jan 11;42:3.
24. 24. Okur M, Erbey F, Bektaş MS, Kaya A, Doğan M, Acar MN, et al. Retrospective clinical and laboratory evaluation of children with brucellosis. Pediatr Int 2012 Apr;54(2):215-8.
25. 25. Downes KJ. Brucella. In: Robert M. Klıegman M, Joseph W. St Geme III M, Nathan J. Blum M, Samır S. Shah M, MSCE, Robert C. Tasker M, MD, Karen M. Wılson M, MPH, et al., editors. Nelson Texbook of Pediatrics. 21 ed2020. p. 6199-206.
26. 26. Benjamin L. Wright, Vickery BP. Eosinophils. In: Robert M. Klıegman M, Joseph W. St Geme III M, Nathan J. Blum M, Samır S. Shah M, MSCE, Robert C. Tasker M, MD, Karen M. Wılson M, MPH, et al., editors. Nelson Text Book. 21 ed2020. p. 4739-48.
27. 27. O’Connell EM, Nutman TB. Eosinophilia in infectious diseases. Immunol Allergy Clin North Am 2015 Aug;35(3):493-522.
28. 28. Butt NM, Lambert J, Ali S, Beer PA, Cross NC, Duncombe A, et al. Guideline for the investigation and management of eosinophilia. Br J Haematol 2017 Feb;176(4):553-72.
29. 29. Karakonstantis S, Kalemaki D, Tzagkarakis E, Lydakis C. Pitfalls in studies of eosinopenia and neutrophil-to-lymphocyte count ratio. Infect Dis (Lond) 2018 Mar;50(3):163-74.
30. 30. Gil H, Bouldoires B, Bailly B, Meaux Ruault N, Humbert S, Magy- Bertrand N. L’éosinopénie en 2018 [Eosinopenia in 2018]. Rev Med Interne 2019 Mar;40(3):173-7.