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Published on: August 5, 2016
An analysis of children with brucellosis associated with pancytopenia
Sinan Akbayram1, Murat Dogan, Cihangir Akgun
1Department of Pediatric Hematology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey. drsinanakbayram@gmail.com
Insights
Brucellosis can cause pancytopenia in children, a rare but significant hematologic abnormality. Early diagnosis and antibiotic treatment lead to complete recovery and normalization of blood counts.
Area of Science:
- Pediatrics
- Hematology
- Infectious Diseases
Background:
- Brucellosis commonly presents with nonspecific hematologic abnormalities.
- While anemia and leukopenia are frequent in acute brucellosis, pancytopenia is less common.
- This study investigates the occurrence and characteristics of pancytopenia in pediatric brucellosis cases.
Purpose of the Study:
- To determine the incidence of pancytopenia in children diagnosed with brucellosis.
- To describe the clinical and hematologic features of pediatric brucellosis with pancytopenia.
- To highlight brucellosis as a differential diagnosis for pediatric pancytopenia.
Main Methods:
- Retrospective analysis of medical records of children (≤16 years) diagnosed with brucellosis.
- Data collected from Yuzuncu Yil University Hospital between 2004 and 2010.
- Diagnosis confirmed by standard tube agglutination test and blood cultures.
Main Results:
- Out of 187 pediatric brucellosis patients, 25 (13.3%) presented with pancytopenia.
- Fever and splenomegaly were the most common clinical signs.
- Bone marrow findings included megakaryocyte increase, erythroid hyperplasia, and granulocytic shift; mild hemophagocytosis was noted in some cases.
Conclusions:
- Brucellosis is an important consideration in the differential diagnosis of pancytopenia in children.
- Prompt antibiotic treatment resulted in complete recovery and normalization of peripheral blood counts within 2-6 weeks.
- Pediatric brucellosis can manifest with significant hematologic derangements like pancytopenia.
Abstract:
Brucellosis produces a variety of nonspecific hematologic abnormalities. Hematologic complications of mild anemia and leukopenia have been frequently associated with acute brucellosis, but pancytopenia is less frequently seen. In this study, records of children with brucellosis aged under or equal to 16 years, admitted to Yuzuncu Yil University Hospital between 2004 and 2010, were analyzed retrospectively. Over this time period, 187 patients with brucellosis were diagnosed. Twenty-five (13.3%) of 187 patients had pancytopenia during admission to hospital. The diagnosis of brucellosis was confirmed by standard tube agglutination test in all patients; titers were 1:320 in 1 patient and 1:1280 in 24 patients. Blood culture was positive for Brucella melitensis in 3 patients (12%). Fever was the most common manifestation, followed by malaise, anorexia, sweating, and weight loss. Fever and splenomegaly were the common signs in most patients. In addition, arthritis was observed in 5 patients, and epistaxis, headache, and abdominal pain were observed in 3 patients. The common bone marrow aspiration findings consisted of increased megakaryocytes and hyperplasia of erythroid series, with a shift to the left of the granulocytic series. Histiocytic hyperplasia was observed in the bone marrow smear of 2 patients. Mild hemophagocytosis was observed in the bone marrow of 3 patients. All patients recovered completely, and their peripheral blood counts returned to normal by 2 to 6 weeks after antibiotic treatment of brucellosis. In conclusion, the authors would like to emphasize that brucellosis should be considered in the differential diagnosis of children with pancytopenia.
