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Microbes & Immunity Childhood brucellosis in Saudi Arabia

the date therapy ended. Clinical cure was defined as the 3.2. Antibiotic regimens used
complete resolution of brucellosis signs and symptoms, Antibiotic regimens varied significantly between the
as documented in progress notes or outpatient visit patients; however, most patients (53%) received a
records. Data were collected up to 3 months post-therapy combination consisting of at least three antibiotics
completion, except for one patient whose data were only (Table 2). Most of the regimens in the younger group
available after 8 months post-therapy. Patients were included rifampin and/or gentamicin with or without
divided into two groups: younger patients (aged 8 years or trimethoprim/sulfamethoxazole. On the other hand,
younger) and older patients (aged older than 8 years). This the older group regimens consisted of rifampin and
stratification was based on the contradiction of doxycycline doxycycline alone or in combination with other agents.
(an essential antibiotic in brucellosis treatment) in patients
younger than 8 years and the more frequent occurrence of 3.3. End of therapy outcomes
brucellosis-associated arthritis in the older age group. 10-13
Clinical outcomes data were available for 18 patients. All
2.4. Statistical analysis patients were clinically cured with no reported mortality
The collected data and laboratory results were presented (Table 3). In addition, temperature, white blood cell
descriptively using numbers, percentages, and mean ± count, inflammatory markers, and liver enzymes were
standard deviation. Statistical package (Statistical Package all normalized. Moreover, the average length of stay
for Social Sciences version 24.0) (IBM Corp., US) was used. of hospitalized patients (n = 9) was 26 days, which was
shorter in the older group (14.8 days) than in the younger
3. Results group (34.4 days). With regards to antibody titers, they
remained elevated in some patients but normalized
3.1. Characteristics of the patients in some, where the median (Interquartile range) was
A total of 138 patients were screened for eligibility, of whom 1:320 (1:80 to 1:1280).
20 met the inclusion criteria and were included in the
study. Reasons for exclusions included duplicate records, 4. Discussion
age older than 18 years, no positive serology, positive Although brucellosis is a neglected disease worldwide,
blood cultures labeled with “Brucella” but did not yield it poses a serious threat to public health in developing
Brucella spp., and no documented antibiotic treatment. nations. Likewise, in Saudi Arabia, it continues to be
Table 1 lists the demographics of included patients. The endemic despite efforts to contain its spread. Any child
mean age was 8.9 years. About two-thirds were males experiencing a fever and having a history of consuming
(65%), and more than half were treated as outpatients unpasteurized milk or animal contact should be evaluated
(55%). The consumption of a dairy product was reported for brucellosis. The primary objective of our study was
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by 6 patients (30%), whereas the source of infection was to describe the characteristics and the clinical outcomes
unknown in the rest of the cohort. Upon presentation, of childhood brucellosis in patients identified at our
about half (50%) of the patients complained of arthralgia institution over 11 years.
and were febrile. Six of the 20 patients (30%) had elevated
liver enzymes at baseline (three times the upper limit of In many countries, Brucella infection is an occupational
normal; range 66 – 252 U/L for alanine transaminase disease, which makes it uncommon among children.
[ALT] and 91 – 155 U/L for aspartate transaminase [AST]) However, this may not be the case in endemic regions where
that were decreased by the end of therapy by about 55% transmission occurs through non-occupational means.
(range 33 – 64 U/L and 22 – 64 U/L for ALT and AST, In our study, male patients outnumbered female patients
respectively). Hepatosplenomegaly was noted in one (67% vs. 33%). One possible explanation could be that
patient, and splenomegaly was observed in another. young male adults are more involved in outdoor activities
Furthermore, two patients had complicated brucellosis and animal care. However, these findings disagreed with
(one had neurobrucellosis whereas the other had a national survey that linked female participation in
epididymo-orchitis), whereas the remaining 18 patients had animal milking to a greater infection risk among females.
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uncomplicated brucellosis. Serological results revealed that About a third of the patients had a history of consuming
18 patients (90%) had antibodies against both B. melitensis dairy products. This observation was consistent with
and B. abortus, whereas the remaining two patients had the findings of a previous study conducted in Al-Khafji
antibodies against either species. Moreover, four patients Joint Operation Hospital between 2011 and 2012, which
had concurrent infections with other pathogens, including reported raw animal milk ingestion as the major risk factor
two cases of cytomegalovirus infection, one case of for brucellosis reported by up to 83% of pediatric patients.
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rheumatic fever, and one case of urinary tract infection. Consuming unpasteurized (or non-boiled) dairy products

Volume 2 Issue 1 (2025) 72 doi: 10.36922/mi.4634