Professional paper

Epidemiological and clinical features of brucellosis in children

Svjetlana Grgić ; Klinika za infektivne bolesti, Klinička bolnica Mostar, Mostar, Bosna i Hercegovina
Jadranka Nikolić ; Klinika za infektivne bolesti, Klinička bolnica Mostar, Mostar, Bosna i Hercegovina
Mira Bradarić ; Dom zdravlja Mostar, Mostar, Bosna i
Siniša Skočibušić ; Klinika za infektivne bolesti, Klinička bolnica Mostar, Mostar, Bosna i Hercegovina

Abstract

Aim: Because of its socio-medical characteristics, brucellosis plays a significant role in the morbidity structure of Mediterranean countries, including Bosnia and Herzegovina. Brucellosis has a wide spectrum of clinical manifestations and can lead to a number of complications with severe sequelae. The purpose of this study was to analyze the clinical and epidemiological features and therapeutic approach in children treated for brucellosis at the Clinic for Infectious Diseases Mostar.
Patients and methods: We conducted a retrospective analysis of clinical and epidemiological parameters collected from medical records of patients younger than 18 years of age treated for brucellosis at the Clinic for Infectious Diseases Mostar in the period 2005–2011.
Results: Over the study period, a total of 60 patients with brucellosis were treated, of whom nine (15%) were children. The children mostly came from the rural areas with positive epidemiological history (records of direct contact with sick animals, sick family member and/or consumption of dairy products from households with confirmed cases of brucellosis). Brucellosis was confirmed by serology in all affected children, while only one child had positive blood culture and this isolate of Brucella melitensis was resistant to trimethoprim-sulfamethoxazole (TMP-SMZ). Most frequent clinical manifestations were fever, night sweats, general weakness, fatigue and loss of appetite, and laboratory findings of leukopenia and lymphocytosis. Osteoarticular form of brucellosis was recorded in 7/9 children, usually monoarthritis while respiratory, genitourinary, skin, ocular and neurological forms of the disease were not recorded. The average duration of brucellosis treatment in affected children was 8.5 weeks. During hospitalization all patients received a combination of gentamicin and rifampin, while after discharge from hospital children younger than eight years continued to take oral combination of rifampin and azithromycin or cefixime, and children older than eight years a combination of rifampin and doxycycline. Cure was achieved in all children.
Conclusion: In Bosnia and Herzegovina brucellosis in children is rare, but it is not an insignificant disease. Therefore, all physicians working in endemic areas should consider brucellosis in the differential diagnosis in children with prolonged fever, arthralgias and leukopenia if coming from rural areas. Therapeutic approach in the pediatric population provides various possibilities for combining antimicrobials, however TMPSMZ does not seem like a prudent choice for empirical treatment considering Brucella resistance to TMP-SMZ in our patients.

Keywords

Brucellosis; children; treatment

Hrčak ID:

105107

URI

https://hrcak.srce.hr/105107

Publication date:

30.12.2012.

Article data in other languages: croatian

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