Bir Merkeze Başvuran Çocukluk Çağı Brusellozu Tanısı Konulan Hastaların Demografik, Hematolojik ve Laboratuvar Bulgularının İncelenmesi
Abstract
Enfekte hayvanlardan ve ürünlerinden insanlara bulaşan bruselloz, ülkemizde ve tüm dünyada halen yaygın olarak görülen zoonotik bir enfeksiyondur. Çalışmamızda tek merkeze başvuran pediatrik bruselloz vakalarının demografik özellikleri, hematolojik ve laboratuvar anormalliklerinin değerlendirilmesi amaçlanmıştır. Bu çalışmada Haziran 2020 ile Haziran 2021 tarihleri arasında bruselloz nedeni ile takip edilen 47 çocuk hasta retrospektif olarak incelenmiştir. Çalışmamızdaki 47 hastanın 23 (%48.9)’ü erkek, 24 (%51.1)’ü kızdı ve yaş ortalaması 9.96 ± 4.26 (1.3-17.5 yaş) idi. Hastaların %48.9’u kırsalda yaşıyordu, 37 (%78.7)’sinde çiğ süt veya süt ürünü tüketim öyküsü vardı. Hastaların %44.7’sinde ise hanede benzer hastalık öyküsü mevcuttu. Başvuru şikayetlerine bakıldığında; en sık başvuru şikayetleri ateş, kas-eklem ağrısı ve halsizlikti. Kas ve eklem ağrısı olan 20 hastadan (%42.6) beş tanesinin artriti vardı (%10.6), en sık tutulan eklem dizdi (%6.4). En sık saptanan fizik muayene bulgusu ateş idi (%12.8). Hastaların %57.4‘ünde en az bir seride hematolojik tutulum gözlendi. En yaygın hematolojik bulgu anemiydi (%46.8). Dörder hastada trombositopeni ve lökopeni tespit edildi (%8.5). Hastaların üçünde bisitopeni (%6.4), birisinde ise pansitopeni gözlendi (%2.1). Brucella aglütinasyon testleri olguların tamamında pozitifti. Kan kültürü pozitiflik oranı %12.8 idi. Hastaların %21.3’ü hastaneye yatırılarak takip edildi. Tüm hastalara kombine tedavi verildi. Tedavi ilişkili yan etki gözlenmedi. Bir hastada relaps görülürken, mortalite saptanmadı. Bruselloz, klinik bulgularının özgül olmaması, komplikasyonlarının fazla olması ve geniş kitleleri etkileyebilmesi nedeniyle halen ülkemizde önemli bir sağlık sorunu olmaya devam etmektedir. Hematolojik bulgularda bozulma da görülebilmesi nedeniyle endemik bölgede yaşayan hastalarda sitopeninin ayırıcı tanısında bruselloz mutlaka akılda tutulmalıdır.
Keywords
Supporting Institution
Yok
Project Number
Yok
Thanks
Bu çalışma Sağlık Bilimleri Üniversitesi SBÜ Adana Şehir ve Eğitim Araştırma Hastanesi'nde yapılmış olup, başka bir yerde sunulmamıştır.
References
- 1. American Academy of Pediatrics. Brucellosis. In: Pickering LK, ed. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics, Elk Grove Village, IL; 2021-2024.
- 2. Keşli R, Bilgin H, Yılmaz H. Determination of in vitro susceptibilities of Brucella spp. Strains against 11 different antibacterial gents isolated from blood cultures. Mikrobiyol Bul. 2017;51(3):260-8.
- 3. Njeru J, Wareth G, Melzer F, et al. Systematic review of brucellosis in Kenya: disease frequency in humans and animals and risk factors for human infection. BMC Public Health. 2016;16:853.
- 4. Pappas G, Kitsanou M, Christou L, et al. Immune thrombocytopenia attributed to brucellosis and other mechanisms of Brucella-induced thrombocytopenia. Am J Hematol. 2004;75:139–41.
- 5. Yilmaz M, Tiryaki O, Namiduru M, et al. Brucellosis-induced immune thrombocytopenia mimicking ITP: a report of seven cases. Int J Lab Hematol. 2007;29(6):442-5.
- 6. Lanzkowsky P, Lipton JM, Fish JD. Hematological reference values. Lanzkowsky’s Manual of Pediatric Hematology and Oncology, 6th edition. Amsterdam, The Netherlands: Elsevier; 2016:709-28.
- 7. Yumuk Z, O'Callaghan D. Brucellosis in Turkey -- an overview. Int J Infect Dis. 2012;16(4):228-35.
