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Hematologic Manifestations of Brucellosis in Children
Naphtali Justman1,2, Yariv Fruchtman1,2, David Greenberg1,2
1From the The Pediatric Infectious Disease Unit.
Insights
Hematologic complications like anemia and leukopenia are common in childhood brucellosis, particularly in Bedouin children with fever and positive blood cultures. Pancytopenia is rare and may indicate other causes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hematology
Background:
- Brucellosis is a prevalent zoonotic disease among the Bedouin population in southern Israel.
- Data on hematologic complications of brucellosis in children are limited.
- This study focuses on anemia, leukopenia, thrombocytopenia, and pancytopenia in childhood brucellosis.
Purpose of the Study:
- To assess the rates and risk factors of hematologic complications in children diagnosed with brucellosis in southern Israel.
- To identify clinical and laboratory factors associated with cytopenias in pediatric brucellosis cases.
Main Methods:
- Retrospective review of medical files for brucellosis cases from 2005-2014 at the sole hospital in southern Israel.
- Identification of cases through positive blood cultures or ICD-9 coding with positive serology.
- Analysis of demographic, clinical, and laboratory data, including cytopenias (anemia, leukopenia, thrombocytopenia, pancytopenia).
Main Results:
- Out of 511 brucellosis episodes, 42% presented with at least one cytopenia.
- Anemia, leukopenia, and thrombocytopenia were observed in 13%, 28%, and 14% of cases, respectively; pancytopenia was rare (2%).
- Older age and fever were significantly associated with cytopenia in multivariate analyses (OR=1.063 and OR=3.127, respectively).
Conclusions:
- Cytopenia is a frequent manifestation of brucellosis in children, especially in bacteremic cases with fever.
- While common cytopenias are noted, the occurrence of pancytopenia warrants further investigation for alternative diagnoses.
- Findings highlight the importance of monitoring hematologic parameters in pediatric brucellosis.
Background:
Brucellosis is a common zoonosis in the Bedouin population of southern Israel. Limited data exist for the rate and risk factors of hematologic complication of brucellosis in children. We assessed anemia, leukopenia, thrombocytopenia and pancytopenia in childhood brucellosis in southern Israel.
Methods:
Our medical center is the sole hospital in southern Israel. All medical files of brucellosis, 2005-2014, identified through positive blood cultures or International Classification of Diseases 9th revision coding with positive serology, were reviewed retrospectively.
Results:
Overall, 511 brucellosis episodes were identified; 42% (N = 214) with ≥1 cytopenia, including 13% (N = 68) anemia, 28% (N = 144) leukopenia, 14% (N = 74) thrombocytopenia and 2% (N = 9) pancytopenia. Overall, 99.8% of episodes were in Bedouin children and 70% in males. In 79% of episodes, blood culture was positive for Brucella melitensis. Acute infections comprised 84% of all episodes. In univariate analysis, older age (10.49 ± 4.81 vs. 9.25 ± 4.89 years), fever (92% vs. 78%), positive blood culture (84% vs. 75%) and IgM ≥1:640 levels (50% vs. 39%) were associated with cytopenia. In contrast, arthralgia was associated with noncytopenic episodes. In multivariate analyses, older age (odds ratio = 1.063) and fever (odds ratio = 3.127) were associated with cytopenia.
Conclusions:
Brucellosis is commonly presented with cytopenia, especially in bacteremic episodes with fever. However, pancytopenia is uncommon and its finding should alert the physician to look for other possible etiologies.
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