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Clinical, Microbiological, and Hematological Characteristics of Pediatric Brucellosis in Saudi Arabia: A
Nawaf R R Alshammari1, Fahaad S Alenazi2,3, Mohd Saleem4
1Department of Pediatrics, College of Medicine, University of Ha'il, Ha'il 81422, Saudi Arabia.
Insights
Pediatric brucellosis in Saudi Arabia often presents with nonspecific symptoms. Hematological abnormalities like anemia and leukopenia can aid in early diagnosis, especially in resource-limited endemic areas.
Area of Science:
- Pediatric infectious diseases
- Zoonotic disease epidemiology
- Hematology in pediatrics
Background:
- Brucellosis is a significant zoonotic disease in Saudi Arabia, posing a particular risk to children.
- Nonspecific symptoms are common in pediatric brucellosis, making diagnosis challenging.
- Hematological abnormalities are underrecognized diagnostic indicators in pediatric brucellosis.
Purpose of the Study:
- To evaluate demographic, clinical, microbiological, treatment, and hematological characteristics of pediatric brucellosis in Hail, Saudi Arabia.
- To assess the diagnostic value of hematological parameters in pediatric brucellosis.
- To identify key indicators for early clinical suspicion in endemic settings.
Main Methods:
- Retrospective observational study of pediatric patients (≤15 years) diagnosed with brucellosis (2014-2025).
- Analysis of demographic, clinical, laboratory, microbiological, and treatment data.
- Comparison of hematological parameters between culture-confirmed and non-culture-confirmed cases using multivariate and ROC analyses.
Main Results:
- 38 pediatric patients included; Brucella melitensis was the predominant species.
- Fever and bone/joint pain were the most frequent symptoms.
- Culture-confirmed cases showed significantly lower hemoglobin, white blood cell, and absolute neutrophil counts; ROC analysis indicated fair diagnostic performance for these parameters.
Conclusions:
- Pediatric brucellosis is frequently associated with anemia, leukopenia, and neutropenia.
- No single hematological parameter is independently predictive, but combined abnormalities support early clinical suspicion.
- Hematological parameters are valuable diagnostic clues, especially in resource-limited endemic areas.
Abstract:
Background and Objectives: Brucellosis remains a significant zoonotic disease in endemic regions such as Saudi Arabia, with children being particularly vulnerable. Pediatric brucellosis often presents with nonspecific symptoms, and hematological abnormalities can serve as important yet underrecognized diagnostic clues. This study aimed to evaluate the demographic, clinical, microbiological, treatment, and hematological characteristics of patients with pediatric brucellosis in the Hail region of Saudi Arabia and to assess the diagnostic value of hematological parameters. Methods: This retrospective observational study included children aged ≤15 years who were diagnosed with brucellosis at a tertiary care hospital in Hail between 2014 and 2025. Demographic, clinical, laboratory, microbiological, and treatment data were analyzed. Hematological parameters were compared between culture-confirmed and non-culture-confirmed brucellosis cases using multivariate and receiver operating characteristic (ROC) analyses. Results: A total of 38 pediatric patients were included (mean age 8.6 years; 57.9% male). Positive culture results were observed in 42.1% of the cases, with Brucella melitensis being the predominant species (68.75%). Fever (89.5%) and bone/joint pain (71.1%) were the most frequent symptoms. Culture-confirmed brucellosis patients had significantly lower hemoglobin levels (10.8 vs. 12.1 g/dL; p = 0.020), white blood cell counts (p = 0.046), and absolute neutrophil counts (p = 0.037). ROC analysis revealed a fair diagnostic performance for hemoglobin (AUROC = 0.695), WBC (0.699), and ANC (0.680). Leukopenia demonstrated high specificity (95.5%) and positive predictive value. Conclusions: Pediatric brucellosis is commonly associated with anemia, leukopenia, and neutropenia. Although no single hematological parameter independently predicts infection, the combination of these abnormalities may support early clinical suspicion, particularly in resource-limited endemic settings.
