Diagnostic and therapeutic challenges of childhood brucellosis in a nonendemic country

Pediatrics. 2008 May;121(5):e1178-83. doi: 10.1542/peds.2007-1874.

Abstract

Objective: We sought [corrected] to define the current epidemiology, clinical manifestations, and course of childhood brucellosis in the United States.

Methods: A retrospective chart review was performed of 20 patients who received a diagnosis of brucellosis over a period of 13 years at a large, tertiary care children's hospital in Dallas, Texas. Diagnostic criteria, epidemiology, clinical presentations, and outcomes were recorded.

Results: Ninety-five percent of the patients had a recent history of either travel to Mexico or ingestion of unpasteurized milk products from Mexico. Fever was an initial complaint in 80% of the patients, and 50% of the patients presented with arthritis. Diagnosis was made via the identification of Brucella melitensis in the blood cultures of 18 patients. Five patients experienced relapse, and 3 experienced treatment failure.

Conclusions: Childhood brucellosis in the United States is now an imported disease, primarily from Mexico. In the context of this epidemiologic link, the diagnosis should be entertained for a patient who presents with signs of systemic inflammation and arthritis. Therapeutic challenges remain.

MeSH terms

  • Adolescent
  • Animals
  • Brucella melitensis / isolation & purification
  • Brucellosis / diagnosis*
  • Brucellosis / drug therapy
  • Brucellosis / epidemiology*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Mexican Americans
  • Mexico
  • Milk / microbiology
  • Recurrence
  • Texas / epidemiology
  • Travel