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Brucellar arthritis of knee in a child
A Palanduz1, L Telhan, Y Yildirmak
1Department of Pediatrics, Sişli Etfal Hospital, Istanbul, Turkey.
Insights
A 15-month-old boy developed knee arthritis, likely from brucellosis acquired via breast milk. This case highlights a potentially long incubation period for pediatric brucellosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Rheumatology
Background:
- Brucellosis is a zoonotic infection that can affect various organs.
- Pediatric brucellosis is less common and often presents with non-specific symptoms.
- Transmission can occur through ingestion of contaminated products or direct contact.
Observation:
- A 15-month-old boy presented with fever and knee swelling.
- Maternal history of brucellosis 11 months prior, with infant initially asymptomatic and tests negative.
- Gram-negative coccobacillary organisms identified in joint fluid, though cultures were sterile.
Findings:
- Positive serum agglutination test for brucellosis with a titer of 1/640.
- Diagnosis of brucellar arthritis of the knee.
- Successful treatment with gentamicin, trimethoprim-sulfamethoxazole, and rifampicin.
Implications:
- Suggests a possible prolonged incubation period for brucellosis transmitted via breast milk in infants.
- Emphasizes the importance of considering brucellosis in pediatric arthritis, even with atypical presentations.
- Highlights the need for thorough maternal and infant history in diagnosing infectious diseases.
Abstract:
A 15-month-old boy was admitted with fever and a swollen knee. His mother had been treated for brucellosis 11 months ago. At that time he had been asymptomatic and had both negative blood culture and serum agglutination tests and breastfeeding had been stopped. The infant had been healthy since then. On admission, blood and joint fluid were obtained for culture and he was commenced on cefuroxim. Gram-negative coccobacillary organisms were seen in the joint fluid. Both cultures remained sterile. He had a positive serum agglutination test with a titer of 1/640. Cefuroxim was then stopped and the child was commenced on a specific course of treatment: gentamicin, trimethoprim-sulfamethoxazole and rifampicin. The infant recovered with this treatment. We conclude that this was brucellar arthritis of the knee and was probably acquired by breastmilk after an exceptionally long incubation period.
