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Childhood brucellosis in Israel
G Gottesman1, D Vanunu, M C Maayan
1Department of Pediatrics, Meir General Hospital, Sapir Medical Center, Kfar Saba, Israel. ggottesman@mailgate.csmc.edu
Background:
Brucellosis has become a major medical problem in Israel particularly in the Muslim Arab population.
Methods:
Eighty-eight children with acute brucellosis are described. Sixty-seven were studied retrospectively during 1987 through 1988, and 21 children were studied prospectively during 1989 through 1992. Epidemiologic, clinical and laboratory features were evaluated, and the outcome of 4 antimicrobial regimens are compared.
Results:
Although the clinical manifestation varied, the classical triad of fever (91%), arthralgia or arthritis (83%) and hepato- and/or splenomegaly (63%) characterized most patients. Sixty-one percent of the children had elevated liver enzymes. Brucella melitensis was isolated from 61% of blood cultures. The relapse rate in patients who were treated with monotherapy (doxycycline) was 43% compared with 14% with regimens of combined therapy with rifampin and doxycycline, streptomycin and doxycycline or rifampin and trimethoprim-sulfamethoxazole (P < 0.049). Eleven children (33%) who were treated for 3 weeks had relapse compared with 1 patient (3.5%) treated for 4 weeks or longer. The total relapse or reinfection rate was 20%. All patients with relapse recovered after a second course of antibiotic therapy. During the 2 years of follow-up one child progressed to chronic osteomyelitis.
Conclusions:
Combination therapy and extending treatment for 4 weeks or longer gave significantly better results than monotherapy or shorter courses of therapy and resulted in fewer relapses.
Insights
Combination antibiotic therapy and extended treatment duration significantly reduce brucellosis relapse rates in children. Longer treatment courses (4+ weeks) are more effective than shorter ones, improving outcomes for pediatric brucellosis patients.
Area of Science:
- Pediatric infectious diseases
- Bacterial zoonoses
- Antimicrobial therapy
Background:
- Brucellosis is a significant public health concern in Israel, particularly affecting the Muslim Arab population.
- The study focuses on acute brucellosis in children, a vulnerable demographic.
Purpose of the Study:
- To evaluate the epidemiologic, clinical, and laboratory features of acute brucellosis in children.
- To compare the efficacy of four different antimicrobial regimens in treating pediatric brucellosis.
- To identify factors influencing relapse rates in children treated for brucellosis.
Main Methods:
- Retrospective and prospective study of 88 children diagnosed with acute brucellosis between 1987 and 1992.
- Analysis of epidemiological data, clinical symptoms, and laboratory findings.
- Comparison of treatment outcomes for four distinct antimicrobial therapy regimens.
Main Results:
- The classical triad of fever, arthralgia/arthritis, and hepatosplenomegaly characterized most cases.
- Brucella melitensis was isolated in 61% of blood cultures; elevated liver enzymes were observed in 61% of children.
- Combination therapy and treatment durations of 4 weeks or longer significantly reduced relapse rates compared to monotherapy or shorter courses (14% vs. 43% relapse).
Conclusions:
- Combination antibiotic therapy is superior to monotherapy for treating pediatric brucellosis.
- Extended treatment duration (4 weeks or longer) significantly lowers the risk of relapse.
- Effective treatment strategies are crucial to prevent complications such as chronic osteomyelitis.