BRUCELLOSIS in CHILDHOOD: A SINGLE CENTER EXPERIENCE

Abstract

Objective: Although brucellosis is a endemic zoonotic disease in our country, the number of children case series related to this disease is quite low. The aim of this study is to evaluate the cases of pediatric brucellosis in our clinic and to contribute to the literature.

Materials and Method: In this study, 80 pediatric patients with the diagnosis of brucellosis follow-up by our clinic between 1 January 2009-30 September 30 2018 were conducted retrospectively. 

Results: Of the 80 patients, 58 (72.5%) were male and 22 (27.5%) were female and the mean age was 11.35±3.92 (6 months-17 years). Living in a rural area was 71.3%,  animal husbandry was 18.8%, consumption of non-pasteurized milk/dairy products 82.5% and a family history of brucellosis was 30%. Of the patients, 65% were acute and 35% were subacute brucellosis. Brucella spp. in the blood culture was found as 17.5%, in bone marrow culture was 6.3%, and in cerebrospinal fluid culture was 2.5%. Among the complications, the most common was arthritis (26.3%), and less frequently sacroiliitis (3.8%), neurobrucellosis (3.8%) and genitourinary involvement (2.5%) were observed. Congenital brucellosis was detected in one patient, Henoch-Schöenlein Purpura associated with brucellosis in one patient and Immun Thrombocytopenic Purpura associated with brucellosis in two patients. 66.3% of the cases were hospitalized. The mean hospitalization stay was 9.19 ± 8.18 (3-52) days. All patients were treated with a combined regimen. The treatment-related side effect was 8.8%. Three patients had relapse, and no mortality was detected.

Conclusion: Brucellosis continues to be a serious public health problem in our country. Although infection is considered as a common occupational disease among adults engaged in animal husbandry, children are at risk for this disease due to the risk of foodborne transmission.

Keywords

• Brucellosis,Child

ÇOCUKLUK ÇAĞINDA BRUSELLOZ: TEK MERKEZ DENEYİMİ

Abstract

Amaç: Bruselloz ülkemizde endemik olarak görülen zoonotik bir hastalık olmasına rağmen bu hastalıkla ilgili çocuk vaka serileri oldukça azdır. Bu çalışma ile kliniğimizde takip edilen pediatrik bruselloz vakalarını değerlendirmek ve literatüre katkı sağlamak amaçlanmıştır.

Gereç ve Yöntemler: Bu çalışmada 1 Ocak 2009 – 30 Eylül 2018 tarihleri arasında kliniğimizde bruselloz tanısı ile takip edilen 80 çocuk hasta retrospektif olarak incelendi.

Bulgular: Çalışmadaki 80 hastanın 58’si (%72.5) erkek, 22’si (%27.5) kız ve yaş ortalaması 11.35±3.92 (6 ay-17 yıl) yıldı. Köy/kırsal alanda yaşama %71.3, hayvancılıkla uğraş %18.8, pastörize edilmemiş süt/süt ürünleri tüketimi %82.5 ve ailede bruselloz öyküsü %30 vakada tespit edildi. Hastaların %65’i akut ve %35’i subakut brusellozdu. Brucella spp. üremesi kan kültüründe %17.5, kemik iliği kültüründe %6.3, beyin omurilik sıvısı kültüründe %2.5 oranında saptandı. Komplikasyonlar arasında en sık artrit (%26.3) daha az sıklıkta sakroileit (%3.8), nörobruselloz (%3.8) ve genitoüriner tutulum (%2.5) gözlendi. Bir hastada konjenital bruselloz, bir hastada bruselloz ilişkili Henoch-Schöenlein Purpurası ve iki hastada bruselloz ilişkili İmmun Trombositopenik Purpura tespit edildi. Vakaların %66.3’ü hospitalize edildi. Ortalama hastaneye yatış süresi 9.19±8.18 (3-52) gün idi. Tüm hastalar kombine rejim ile tedavi edildi. Tedavi ilişkili yan etki %8.8 oranında gözlendi. Üç hastada relaps görülürken mortalite saptanmadı.

Sonuç: Bruselloz ülkemizde bir halk sağlığı sorunu olarak ciddiyetini korumaya devam etmektedir. Enfeksiyon hayvancılıkla uğraşan yetişkinler arasında yaygın bir meslek hastalığı olarak kabul edilmekle birlikte, gıda kaynaklı bulaş riski nedeniyle çocuklar bu hastalık açısından risk altındadır. 

