Brucellosis in children: clinical observations in 115 cases.

OBJECTIVE

Brucellosis is endemic in Saudi Arabia. This report summarizes the epidemiology of brucellosis in children.

METHOD: A retrospective review was made of medical records of all patients admitted to King Fahad National Guard Hospital with brucellosis during the period from 1984 to 1995.

RESULTS

Children < or =12 years constituted 115/545 (21%) of the total brucellosis admissions. The mean age was 5.8 years and 64% of the patients were males. Consumption of unpasteurized milk (often from camel) was the main source of infection. In 70% the clinical picture was dominated by arthritis, 20% of patients presented with a non-specific febrile illness without localizing signs, and 10% had a febrile illness with uncommon presentations. Brucella serology was most helpful in making an early diagnosis. Initial titers of >1:640 were found in 90% of the cases. Bacteremia was observed in 45% and of the isolates speciated, 96% were Brucella melitensis. No increase in resistance to commonly used antimicrobials was noted during the 12-year study period. A combination of rifampin plus co-trimoxazole with or without streptomycin was used in two thirds of the patients. The overall rate of relapse was 9% and one patient died from neurobrucellosis.

CONCLUSION

Brucellosis presents in various ways and should be included in the differential diagnosis of arthritis in endemic countries. Prevention should rely on education including on boiling raw milk.