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Clinical Differences Between Culture-positive and Culture-negative Brucellosis in Childhood: A Single-center
Mehtap Akça1, Berfin Özgökçe Özmen2, Güldane Dikme3
1From the Division of Pediatric Infectious Diseases, Department of Pediatrics, Toros State Hospital.
Insights
Brucellosis is a significant public health issue in Turkey, affecting children through foodborne transmission. This study analyzed 181 pediatric cases, highlighting common symptoms, complications like bone and joint involvement, and treatment outcomes.
Area of Science:
- Infectious Diseases
- Pediatrics
- Public Health
Background:
- Brucellosis is a prevalent zoonotic disease posing a global public health challenge.
- Pediatric brucellosis case series are limited, necessitating further research.
Purpose of the Study:
- To analyze pediatric brucellosis cases diagnosed at a Turkish clinic.
- To contribute to the medical literature on pediatric brucellosis.
Main Methods:
- Retrospective evaluation of 181 pediatric brucellosis cases (2013-2023).
- Data collected included demographics, epidemiology, clinical signs, lab results, and treatment outcomes.
- Diagnosis confirmed via clinical assessment, microbiologic cultures, and serologic testing (Coombs anti-Brucella agglutination test).
Main Results:
- The study included 181 patients (54.1% male), with a mean age of 10.5 years.
- Risk factors included rural living (48.1%), animal contact (42.2%), unpasteurized dairy consumption (64.1%), and family history (34.3%).
- Acute brucellosis was diagnosed in 92.3% of cases; bone/joint involvement (22.1%) was the most common complication. Brucella spp. were detected in 24.3% of blood cultures.
Conclusions:
- Brucellosis remains a significant public health concern in Turkey, affecting children via foodborne transmission.
- Pediatric brucellosis cases exhibit distinct epidemiological and clinical features requiring tailored management strategies.
Objective:
Brucellosis is a zoonotic infectious disease that is widely prevalent and remains a major public health concern worldwide. Although endemic in our country, there are limited pediatric case series concerning this disease. This study aims to analyze pediatric cases of brucellosis diagnosed in our clinic and to provide a contribution to the current body of medical literature.
Methods:
This study included 181 cases diagnosed with brucellosis who were followed up in the Pediatric Infectious Disease Department of Mersin University Faculty of Medicine between January 1, 2013, and July 1, 2023, in Turkey. The cases were retrospectively evaluated based on their demographic and epidemiologic characteristics, clinical symptoms, physical examination findings, laboratory and microbiologic results, complications and treatment responses from medical records. Brucellosis was diagnosed in patients through an integrated assessment of clinical manifestations, microbiologic culture results and serologic testing (Coombs anti-Brucella agglutination test).
Results:
In this study, a total of 181 patients were included, of which 98 (54.1%) were male and 83 (45.9%) were female. The mean age of the patients was 10.52 ± 4.23 years, ranging from 1 to 17 years. Living in rural areas was identified in 48.1% of the cases, while 42.2% had contact with animals, 64.1% consumed unpasteurized milk/dairy products and 34.3% had a family history of brucellosis. Of the patients, 92.3% were diagnosed with acute brucellosis and 7.7% were diagnosed with subacute brucellosis. Standard tube agglutination at a titer of 1/160 or higher was observed in 71.8% of the cases. Brucella spp. growth was detected in 24.3% of blood cultures and 0.56% of bone marrow cultures, while no growth was observed in cerebrospinal fluid cultures. Patients with bacteremia exhibited significantly higher rates of fever, night sweats, abdominal pain, lymphadenopathy, positive standard tube agglutination test results and disease relapse. When evaluating brucellosis-related complications, bone and joint involvement was the most common, observed in 22.1% (n = 40) of the patients, followed by neurobrucellosis in 2 patients and pleuritis in 1 patient. All patients were treated with a combined regimen. Relapse was observed in 4 patients, while no mortality was reported.
Conclusions:
Brucellosis remains a major public health concern in Turkey. While brucellosis is frequently observed in adults engaged in livestock farming, children are also at risk due to the possibility of foodborne transmission.
