Elevated risk of osteoarticular complications in children with acute Brucella melitensis infection

Infection with brucella microorganisms is considered uncommon in the paediatric age group. We report nine paediatric patients between the ages of 8 to 17 years with acute Brucella melitensis infection, who presented with spiking fever, night sweats, anorexia and malaise for 5 to 60 days prior to diagnosis. Four patients developed various osteoarticular complications: migratory arthralgia, hydroarthrosis of the knees, arthritis and osteomyelitis. Therapy with tetracyclines alone or in combination with streptomycin resulted in complete recovery in eight children. This combination failed in one patient who developed severe osteoarticular disease successfully responding to rifampicin. Since infection of bone and joints leads to irreversible damage, early recognition and immediate management are crucial for recovery. Rifampicin might be of benefit in children with severe osteoarticular complications when the traditional anti-brucella regimen fails.