İstanbul'da Hastaneye Yatırılan Pediatrik Brusellozlu Hastaların Retrospektif Değerlendirmesi: Tek Merkezli Bir Çalışma

Year 2024, Volume: 14 Issue: 5, 245 - 250, 25.09.2024

Ayşe Karaaslan , Ceren Çetin , Merve Akçay , Damla Beytorun , Nahide Haykır Zehir , Yakup Çağ , Yasemin Akın

https://doi.org/10.16899/jcm.1516096

Abstract

Giriş: Bruselloz, zoonotik bir hastalık olup, başlıca enfekte sığır, koyun ve domuz gibi hayvanların ürünlerinin tüketilmesi sonucu gelişir.
Materyal-Metod: Üçüncü düzey bir şehir hastanesinde bruselloz tanısıyla hastaneye yatan 18 yaş altı çocuk hastalar çalışmaya dahil edildi. Seroloji titresinin ≥1:160 olması ve/veya kan kültüründe Brucella spp. üremesi bruselloz tanısı için tanı kriteri olarak belirlendi.
Bulgular: 35 bruselloz tanılı çocuk hastanın 22’si erkek, 13’ü kız idi ve ortalama yaş 154.2 ± 53.1ay (25-214) olarak belirlendi. Hastane başvuru şikayetleri sıklık sırasında göre şöyle belirlendi; eklem ağrısı (%51.4), ateş (%31.4), baş ağrısı (%17.1) ve karın ağrısı (%5.2). Hastaların 11’inde (%31.4) poliartralji, 7’sinde (%20) ise monoartralji şikayeti mevcut idi. En sık saptanan fizik muayene bulguları sırasıyla hepatomegali (%48.6) ve splenomegali (%40) olarak belirlendi. Hastaların %17.1'inde eklem tutulumu saptandı. 3 (%8.6) hastada sakroiliak eklem, 2 (%5.7) hastada ayak bileği eklemi, 1(%2.9) hastada ise diz eklem tutulumu raporlandı. Anemi (%60) en sık saptanan hematolojik bulgu idi. Hemoglobin değeri ortalama 12,5±1,44 (10,2-15,9) g/dl olarak saptandı. Hastalar eklem tutulumu açısından karşılaştırıldığında; eklem tutulumu olan hastalarda nötrofil sayısı ve tedavi süresi istatistiksel olarak daha yüksek bulundu (p<0,05).
Tartışma: Bruselloz ülkemizde endemik olan, tüm yaş gruplarını etkileyen, komplikasyon ve nükslere neden olabilen zoonotik bir hastalıktır ve ülkemiz için ciddi bir halk sağlığı sorunu olmaya devam etmektedir.

Keywords

Brusella, çocuk, zoonotik hastalık

Ethical Statement

Yazarların tamamı makalenin tasarımına, yürütülmesine ve analizine katıldıklarını ve son halini onayladıklarını beyan ederler. Ek olarak, bu makaleyle bağlantılı olarak herhangi bir çıkar çatışması yoktur ve açıklanan materyal yayın aşamasında değildir veya başka bir yerde yayınlanmak üzere değerlendirilmemektedir. Gönderilen makale başka bir mecrada yayınlanmamış olup, farklı bir bilimsel dergi veya başka bir yayına sunulmayacaktır. Çalışma herhangi bir finansman almadı.

Retrospective Evaluation of Pediatric Patients Hospitalized with Brucellosis: Single Center Study in Istanbul

Abstract

Aim: Brucellosis is a zoonotic disease and mainly develops as a result of consuming products of infected animals such as cattle, sheep and pigs.

Material-Methods: Pediatric patients under the age of 18 who were hospitalized with a diagnosis of brucellosis in a third-level city hospital were included in the study. Serology titer ≥1:160 and/or Brucella spp in blood culture growth was determined as the diagnostic criterion for the diagnosis of brucellosis.

