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A prospective study of brucellosis in children: relative frequency of pancytopenia
Mohamed A El-Koumi1, Mona Afify, Salha H Al-Zahrani
1Department of Pediatrics, Al-Khafji Joint Operation Hospital. Kingdom of Saudi Arabia.
Insights
Pancytopenia is an uncommon but significant complication in pediatric brucellosis. This study highlights the importance of considering brucellosis in children presenting with pancytopenia, especially in endemic regions.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Epidemiology
Background:
- Hematological complications are frequent in brucellosis.
- Pancytopenia is a rare but documented complication, primarily in adults, but also observed in children.
- Brucellosis remains a public health concern in endemic areas.
Purpose of the Study:
- To determine the frequency of pancytopenia in pediatric brucellosis cases.
- To investigate the clinical and hematological features associated with pancytopenia in children with brucellosis.
- To emphasize the role of brucellosis in the differential diagnosis of pediatric pancytopenia.
Main Methods:
- A study was conducted on 60 pediatric brucellosis patients at Al-Khafji Joint Operation Hospital, Saudi Arabia.
- Complete blood count (CBC) and blood cultures were performed for all patients.
- Bone marrow (BM) aspiration was performed for patients diagnosed with pancytopenia.
Main Results:
- Pancytopenia was observed in 18% (11 out of 60) of pediatric brucellosis cases.
- Common symptoms included excessive sweating (68%), bone aches (62%), and chills (55%).
- Anemia (43%) and leukopenia (38%) were the most frequent hematological findings. Brucella melitensis was the predominant species identified.
Conclusions:
- Pancytopenia, while uncommon, is a potential complication of brucellosis in children.
- Brucellosis should be considered in the differential diagnosis of pediatric pancytopenia, particularly in Saudi Arabia.
- Early recognition and diagnosis are crucial for effective management and to prevent severe outcomes.
Unlabelled:
Hematological complications in brucellosis are common. Pancytopenia, although mainly reported in adults has also been described in children with brucellosis. This investigation was conducted to estimate the relative frequency of pancytopenia in children with brucellosis. The current study was conducted in Al-Khafji joint operation hospital, Saudi Arabia. Sixty patients with brucellosis, were enrolled in the study. Complete blood count (CBC) and blood culture were performed for all cases. Bone marrow (BM) aspiration was considered only in those with pancytopenia. Out of 60 children with brucellosis, 50 (83%) ingested raw animal milk and 27 (45%) had a positive family history of brucellosis. The common presenting symptoms and signs included excessive sweating (68%), bone aches (62%), chills (55%), arthritis (32%), hepatomegaly (18%), and splenomegaly (15%). The main hematological manifestations included anemia (43%), leukopenia (38%) and leukocytosis (20%). Pancytopenia was detected in 11 patients (18%). Blood culture for Brucella was positive in 38% (23 patients). B.melitensis from 21 patients was cultured in vitro. Out of 9 BM aspirate cultures, 3 were positive for B. melitensis. Out of 11 patients with pancytopenia, 9 (82%) patients had bone aches and weakness, 7 (64%) patients had sweating and chills, and 6 (55%) patients had petechiea and purpura.
Conclusion:
The current study concludes that although pancytopenia is an uncommon complication of brucellosis in children, it does occur. Therefore, brucellosis should be considered in the differential diagnosis of pancytopenia in children, particularly in endemic areas such as Saudi Arabia.