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A prospective study of brucellosis in children: relative frequency of pancytopenia
Mohamad A El-Koumi1, Mona Afify2, Salha H Al-Zahrani2
1Department of Pediatrics, Al-Khafji Joint Operation Hospital , Kingdom of Saudi Arabia.
Insights
Pancytopenia in children with brucellosis is uncommon but occurs, affecting 18% of cases studied. Brucellosis should be considered in pediatric pancytopenia diagnoses, especially in Saudi Arabia.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Epidemiology
Background:
- Hematological complications are frequent in brucellosis.
- Pancytopenia is a known complication, primarily documented in adults but also observed in children.
Purpose of the Study:
- To determine the frequency of pancytopenia in pediatric brucellosis cases.
- To highlight brucellosis as a differential diagnosis for childhood pancytopenia.
Main Methods:
- A study of 60 children diagnosed with brucellosis in Saudi Arabia.
- Complete blood count (CBC) and blood cultures were performed; bone marrow aspiration was done for pancytopenic patients.
Main Results:
- Pancytopenia was identified in 11 (18%) of the pediatric brucellosis patients.
- Common symptoms included sweating, bone aches, and chills. Anemia and leukopenia were the most frequent hematological findings.
- Brucella was cultured from 38% of patients, with B. melitensis being the predominant species.
Conclusions:
- Pancytopenia, while uncommon, is a potential hematological complication of brucellosis in children.
- Brucellosis warrants consideration in the differential diagnosis of pediatric pancytopenia, particularly in endemic regions like Saudi Arabia.
Objective:
Hematological complications of 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.
Methods:
The current study was conducted in Al-Khafji Joint Operations 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.
Findings:
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 (18%) patients. 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 sweating and chills, 6 (55%) patients petechiae 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.
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