ABSTRACT
OBJECTIVE: To describe the main epidemiological, clinical, and laboratory features, treatment options and outcome in children with brucellosis. METHODS: Retrospectively evaluated data were obtained from 317 pediatric patients with brucellosis that were treated at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, during the period from 1989 to 2011. The medical records and follow-up protocols were used for evaluation. RESULTS: Childhood brucellosis composed 317 (18.7%) of 1691 patients with brucellosis. The patients were median 9 years old, ranging from 7 months to 14 years, and 201 (63.4%) were males. Family history was present in 197 (62.1%), and direct contact with animals occurred in 140 (44.2%) of the children. The dominant manifestations were fever in 248 (78.2%), joint pain in 228 (71.9%) and hepatomegaly in 216 (68.1%). Organ affection was present in 206 (65.0%) of the patients. One hundred and six (33.4%) of the patients were treated with combination composed of two, and 211 (66.6%) with three antimicrobial agents. Relapses were registered in 21 (6.6%), and therapeutic failures in 3 (0.9%) of the children. CONCLUSIONS: In endemic regions childhood brucellosis represents a significant part of human cases. Wide spectrum of clinical manifestations, frequent affection of various organ systems and possibility of relapses show that brucellosis could be a serious disease in this age group. The presence of fever, joint pain, sweating, and affection of various systems in children from endemic regions should alert pediatricians for the possibility of brucellosis.
ABSTRACT
AIM: To describe the frequency, types, clinical characteristics, diagnostic tools, and outcome of osteoarticular brucellosis. METHODS: The study was carried out at the Hospital for Infectious Diseases in Skopje between January 1998 and December 2002. Three hundred and thirty one consecutive patients with brucellosis were enrolled and prospectively assessed according to a previously designed protocol. Brucellosis was diagnosed on the basis of clinical signs, and confirmed by the detection of specific antibodies at significant titers. RESULTS: One hundred and ninety six (59.2%) patients had osteoarticular involvement. Peripheral arthritis was found in 119 (60.7%) patients, followed by sacroiliitis in 60 (30.6%) and spondylitis in 56 (28.6%) of them. In 86 (43.9%) patients, osteoarticular changes were localized in two or more sites. The patients with osteoarticular brucellosis showed more prolonged illness prior to diagnosis and higher erythrocyte sedimentation rate, compared to those without osteoarticular localization. There were no other significant demographic, epidemiological, clinical, and laboratory differences between the two groups. Relapses occurred in 28 (17.5%) and therapeutic failure in 25 (12.8%) patients, 24 of them with spondylitis. CONCLUSIONS: Osteoarticular brucellosis was a common form of focal brucellosis and the most unfavorable outcome was seen in patients with spondylitis.
