Childhood pneumonia due to brucellosis: A case report
Songsong Xie1,2, Yan Zhou1, Rongjiong Zheng1
1Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi.
Insights
Childhood brucellosis can mimic other illnesses, complicating diagnosis. Early identification and prompt treatment with a specific antibiotic regimen are crucial for successful outcomes in pediatric pulmonary brucellosis.
Area of Science:
- Pediatric infectious diseases
- Rare pediatric complications
- Bacterial pneumonia mimicry
Background:
- Childhood brucellosis presents a significant public health challenge, often mimicking other conditions and leading to misdiagnosis.
- Pulmonary involvement is an infrequent but serious complication of brucellosis in children.
- Prompt diagnosis and appropriate treatment are vital for managing pediatric brucellosis.
Observation:
- A 23-month-old child presented with prolonged fever and cough, initially diagnosed as pneumonia.
- Conventional antibiotic therapy proved ineffective, necessitating further investigation.
- Brucella melitensis was identified on the second blood culture after initial negative results.
Findings:
- The child received a 6-week course of rifampin and trimethoprim-sulfamethoxazole.
- Treatment resulted in complete recovery without complications.
- A one-year follow-up confirmed the child remained asymptomatic.
Implications:
- Non-specific clinical and radiological findings in pediatric pulmonary brucellosis can delay diagnosis.
- The second blood culture is critical for identifying Brucella species.
- In endemic regions, consider pulmonary brucellosis in children presenting with fever and cough, even with initial pneumonia diagnosis.
Rationale:
Childhood brucellosis is a significant community health problem. It may imitate other conditions and may be misdiagnosed. Pulmonary involvement is a rare complication of childhood brucellosis.
Patient Concerns:
A 23-month-old child was referred to our hospital with a 3-week history of fevers and cough. He was initially diagnosed with pneumonia.
Diagnoses And Interventions:
Conventional antibiotic treatment was ineffectual. Total leukocyte count was 10,300/mm, hemoglobin was 8.5 g/dL, and platelet count was 250,000/mm. The erythrocyte sedimentation rate and procaicltonin were 25 mm/h and 0.12 ng/mL, respectively. Chest radiography showed pneumonic infiltrate in both lungs.The initial bacteriologic test results were negative. Ten days after admission, Brucella melitensis were isolated from the second blood culture. This child was cured with the 2-drug regimen (rifampin+trimethopicin-sulfamethoxazole) for 6 weeks.
Outcomes:
The child recovered well with no occurrence of complications. The child remained asmptomatic without any signs or symptoms at a follow-up of 1 year.
Lessons:
Non-specific findings of pulmonary brucellosis in children often make diagnosis difficult. The second blood culture is essential. In endemic areas, children with fevers and cough should be included in the diagnosis in cases of pulmonary brucellosis.
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