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Abstract:
Brucellosis has always been an unusual disease in children and, concomitant with the control of the disease in domestic animals, reports have become sparse. The pediatrician, therefore, may not be aware of the protean clinical manifestations of childhood brucellosis. In 1973, nine cases occurred during a three-month period in El Paso, Texas. All cases were marked by spiking fevers and lethargy of four days to four weeks in duration. Tender hepatomegaly or splenomegaly was striking in seven patients. Other characteristics included epistaxis, arthralgia, myalgia, and weight loss. Leukopenia and leukemoid reaction were found in five patients. All of the patients tested had elevated liver enzymes. Febrile agglutinins were invaluable in screening for an early clue to diagnosis. When Brucella abortus antigen agglutinated serum from patients with a positive screen in dilutions greater than 1:320, a presumptive diagnosis of brucellosis was made. Brucella was isolated from the blood or bone marrow in seven patients and the time of incubation proved crucial for successful recovery. Bacterial blood cultures are usually discarded at ten days of age, as were cultures from the only two patients from whom the organism was not recovered. All of the cultures incubated for 12 to 15 days grew B. melitensis, an unusual causative species in the United States. However, several patients admitted eating cheese from the State of Chihuahua, Mexico, made from unpasteurized goat's milk, the presumed source of the infection. Within one to three days, all patients responded dramatically to antibiotics; tetracycline was given orally for 21 days and streptomycin intramuscularly for 14 days. Pediatricians caring for patients in areas where consumption of unpasteurized milk products is likely would do well to consider brucellosis in a child with obscure fever or toxic hepatosplenomegaly.
Insights
Brucellosis is an uncommon childhood illness. Pediatricians should consider brucellosis in children with unexplained fever or enlarged liver/spleen, especially after consuming unpasteurized dairy products.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Brucellosis is rare in children, with decreasing reports due to animal disease control.
- Pediatricians may be unfamiliar with the diverse clinical presentations of childhood brucellosis.
- A cluster of nine pediatric cases in El Paso, Texas, highlighted the disease's protean manifestations.
Purpose of the Study:
- To describe the clinical features, diagnosis, and treatment of a brucellosis outbreak in children.
- To emphasize the importance of considering brucellosis in pediatric patients with obscure fever and hepatosplenomegaly.
Main Methods:
- Retrospective review of nine pediatric brucellosis cases.
- Clinical data collection including symptoms, physical findings, laboratory results, and diagnostic methods.
- Microbiological investigation, including blood and bone marrow cultures.
- Treatment efficacy assessment based on clinical response to antibiotics.
Main Results:
- Cases presented with spiking fevers, lethargy, tender hepatosplenomegaly, epistaxis, arthralgia, myalgia, and weight loss.
- Laboratory findings included leukopenia or leukemoid reaction and elevated liver enzymes.
- Febrile agglutinins were crucial for diagnosis; Brucella was isolated from seven patients.
- Unusual isolation of Brucella melitensis, linked to consumption of unpasteurized goat's milk cheese from Mexico.
- All patients showed rapid improvement with a combination of oral tetracycline and intramuscular streptomycin.
Conclusions:
- Brucellosis presents with varied symptoms in children, including fever and hepatosplenomegaly.
- Prompt diagnosis relies on clinical suspicion, serological tests (febrile agglutinins), and prolonged blood/bone marrow cultures.
- Consumption of unpasteurized dairy products is a significant risk factor, necessitating pediatrician awareness in endemic or risk areas.