Results: Of the 35 pediatric patients diagnosed with brucellosis, 22 were boys and 13 were girls, and the average age was determined as 154.2 ± 53.1 months (25-214). Hospital admission complaints were determined in order of frequency as follows; joint pain (51.4%), fever (31.4%), headache (17.1%) and abdominal pain (5.2%). Eleven of the patients (31.4%) had polyarthralgia and 7 (20%) had monoarthralgia. The most common physical examination findings were hepatomegaly (48.6%) and splenomegaly (40%), respectively. Joint involvement was detected in 17.1% of the patients. Sacroiliac joint involvement was reported in 3 (8.6%) patients, ankle joint involvement in 2 (5.7%) patients, and knee joint involvement in 1 (2.9%) patient. Anemia (60%) was the most common hematological finding. The average hemoglobin value was determined as 12.5±1.44 (10.2-15.9) g/dl. When patients are compared in terms of joint involvement; neutrophil count and treatment duration were found to be statistically higher in patients with joint involvement (p<0.05).

Conclusion: Brucellosis is a zoonotic disease that is endemic in our country, affects all age groups, and can cause complications and relapses, and continues to be a serious public health problem for our country.

Keywords

Brucella, child, zoonotic disease

Ethical Statement

All of the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version. Additionally, there are no conflicts of interest in connection with this paper, and the material described is not under publication or consideration for publication elsewhere. The article submitted has not been published in any other medium and shall not be submitted to a different scientific journal or any other publication. The study did not receive any funding.

