Pediatric brucellosis: predictors of hospitalization, complications, and relapse in a nationwide multicenter cohort
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Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
Aylin Irmak Kuruc1, Kubra Aykac1, Ozlem Cakici2
1Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Insights
Pediatric brucellosis in Türkiye typically has a favorable outcome with low complication and relapse rates. Early detection via household contact screening and treatment adherence are crucial for managing this zoonotic disease in children.
Area of Science:
- * Infectious Diseases
- * Pediatric Medicine
- * Public Health
Background:
- * Brucellosis is a significant zoonotic disease globally, but comprehensive pediatric data, especially from highly endemic regions, remain limited.
- * Understanding risk factors for complications, relapse, and hospitalization is essential for effective pediatric brucellosis management.
- * Previous studies highlight the importance of early detection and treatment adherence for favorable outcomes in brucellosis.
Purpose of the Study:
- * To characterize pediatric brucellosis in Türkiye, a country with high endemicity.
- * To identify independent risk factors associated with complications, relapse, and hospitalization in children diagnosed with brucellosis.
- * To contribute large-scale pediatric data to the global understanding of brucellosis.
Main Methods:
- * A retrospective nationwide multicenter cohort study involving 1052 children (0-18 years) with confirmed brucellosis.
- * Data collected from 32 hospitals in Türkiye between January 2019 and June 2024.
- * Statistical analysis employed multiple backward logistic regressions, with Firth penalization for complication and relapse models.
Main Results:
- * The cohort included 1052 children; 8.3% experienced complications (primarily osteoarticular), and 3.2% relapsed.
- * Complications were linked to headache, arthralgia/arthritis, culture positivity, night sweating, and myalgia.
- * Relapse was associated with female sex, while treatment compliance was protective. Hospitalization was linked to various symptoms and lab findings, with household contact screening being protective.
Conclusions:
- * Pediatric brucellosis in Türkiye generally presents a favorable clinical course with low rates of complications and relapse.
- * Musculoskeletal and constitutional symptoms at presentation can predict complicated disease, emphasizing the need for vigilant clinical assessment.
- * Treatment adherence is the primary determinant of relapse, and early detection through household contact screening can reduce the overall disease burden.
Abstract:
Brucellosis is a common zoonosis worldwide, yet large-scale pediatric data are scarce. This nationwide multicenter study from Türkiye, a highly endemic country, aimed to characterize pediatric brucellosis and identify independent risk factors for complications, relapse, and hospitalization. A retrospective cohort was conducted across 32 hospitals between January 2019 and June 2024. Children aged 0-18 years with confirmed brucellosis were included. Data were analyzed by multiple backward logistic regressions, with Firth penalization for the complication and relapse models. A total of 1052 children were included (median age 12 years; 69.9% male). Complications occurred in 87 patients (8.3%), most frequently osteoarticular (spondylitis, sacroiliitis, and osteomyelitis), whereas neurobrucellosis was rare (0.9%); relapse occurred in 34 patients (3.2%). Complications were independently associated with headache (adjusted OR 3.566, 95% CI 1.861-6.637), arthralgia/arthritis, culture positivity, night sweating, and myalgia. Relapse was independently associated with female sex (adjusted OR 3.675, 95% CI 1.617-8.568), whereas treatment compliance was protective (adjusted OR 0.254, 95% CI 0.092-0.857). Hospitalization (34.1%) was independently associated with headache, diarrhea, hepatomegaly, lymphadenopathy, fever, elevated CRP, and lower hemoglobin, whereas diagnosis through household contact screening was protective. Conclusion: Pediatric brucellosis in Türkiye generally follows a favorable course, with low complication and relapse rates. Readily identifiable musculoskeletal and constitutional symptoms at presentation may help predict complicated disease, while treatment adherence remains the key determinant of relapse. Early detection through household contact screening may reduce disease burden in endemic regions. What is Known: • Brucellosis is a common zoonosis with limited pediatric data worldwide. Early detection and treatment adherence are critical for favorable outcomes. • Complications and relapse are recognized but poorly defined in children What is New: • This is one of the largest nationwide pediatric brucellosis cohorts reported to date, including 1052 children. Household contact screening shown protective against hospitalization. • Treatment adherence, rather than disease severity or complications, was the key determinant of relapse in pediatric brucellosis.