Background: Data on the various aspects of brucellosis in children living in southern Israel are missing.
Objectives: To study the epidemiological, microbiological, diagnostic, clinical, therapeutic and outcome features of brucellosis in children
Patients and Methods: The study population included all patients hospitalized with a diagnosis of brucellosis. The diagnosis was established according to a clinical presentation compatible with brucellosis + presence of Brucella bacteremia (BB).
Results: Of 252 episodes identified, 128 (50.8%) had positive blood cultures and B. melitensis grew in all cultures. Overall duration of symptoms before diagnosis was 10.1±10.9 days. Fever at diagnosis was recorded in <20% of the patients. The most frequent symptoms were arthralgia, weakness, gastrointestinal disturbances, myalgia and headache (61.7%, 32, 8%, 27.3%, 25.0% and 18.8%, respectively). The main clinical findings recorded included monoarthritis, hepatosplenomegaly, lymphadenopathy, heart murmur and skin rash (36.7%, 25%, 17.2%, 11.7 and 9.4%, respectively). Anemia, leukopenia, thrombocytopenia and pancytopenia were reported in 17,6%, 29.6%, 12.8 and 2.3% of the patients. Twenty-nine (30.5%) patients with BB had serum agglutinin titers ≤1/160 (13, 13.7%%, had titers<1/160). Twenty-seven (93%) of the 29 patients aged 0-4 years were treated with gentamicin and trimethoprim-sulfamethoxazole and a total of 77 (60.2%) patients received gentamicin and doxycycline.
Conclusions: Childhood brucellosis remains an important public health problem in southern Israel. BB was diagnosed in >50% of the children with brucellosis, B. melitensis was identified in all diagnosed cases and all patients were of Moslem Bedouin ethnicity. Arthralgia, weakness and gastrointestinal complaints were the most commonly reported symptoms and monoarthritis, hepatosplenomegaly and lymphadenopathy were the most common clinical findings. A considerable number of patients with BB had undetectable/low serum agglutinin titers, suggesting insufficient reliability on serology alone in the diagnosis of brucellosis.