Keywords

• Bruselloz,Çocuk

References

1. 1. Pappas G. The changing Brucella ecology: novel reservoirs, new threats. Int J Antimicrob Agents 2010;36:S8-11.
2. 2. Seleem MN, Boyle SM, Sriranganathan N. Brucellosis: a re-emerging zoonosis. Vet Microbiol 2010;140:392-8.
3. 3. Atluri VL, Xavier MN, de Jong MF,  den Hartigh AB, Tsolis RM. Interactions of the human pathogenic Brucella species with their hosts. Annu Rev Microbiol 2011;65:523-41.
4. 4. Yagupsky P. Pediatric brucellosis: an (almost) forgotten disease. Adv Exp Med Biol 2011;719:123-32.
5. 5. Buzgan T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, et al. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis 2010;14:e469-78.
6. 6. Ramin B, MacPherson P. Human brucellosis. BMJ 2010;341:884-5.
7. 7. Centers for Disease Control and Prevention. Brucella suis infection associated with ferals wine hunting—three states, 2007-2008, MMWR Morb Mortal Wkly Rep 2009;58:618-21.
8. 8. Mantur BG, Akki AS, Mangalgi SS, Patil SV, Gobbur RH, Peerapur BV. Childhood brucellosis: a microbiological, epidemiological and clinical study. J Trop Pediatr 2004;50:153-7.

9. 9. Araj GF. Update on laboratory diagnosis of human brucellosis. Int J Antimicrob Agents 2010;36:12-7.
10. 10. Yumuk Z, O’Callaghan D. Brucellosis in Turkey - an overview. Int J Infect Dis 2012;16: 228-35.11. Tanir G, Tufekci SB, Tuygun N. Presentation, complications, and treatment outcome of brucellosis in Turkish children. Pediatr Int 2009;51:114-9.
11. 12. Helvacı M, Atila D, Barışık V. Çocukluk çağı brusellozlu 57 vakanın geriye dönük değerlendirilmesi. Tepecik Eğit Hast Derg 2011;21:135-8.
12. 13. Çelebi S, Hacımustafaoğlu M, Demirtaş F, Salı E, Gül Ü, Özel M. Çocukluk çağında bruselloz. J Pediatr Inf 2011;5:59-62.
13. 14. Yoldas T, Tezer H, Ozkaya-Parlakay A, Sayli TR. Clinical and laboratory findings of 97 pediatric brucellosis patients in central Turkey. J Microbiol Immunol Infect 2015;48:446-9.
14. 15. Vardar F, Gökşen D, Kurugül Z, Özkınay F. Bruselloz Tanı ve Sağaltımı. Ege Pediatri Bülteni 2000;7:29-32
15. 16. Kara SS, Aslan MH, Volkan B, Özel M, Fettah A. Bruselloz Tanılı 94 Çocuk Hastanın Retrospektif Olarak Değerlendirilmesi. Kocatepe Medical Journal 2016;17:60-5.
16. 17. Bosilkovski M, Kirova-Urosevic V, Cekovska Z, Labacevski N, Cvetanovska M, Rangelov G, et al. Osteoarticular involvement in childhood brucellosis: experience with 133 cases in an endemic region. Pediatr Infect Dis J 2013;32:815-9.18. Günal Ö, Bahadır-Ülger FE, Barut Ş, Ülger A. Osteoartiküler Bruselloz. Klimik Dergisi 2011;24:76-81.
17. 19. Martinez-Chamorro E, Munoz A, Esparza J, Munoz MJ, Giangaspro E. Focal cerebral imvolvement by neurobrucellosis: pathological and MRI findings. Eur J Radiol 2002;43:28-30.
18. 20. Haji-Abdolbagi M, Rasooli-Nejad M, Jafari S, Hasibi M, Soudbakhsh A. Clinical and laboratory findings in neurobrucellosis: Review of 31 cases. Arch Iranian Med 2008;11:21-5.
19. 21. Akgun C, Akbayram S, Guner S, Aktar F, Temel H, Basaranoglu M. Brucellosis as a trigger agent for Henoch-Schönlein purpura. Bratisl Lek Listy. 2012;113:506-7.
20. 22. Farah RA, Hage P, Al Rifai A, Afif C. Immune thrombocytopenic purpura associated with brucellosis. Case report and review of the literature. J Med Liban 2010;58:241-3.
21. 23. Roushan MR, Mohraz M, Janmohammadi N, Hajiahmadi M. Efficacy of cotrimoxazole and rifampin for 6 or 8 weeks of therapy in childhood brucellosis. Pediatr Infect Dis J 2006;25: 544-5.