Atipik Prezentasyonlu İki Çocukluk Çağı Brusellozis Olgusu

Yıl 2010, Cilt: 8 Sayı: 2, 39 - 43, 01.09.2010

Tolga Altuğ Şen Tevfik Demir Reşit Köken Afşin Ahmet Kundak Faruk Alpay

Öz

Giriş: Brusellozis ülkemizde hala sık görülmekte, zaman zaman seyrek görülen klinikbulgularla prezente olabilmektedir.Olgu 1: On yaşında erkek hasta halsizlik, kilo kaybı, dişeti kanaması nedeniyle kliniğimize başvurdu. Fizik muayenesinde servikal bölgede lenfadenopati, hepatosplenomegalitespit edilen olgunun tam kan sayımında pansitopenisinin olduğu gözlendi. Kemik iliğiaspirasyonu incelemesinde, kemik iliği elemanlarının hiposellüler olduğu görüldü. Brusella aglütinasyon titresi 1:1280 olan olgunun kan kültüründe Brusella mellitensis üredi. Pansitopeninin brusellaya yönelik antibiyotik tedavisinden sonra düzeldiği gözlendi.Olgu 2: Dokuz yaşındaki kız olgu acil servisimize birkaç gündür süren çarpıntı nedeniyle başvurdu. Kalp hızı dakikada 136 sayılan olgunun elektrokardiyografisi sinüzal taşikardiyle uyumlu bulundu. Ekokardiyografik incelemesi tamamen normal olan olgununöyküsünde son 1 aydır kilo kaybı ve kolay yorulma olması üzerine bakılan brusella aglütinasyon titresi 1:1280 bulundu. Kan kültüründe mikroorganizma üremeyen olgununbrusella için başlanılan antiyoterapiye iyi yanıt verdiği, 1 hafta sonra kalp hızının normale döndüğü gözlendi. Tek başına taşikardinin bulunması brusella hastalığı için dahaönce bildirilmemiş erken bir bulgu olarak dikkatimizi çekmiştir.Tartışma: Brusella pansitopeninin nadir nedenlerinden biridir; bu nedenle pansitopeninin ayırıcı tanısında akla getirilmelidir. Brusella kardiyovasküler sistemi tutabilen birhastalık olarak bilinse de daha önce tek bulgunun ateşe bağlı olmayan taşikardi olduğu ve tedaviyle taşikardinin gerilediği bir olgu bildirilmemiş olması olgumuzu ilginç kılmaktadır

Anahtar Kelimeler

Brusellozis, pansitopeni, çocuk, taşikardi

Two Unusual Presentations of Childhood Brucella Cases

Öz

Introduction: Brucellozis is still a common infectious disease in our country and sometimes it may be presented with uncommon clinical manifestations.Case 1: A ten years old male was presented to our clinic with complaints of malaise,weight loss, petechia, and bleeding of gums. On physical examination cervical lymphadenopathy and hepatosplenomegaly had been detected and in complete bloodcount pancytopenia was found.admitted to our clinic. In bone marrow aspiration hypocellular bone marrow was seen. His Brucella agglutination test was positive at1:1280 titer and the blood culture was positive for Brucella mellitensis. The pancytopenia was resolved after the antibiotherapy. Case 2: A nine-year-old female was referred to our clinic with tachycardia, who hadthe cardiac rate of 136/min. The electrocardiography showed sinusal tachycardia andechocardiography was normal, no endocarditis or pericarditis was present. She hadcomplaints of fatigue and lassitude for the last month. Her brucella agglutination testwas positive at 1:1280 titer and blood culture was negative. After antibiotherapy hersymptoms regressed, cardiac rate decreased to 80-100/min. Isolated tachycardia maybe the early manifestaion of brucellosis in children which has not been reported previously. Conclusion: Brucellosis is a rare cause of pancytopenia, it should be considered in differential diagnosis with pancytopenia of children. Brucellosis was known to be involved cardiovascular system, but tachycardia which was not due to fever as theonly sign of disease has not been reported previously made our case very interesting

