Human Brucellosis among children and adults in northern Israel, twenty-year follow-up

Introduction: Brucellosis in Israel is reported from all over the country, matching the Arabs living places. Most clinical data on brucellosis in Israel came from the South.

Objective: To characterize patients with brucellosis from a large hospital in the North and to evaluate predicting factors for unfavorable clinical outcome including children and adults.

Methods: A retrospective cohort study was conducted at Rambam Health Care Campus between 2000 to 2019. Data of patients with confirmed (positive cultures) or presumed (serology or molecular test for Brucella spp.) brucellosis were retrieved from patients’ medical records. Predicting factors for clinical failure defined as emergence of new complications, relapse or 3-months mortality and comparison between children and adults with HB were evaluated.

Results: We identified 242 patients with brucellosis. 27(11%) patients had clinical failure. Adults comprised 173(71.5%) of patients. 199(82.2%) had bacteremia of Brucella spp.. Vertebral osteomyelitis was the most common complication among adults 25(14.5%), while septic arthritis among children 12(17.4%). Shorter duration of fever until start of treatment and treatment regimens other than doxycycline-gentamicin were associated with higher rates of clinical failure (OR 0.865[0.083-0.834] and 0.263[0.794-0.942], respectively). Arthritis, limping, and lymphadenopathy were reported at higher rates among pediatric patients (p 0.015, <0.001, 0.044 respectively). While back pain, night sweats, chills, weight loss, respiratory and gastrointestinal symptoms among adults (<0.001, <0.001, 0.002, 0.03 and 0.008 respectively).

Conclusion: Patients presenting with fever of short duration should be followed closely for clinical response. Clinical manifestations differ among children and adults. However, clinical response to treatment is similar.