References

• 1-Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis. 2006;6(2):91-9. doi: 10.1016/S1473-3099(06)70382-6. PMID: 16439329.
• 2-Troy SB, Rickman LS, Davis CE. Brucellosis in San Diego: epidemiology and species-related differences in acute clinical presentations. Medicine (Baltimore). 2005;84(3):174-187. doi: 10.1097/01.md.0000165659.20988.25. PMID: 15879907.
• 3-Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med. 2005;2;352(22):2325-36. doi: 10.1056/NEJMra050570. PMID: 15930423.
• 4-Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Osteoarticular involvement in brucellosis: study of 196 cases in the Republic of Macedonia. Croat Med J. 2004;45(6):727-33. PMID: 15578807.
• 5-Araj GF. Update on laboratory diagnosis of human brucellosis. Int J Antimicrob Agents. 2010;36 Suppl 1:S12-7. doi: 10.1016/j.ijantimicag.2010.06.014. Epub 2010 Aug 9. PMID: 20692128.
• 6-Young EJ. Brucella species (Brucellosis). In: Long SS, Ficher M, Prober CG (eds). Principles and practice of pediatric infectious diseases (5th ed). Philadelphia, PA: Elsevier, 2018: 861-865. https://doi.org/10.1016/ B978-1-4377-2702-9.00163-X
• 7-Kaman A, Öz FN, Fettah A, Durmuş SY, Teke TA, Tanır G. Clinicoepidemiological findings of childhood brucellosis in a tertiary care center in Central Anatolia: with the emphasis of hematological findings. Turk J Pediatr. 2022;64(1):10-18. doi: 10.24953/turkjped.2020.3075. PMID: 35286026.
• 8-Bosilkovski M, Dimzova M, Grozdanovski K. Natural history of brucellosis in an endemic region in different time periods. Acta Clin Croat. 2009;48(1):41-6. PMID: 19623871.
• 9-T.C. Ministry of Health, General Directorate of Public Health, Department of Zoonotic and Vector Borne Diseases. Brucellosis statistics. https://hsgmdestek.saglik.gov.tr/tr/zoonotikvektorel-bruselloz/istatistik. Accesed August 14, 2023.
• 10-Centers for Disease Control (CDC) Brucellosis Reference Guide 2017. https://www.cdc.gov/brucellosis/pdf/brucellosi-reference-guide.pdf (Accessed on May 23, 2019).
• 11-Qasim SS, Alshuwaier K, Alosaimi MQ et al. Brucellosis in Saudi Children: Presentation, Complications, and Treatment Outcome. Cureus. 2020;1;12(11):e11289. doi: 10.7759/cureus.11289. PMID: 33274162; PMCID: PMC7707957.
• 12-Tanir G, Tufekci SB, Tuygun N. Presentation, complications, and treatment outcome of brucellosis in Turkish children. Pediatr Int. 2009;51(1):114-9.
• 13-Zheng R, Xie S, Lu X, Sun L, Zhou Y, Zhang Y, Wang K. A Systematic Review and Meta-Analysis of Epidemiology and Clinical Manifestations of Human Brucellosis in China. Biomed Res Int. 2018;22;2018:5712920.
• 14-Logan LK, Jacobs NM, McAuley JB, Weinstein RA, Anderson EJ. A multicenter retrospective study of childhood brucellosis in Chicago, Illinois from 1986 to 2008. Int J Infect Dis. 2011;15(12):e812-7.
• 15-Özdem S, Tanır G, Öz FN at al. Bacteremic and Nonbacteremic Brucellosis in Children in Turkey. J Trop Pediatr. 2022;7;68(1):fmab114.
• 16-Ahmetagić S, Porobić Jahić H, Koluder N et al. Brucellosis in children in Bosnia and Herzegovina in the period 2000 - 2013. Med Glas (Zenica). 2015 Aug;12(2):177-82.
• 17-Madut NA, Nasinyama GW, Muma JB et al. Prevalence of brucellosis among patients attending Wau Hospital, South Sudan. PLoS One. 2018;27;13(6):e0199315.
• 18-Enkelmann J, Stark K, Faber M. Epidemiological trends of notified human brucellosis in Germany, 2006-2018. Int J Infect Dis. 2020;93:353-358.
• 19-Mohammad A. Alshaalan, Sulaiman A. Alalola, Maha A. Almuneef, et al. AlShahrani, Sameera AlJohani, Brucellosis in children: Prevention, diagnosis and management guidelines for general pediatricians endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS). International Journal of Pediatrics and Adolescent Medicine,2014;1: 40-46.
• 20-Parlak M, Akbayram S, Doğan M et al. Clinical manifestations and laboratory findings of 496 children with brucellosis in Van, Turkey. Pediatr Int. 2015;57(4):586-9. doi: 10.1111/ped.12598. Epub 2015 May 21. PMID: 25675977.
• 21-Akya A, Bozorgomid A, Ghadiri K et al. Usefulness of Blood Parameters for Preliminary Diagnosis of Brucellosis. J Blood Med. 2020;30;11:107-113. doi: 10.2147/JBM.S245513. PMID: 32280292; PMCID: PMC7125307.
• 22-Balın ŞÖ, Tartar AS, Akbulut A. The predictive role of haematological parameters in the diagnosis of osteoarticular brucellosis. Afr Health Sci. 2018;18(4):988-994. doi: 10.4314/ahs.v18i4.19. PMID: 30766564; PMCID: PMC6354860.
• 23-Gür A, Geyik MF, Dikici B et al. Complications of brucellosis in different age groups: a study of 283 cases in southeastern Anatolia of Turkey. Yonsei Med J. 2003;44(1):33-44. doi: 10.3349/ymj.2003.44.1.33. PMID: 12619173.
• 24-Akkoc G, Tekerek S. Osteoarticular Involvement in Childhood Brucellosis: Evaluation of Clinical, Laboratory and Radiologic Features of 185 Cases. Pediatr Infect Dis J. 2023;1;42(5):381-388. doi: 10.1097/INF.0000000000003844. Epub 2023 Jan 31. PMID: 36795549.
• 25-Fanni F, Shahbaznejad L, Pourakbari B, Mahmoudi S, Mamishi S. Clinical manifestations, laboratory findings, and therapeutic regimen in hospitalized children with brucellosis in an Iranian Referral Children Medical Centre. J Health Popul Nutr. 2013;31(2):218-22. doi: 10.3329/jhpn.v31i2.16386. PMID: 23930340; PMCID: PMC3702343.
• 26-Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME, Memish ZA, Roushan MR, Rubinstein E, Sipsas NV, Solera J, Young EJ, Pappas G; International Society of Chemotherapy; Institute of Continuing Medical Education of Ioannina. Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med. 2007;4(12):e317.
• 27-Alp E, Doganay M. Current therapeutic strategy in spinal brucellosis. Int J Infect Dis. 2008;12(6):573-7. doi: 10.1016/j.ijid.2008.03.014. Epub 2008 Jun 9. PMID: 18539496.
• 28-Colmenero JD, Ruiz-Mesa JD, Plata A et al. Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin Infect Dis. 2008;1;46(3):426-33. doi: 10.1086/525266. PMID: 18181740.
• 29-Pappas G, Seitaridis S, Akritidis N, Tsianos E. Treatment of brucella spondylitis: lessons from an impossible meta-analysis and initial report of efficacy of a fluoroquinolone-containing regimen. Int J Antimicrob Agents. 2004;24(5):502-7. doi: 10.1016/j.ijantimicag.2004.05.003. PMID: 15519485.