- 8. Gündeşlioğlu ÖÖ. Brucella infection in children: Evaluation of 148 pediatric patients. J Clin Anal Med. 2019;10(1):99-103.
- 9. Özcanaslan FÇ, Çay Ü, Özgür Gündeşlioğlu Ö, et al. Retrospective evalution of pediatric brucella patients followed and family screening with household members for brucella infection. J Pediatr Inf. 2021;15(2):69-74.
- 10. Çiftdoğan DY, Aslan S. Unrecognized pediatric and adult family members of children with acute brucellosis. Braz J Infect Dis. 2017;21(5):520-4.
- 11. Helvacı M, Atila D, Barışık V. Çocukluk çağı brusellozlu 57 vakanın geriye dönük değerlendirilmesi. Tepecik Eğit Hast Derg. 2011;21(3):135-8.
- 12. Çelebi S, Hacımustafaoğlu M, Demirtaş F, et al. Çocukluk çağında bruselloz. J Pediatr Inf. 2011;5:59-62.
- 13. Kazanasmaz H, Geter S. Investigation of the sensitivity and specificity of laboratory tests used in differential diagnosis of childhood brucellosis. Cureus. 2020;12(1):e6756.
- 14. Aypak A, Aypak C, Bayram Y. Hematological findings in children with brucellosis. Pediatr Int. 2015;57(6):1108-11.
- 15. Jia B, Zhang F, Lu Y, et al. The clinical features of 590 patients with brucellosis in Xinjiang, China with the emphasis on the treatment of complications. PLoS Negl Trop Dis. 2017;11(5):e0005577.
- 16. Tanir G, Tufekci SB, Tuygun N. Presentation, complications, and treatment outcome of brucellosis in Turkish children. Pediatr Int. 2009;51(1):114-9.
- 17. Yılmaz K, Bayraktaroğlu Z, Sivaslı E, et al. Bruselloz tanılı çocuk hastalarda klinik ve laboratuar verilerinin değerlendirilmesi. Çocuk Derg. 2004;4(2):102-6.
- 18. Kanık Yüksek S, Gülhan B. Çocukluk çağinda bruselloz: tek merkez deneyimi. Türkiye Çocuk Hast Derg. 2019;13(6):435-41.
- 19. Pourakbari B, Abdolsalehi M, Mahmoudi S, et al. Epidemiologic, clinical, and laboratory characteristics of childhood brucellosis: A study in an Iranian children's referral hospital. Wien Med Wochenschr. 2019;169(9-10):232-9.
- 20. Roushan MR, Mohraz M, Janmohammadi N, et al. Efficacy of cotrimoxazole and rifampin for 6 or 8 weeks of therapy in childhood brucellosis. Pediatr Infect Dis J. 2006;25(6):544-5.
- 21. Bruselloz. Zoonotik ve Vektörel Hastalıklar Dairesi Başkanlığı. Erişim tarihi 10 Haziran 2023, https://hsgm.saglik.gov.tr/tr/zoonotikvektorel-bruselloz.
Evaluation of Demographic, Hematological and Laboratory Findings of Patients with Childhood Brucellosis Admitted to a Single Center
Abstract
Brucellosis, transmitted to humans from infected animals and their products, is a zoonotic infection still common in our country and worldwide. We aimed to evaluate the demographic characteristics, and hematological and laboratory abnormalities of pediatric brucellosis cases admitted to a single center. In this study, 47 pediatric patients who were followed up with the diagnosis of Brucellosis between June 2020-2021 were retrospectively analyzed. Of the 47 patients, 48.9% were male and 51.1% were female, mean age was 9.96 ± 4.26 years. 48.9% of patients lived in rural areas, 78.7% of patients had a history of using raw milk. 44.7% had a similar disease history in the household. Five of 20 patients with muscle and joint pain had arthritis (10.6%), the most commonly involved joint was the knee the and the most common abnormal physical examination finding was fever (12.8%). Hematological involvement was observed in at least one series in 57.4% of patients. The most common hematological finding was anemia (46.8%). Thrombocytopenia and leukopenia were detected in four patients (8.5%). In all cases, agglutination tests were positive. The rate of blood culture positivity was 12.8%. 21.3% of patients were hospitalized. Combined therapy was given to all patients. No treatment-related side effects were observed. While relapse was observed in 1 patient, no mortality was detected. Brucellosis still continues to be an important health problem, because its clinical findings are not specific, and complications are high. It should definitely be kept in mind in the differential diagnosis of cytopenia in patients living in endemic areas because of the presence of deterioration in hematological findings.
Project Number
Yok
References
- 1. American Academy of Pediatrics. Brucellosis. In: Pickering LK, ed. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics, Elk Grove Village, IL; 2021-2024.
