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 ≤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 nonspecific 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 cotrimoxazole 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.