Brucellosis-Induced Pancytopenia in Children: A Prospective Study
Mona Afify1, Salha H Al-Zahrani1 , and Mohamad A El-Koumi2
1Department of Biology, Science College for Girls, King AbdulAziz University.
2Department of Pediatrics, Al-Khafji Joint Operation Hospital*, Kingdom of Saudi Arabia.
ABSTRACT: Brucellosis, a zoonotic infection, constitutes a major health and economic problem in many parts of the world, including countries of the Mediterranean Basin, The Middle East and The Arabian Gulf. Hematological complications in brucellosis are common and can be multi-factorial due to the pathogen's tropism for central (bone marrow) and peripheral (spleen) organs of the reticuloendothelial system (RES). Pancytopenia, although mainly reported in adults has also been described in children with brucellosis. This investigation was conducted to estimate the relative frequency of pancytopenia in children with brucellosis. The study was carried out in Al-Khafji region. All children suffering from fever of more than 5 days without clinically evident cause and associated with symptoms suggestive of brucellosis were screened by a rapid slide serum agglutination test for presence of brucellosis. Sixty patients who had tube agglutination titre > 1: 160 or had positive blood and/or bone marrow (BM) culture for brucellosis, were enrolled in the study. At enrollment, the following investigations were performed: CBC, blood culture and BM, aspiration was carried out in all patients with pancytopenia, to exclude malignancy. Obtained results revealed that: out of 60 children with brucellosis, 50 (83%) ingested raw animal milk and 45% had a positive family history of brucellosis. The commonly presenting symptoms and signs included; excessive sweating (68%), bone aches (62%), chills (55%), arthritis (32%), and hepatosplenomegaly. The most commonly detected hematological manifestations included; anemia (in 43%), leukopenia (in 38%) and leukocytosis (in 20%). Meanwhile, pancytopenia was detected in 11 patients (18%). Positive blood culture for brucella was seen in 38% (23 patients). melitensis from 21 patients was cultured in vitro.. Out of 9 BM cultures, 3 were positive for B. melitensis and 6 cultures were negative. Out of 11 patients with pancytopenia, 9 patients (82%) presented with bone aches and weakness, 7(64%) presented with sweating and chills, 6(55%) of patients had petechiea and purpura, 5 (46%) had splenomegaly and 5 (46%) had hepatomegaly. The majority of patients with brucella-induced pancytopenia had agglutination titres of > 1: 320 and all of them had positive blood culture for B. melitensis. In conclusion in a patient with fever, arthalgia, chills and hematological abnormalities such as anemia, leukopenia, thrombocytopenia or pancytopenia, brucellosis should be kept in mind, especially in geographical areas where the disease is still endemic, as in our region.
[Mona Afify, SalhaHAl-Zahrani,and Mohamad A El-Koumi. Brucellosis-Induced Pancytopenia in Children:AProspective Study. Life Sci J 2013;10(1):1364-1368] (ISSN:1097-8135).http://www.lifesciencesite.com.
Key words: Pancytopenia-endemic brucellosis- fever of unknown origin.