Anahtar Kelimeler

Brucellosis, pancytopenia, childhood, tachycardia

Kaynakça

• 1. Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M et al. Complications associated with Brucella melitensis infection: A study of 530 cases. Medicine 1996;75:195-211.
• 2. Crosby E, Ilosa L, Miro Quesada M, Carrillo C, Gotuzzo E. Hematologic changes in brucellosis. J Infect Dis 1984;150:419-24.
• 3. Al-Eissa Y, al-Nasser M. Haematological manifestations of childhood brucellosis. Infection 1993;21:23-6.
• 4. Celebi H, Vardi S, Uygun A. Severe Thrombocytopenia In Acute Brucellosis: A Case Report. The Internet Journal of Hematology 2007;3:1-5.
• 5. Sevinc A, Kutlu NO, Kuku I, Ozgen U, Aydogdu I, Soylu H. Severe epistaxis in brucellosis-induced isolated throm￾bocytopenia: a report of two cases. Clin Lab Haematol 2000;22:373-5.
• 6. Karakukcu M, Patiroglu T, Ozdemir MA, Gunes T, Gumus H, Karakukcu C. Pancytopenia, a rare hematologic manifesta￾tion of brucellosis in children. J Pediatr Hematol Oncol 2004;26:803-6.
• 7. Yildirmak Y, Palanduz A, Telhan L, Arapoglu M, Kayaalp N. Bone marrow hypoplasia during Brucella infection. J Pedi￾atr Hematol Oncol 2003;25:63-4.
• 8. al-Eissa YA, Assuhaimi SA, al-Fawaz IM, Higgy KE, al-Nas￾ser MN, al-Mobaireek KF. Pancytopenia in children with brucellosis: clinical manifestations and bone marrow fin￾dings. Acta Haematol 1993;89:132-6.
• 9. Akdeniz H, Irmak H, Seckinli T, Buzgan T, Demiröz AP. He￾matological manifestations in brucellosis cases in Turkey. Acta Med Okayama 1998;52:63-5.
• 10. al-Eissa YA, Kambal AM, al-Nasser MN, al-Habib SA, al-Fa￾waz IM, al-Zamil FA. Childhood brucellosis: a study of 102 cases. Pediatr Infect Dis J 1990;9:74-9.
• 11. García P, Yrivarren JL, Argumans C, Crosby E, Carrillo C, Gotuzzo E. Evaluation of the bone marrow in patients with brucellosis. Clinico-pathological correlation. Enferm Infecc Microbiol Clin 1990;8:19-24.
• 12. Z. Abdi-Liae, A. Soudbakhsh, S. Jafari, H. Emadi and K. To￾maj. Haematological manifestations of brucellosis Acta Medica Iranica 2007;45:145-8.
• 13. Young EJ. Brucella species. In: Mandell GL, Bennett JE, Dolin R (eds.) Principles and practice of infectious disea￾ses. New York: Churchill Livingstone Inc., 2005; p. 2666-72.
• 14. Aysha MH, Shayib MA. Pancytopenia and other haemato￾logical findings in brucellosis. Scand J Haematol 1986;36:335-8.
• 15. Shalev H, Abramson O, Levy J. Hematological manifestati￾ons of brucellosis in children. Pediatr Infect Dis J 1994;13:543-5.
• 16. Young EJ. An overview of human brucellosis. Clin Infect Dis 1995;21:283-9.
• 17. Pappas G, Kitsanou M, Christou L. Immune thrombocytopeni￾a attributed to brucellosis and other mechanisms of Brucella￾induced thrombocytopenia. Am J Hematol 2004;75:139-41.
• 18. Cohen PS, Maguire JH, Weinstein L. Infective endocarditis caused by gram-negative bacteria: a review of the literatu￾re. Progr Cardiovasc Dis 1980;22:205-42.
• 19. Berbarie EF, Cockerill FR, Steckelberg JM. Infective endo￾carditis due to unusual or fastidious microorganisms. Ma￾yo Clin Proc 1997;72:532-42.
• 20. Young EJ. An overview of human brucellosis. Clin Infect Dis 1995;21:283-9.
• 21. Hadjinikololaou L, Triposkiadis F, Zairis M, Chlapoutakis E, Spyrou P. Succesful management of Brucella melitensis endocarditis with combined medical and surgical appro￾ach. European Journal of Cardio-thoracic Surgery 2001;19:806-10.
• 22. Peter G. Summaries of infectious diseases. In Peter G (ed.) Red Book: Report of the Committee on Infectious Diseases, 24th ed., American Academy of Pediatrics Press; 1997; p. 157-9.
• 23. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucello￾sis. N Engl J Med 2005;352:2325-6.
• 24. Yildiz F, Tanyel E, Hatipo¤lu CA, Ertem GT, Tülek N, Oral B. Evaluation of Brucella tube agglutination test in patients with brucellosis, patients with bacterial infections other than brucellosis and healthy subjects. Mikrobiyol Bul 2005;39:211-7.
• 25. Sirmatel F, Türker M, Bozkurt AI. Evaluation of the methods used for the serologic diagnosis of brucellosis. Mikrobiyol Bul 2002;36:161-7.