- 2. Keşli R, Bilgin H, Yılmaz H. Determination of in vitro susceptibilities of Brucella spp. Strains against 11 different antibacterial gents isolated from blood cultures. Mikrobiyol Bul. 2017;51(3):260-8.
- 3. Njeru J, Wareth G, Melzer F, et al. Systematic review of brucellosis in Kenya: disease frequency in humans and animals and risk factors for human infection. BMC Public Health. 2016;16:853.
- 4. Pappas G, Kitsanou M, Christou L, et al. Immune thrombocytopenia attributed to brucellosis and other mechanisms of Brucella-induced thrombocytopenia. Am J Hematol. 2004;75:139–41.
- 5. Yilmaz M, Tiryaki O, Namiduru M, et al. Brucellosis-induced immune thrombocytopenia mimicking ITP: a report of seven cases. Int J Lab Hematol. 2007;29(6):442-5.
- 6. Lanzkowsky P, Lipton JM, Fish JD. Hematological reference values. Lanzkowsky’s Manual of Pediatric Hematology and Oncology, 6th edition. Amsterdam, The Netherlands: Elsevier; 2016:709-28.
- 7. Yumuk Z, O'Callaghan D. Brucellosis in Turkey -- an overview. Int J Infect Dis. 2012;16(4):228-35.
- 8. Gündeşlioğlu ÖÖ. Brucella infection in children: Evaluation of 148 pediatric patients. J Clin Anal Med. 2019;10(1):99-103.
- 9. Özcanaslan FÇ, Çay Ü, Özgür Gündeşlioğlu Ö, et al. Retrospective evalution of pediatric brucella patients followed and family screening with household members for brucella infection. J Pediatr Inf. 2021;15(2):69-74.
- 10. Çiftdoğan DY, Aslan S. Unrecognized pediatric and adult family members of children with acute brucellosis. Braz J Infect Dis. 2017;21(5):520-4.
- 11. Helvacı M, Atila D, Barışık V. Çocukluk çağı brusellozlu 57 vakanın geriye dönük değerlendirilmesi. Tepecik Eğit Hast Derg. 2011;21(3):135-8.
- 12. Çelebi S, Hacımustafaoğlu M, Demirtaş F, et al. Çocukluk çağında bruselloz. J Pediatr Inf. 2011;5:59-62.
- 13. Kazanasmaz H, Geter S. Investigation of the sensitivity and specificity of laboratory tests used in differential diagnosis of childhood brucellosis. Cureus. 2020;12(1):e6756.
- 14. Aypak A, Aypak C, Bayram Y. Hematological findings in children with brucellosis. Pediatr Int. 2015;57(6):1108-11.
- 15. Jia B, Zhang F, Lu Y, et al. The clinical features of 590 patients with brucellosis in Xinjiang, China with the emphasis on the treatment of complications. PLoS Negl Trop Dis. 2017;11(5):e0005577.
- 16. Tanir G, Tufekci SB, Tuygun N. Presentation, complications, and treatment outcome of brucellosis in Turkish children. Pediatr Int. 2009;51(1):114-9.
- 17. Yılmaz K, Bayraktaroğlu Z, Sivaslı E, et al. Bruselloz tanılı çocuk hastalarda klinik ve laboratuar verilerinin değerlendirilmesi. Çocuk Derg. 2004;4(2):102-6.
- 18. Kanık Yüksek S, Gülhan B. Çocukluk çağinda bruselloz: tek merkez deneyimi. Türkiye Çocuk Hast Derg. 2019;13(6):435-41.
- 19. Pourakbari B, Abdolsalehi M, Mahmoudi S, et al. Epidemiologic, clinical, and laboratory characteristics of childhood brucellosis: A study in an Iranian children's referral hospital. Wien Med Wochenschr. 2019;169(9-10):232-9.
- 20. Roushan MR, Mohraz M, Janmohammadi N, et al. Efficacy of cotrimoxazole and rifampin for 6 or 8 weeks of therapy in childhood brucellosis. Pediatr Infect Dis J. 2006;25(6):544-5.
- 21. Bruselloz. Zoonotik ve Vektörel Hastalıklar Dairesi Başkanlığı. Erişim tarihi 10 Haziran 2023, https://hsgm.saglik.gov.tr/tr/zoonotikvektorel-bruselloz.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | Original Article |
| Authors | |
| Project Number | Yok |
| Publication Date | August 21, 2023 |
| Submission Date | July 17, 2022 |
| Published in Issue | Year 2023 Volume: 10 Issue: 2 |
