J Pediatr Infect Dis 2023; 18(03): 139-144
DOI: 10.1055/s-0043-1764205
Original Article

Predicting Factors of Brucella melitensis Bacteremia in Children Admitted with Brucellosis

1   Department of Pediatric Infectious Diseases, Sanliurfa Education and Research Hospital, Sanliurfa, Türkiye
,
2   Sanliurfa Provincial Health Directorate, Turkish Ministry of Health, Sanliurfa, Türkiye
,
3   Department of Pediatrics, Sanliurfa Education and Research Hospital, Sanliurfa, Türkiye
,
4   Department of Pediatrics, Faculty of Medicine, Harran University, Sanliurfa, Türkiye
› Author Affiliations

Abstract

Objective Brucellosis is the most common zoonotic disease. Isolation of Brucella melitensis in blood culture is accepted as the gold standard for diagnosis. This study aims to determine the predictive factors of B. melitensis bacteremia in pediatric patients followed up with brucellosis.

Methods Two-hundred twenty pediatric brucellosis patients were included in the study. The epidemiological, clinical, and laboratory data were recorded.

Results The patients comprised 63.2% males and 36.8% females with a mean age of 10.45 ±  4.36 years (range, 1–18 years), and 70.5% were younger than 14 years old. B. melitensis was isolated in the blood culture in 33.6% of patients. In the epidemiological history of pediatric patients with bacteremic brucellosis, there was a history of dealing with, owning, or working with livestock. In patients with brucellosis, fever and weight loss, hepatomegaly, and arthritis were more common in patients with bacteremia than in those without bacteremia. Among laboratory findings, leukopenia, low albumin value, and high C-reactive protein were calculated as predictors of Brucella bacteremia in patients with brucellosis.

Conclusion In regions where brucellosis is endemic, serum agglutination tests may be positive without clinical findings. Brucellosis can mimic many other diseases, so the definitive diagnosis is demonstrated by bacteremia. Blood cultures should be taken in patients with predictive factors suggestive of brucellosis.



Publication History

Received: 30 August 2022

Accepted: 26 January 2023

Article published online:
16 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Republic of Türkiye, Ministry of Health, Brucellosis statistical data for 2008–2017.. Accessed February 14, 2023 at: https://hsgm.saglik.gov.tr/tr/zoonotikvektorel-bruselloz/istatistik
  • 2 Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis 2006; 6 (02) 91-99
  • 3 Young EJ. . Brucellosis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 8th ed, Philadelphia: Elsevier; 2019:1156–1159
  • 4 Redbook American Academy of Pediatrics. . Brucellosis. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021:238–240
  • 5 Downes KJ. . Brucella. In: Kliegman RM, St Geme III JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2020:1536–1538
  • 6 Apa H, Devrim I, Memur S. et al. Factors affecting Brucella spp. blood cultures positivity in children. Vector Borne Zoonotic Dis 2013; 13 (03) 176-180
  • 7 Çiftdoğan DY, Aslan S. Unrecognized pediatric and adult family members of children with acute brucellosis. Braz J Infect Dis 2017; 21 (05) 520-524
  • 8 Gul HC, Erdem H. . Brucellosis (Brucella species). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia: Elsevier; 2020;2753–2758
  • 9 Mantur BG, Mulimani MS, Bidari LH, Akki AS, Tikare NV. Bacteremia is as unpredictable as clinical manifestations in human brucellosis. Int J Infect Dis 2008; 12 (03) 303-307
  • 10 Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med 2005; 352 (22) 2325-2336
  • 11 Yagupsky P. Detection of Brucellae in blood cultures. J Clin Microbiol 1999; 37 (11) 3437-3442
  • 12 Gottesman G, Vanunu D, Maayan MC. et al. Childhood brucellosis in Israel. Pediatr Infect Dis J 1996; 15 (07) 610-615
  • 13 Shaalan MA, Memish ZA, Mahmoud SA. et al. Brucellosis in children: clinical observations in 115 cases. Int J Infect Dis 2002; 6 (03) 182-186
  • 14 Memish Z, Mah MW, Al Mahmoud S, Al Shaalan M, Khan MY. Brucella bacteraemia: clinical and laboratory observations in 160 patients. J Infect 2000; 40 (01) 59-63
  • 15 World Health Organization (WHO). . Brucellosis. Accessed February 14, 2023 at: https://www.who.int/news-room/fact-sheets/detail/brucellosis
  • 16 Almuneef MA, Memish ZA, Balkhy HH. et al. Importance of screening household members of acute brucellosis cases in endemic areas. Epidemiol Infect 2004; 132 (03) 533-540
  • 17 Tabak F, Hakko E, Mete B, Ozaras R, Mert A, Ozturk R. Is family screening necessary in brucellosis?. Infection 2008; 36 (06) 575-577
  • 18 Ismayilova R, Mody R, Abdullayev R. et al. Screening of household family members of brucellosis cases and neighboring community members in Azerbaijan. Am J Trop Med Hyg 2013; 88 (05) 929-931
  • 19 Tanir G, Tufekci SB, Tuygun N. Presentation, complications, and treatment outcome of brucellosis in Turkish children. Pediatr Int 2009; 51 (01) 114-119
  • 20 Almuneef M, Memish ZA, Al Shaalan M, Al Banyan E, Al-Alola S, Balkhy HH. Brucella melitensis bacteremia in children: review of 62 cases. J Chemother 2003; 15 (01) 76-80
  • 21 Qie C, Cui J, Liu Y, Li Y, Wu H, Mi Y. Epidemiological and clinical characteristics of bacteremic brucellosis. J Int Med Res 2020; 48 (07) 300060520936829
  • 22 Kadanali A, Ozden K, Altoparlak U, Erturk A, Parlak M. Bacteremic and nonbacteremic brucellosis: clinical and laboratory observations. Infection 2009; 37 (01) 67-69
  • 23 Shi C, Wang L, Lv D. et al. Epidemiological, clinical and laboratory characteristics of patients with brucella ınfection in Anhui province, China. Infect Drug Resist 2021; 14: 2741-2752
  • 24 Ben-Shimol S, Farahvar S, Fruchtman Y, Justman N. Factors associated with single and recurrent bacteremia in childhood brucellosis. J Pediatric Infect Dis Soc 2020; 9 (06) 664-670
  • 25 Copur B, Sayili U. Laboratory and clinical predictors of focal involvement and bacteremia in brucellosis. Eur J Clin Microbiol Infect Dis 2022; 41 (05) 793-801