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Microbes & Immunity Childhood brucellosis in Saudi Arabia

Brucella serology and culture at baseline; therefore, be noted that SAT has a reported high sensitivity rate
clinicians must base their diagnosis on the clinical picture of 93% – 100%, indicating a low likelihood of reporting
of the disease and use the culture and/or the serology false-negative results. However, false-positive results
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as a guide to confirm the diagnosis. In our study, can occur as a result of cross-reactions with antibodies to
20
leukopenia and thrombocytopenia were the hematological other Gram-negative bacteria, such as Salmonella spp. and
abnormalities that our patient cohort experienced during Yersinia spp. In our hospital, the speciation of Brucella
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the active course of brucellosis. Moreover, only 10 of is done using serological tests, where all the patients in
the 20 patients had elevated liver transaminases. These our current cohort had SAT done for them. Interestingly,
findings are consistent with earlier studies. It should however, 18 (90%) of the patients tested positive for both
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B. melitensis and B. abortus antibodies compared with two
Table 2. Antibiotic regimens used (in descending order of patients who tested positive for either of the two species.
the number of patients) Some potential explanations for this observation include
co-infection by both species, previous exposure to one of
Regimen Age group n the two species and then developing a new infection by the
Aminoglycoside+trimethoprim/ Younger group 3 other since Brucella antibodies could persist for years,
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sulfamethoxazole+rifampin
Aminoglycoside+trimethoprim/sulfamethoxazole Younger group 3 or cross-reactivity due to overlapping epitopes of Brucella
antigens leading to a false-positive result for multiple
Doxycycline+trimethoprim/ Older group 2 species. The first two explanations could be attributed to
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sulfamethoxazole+rifampin+ceftriaxone
Doxycycline+rifampin+ciprofloxacin Older group 2 the endemicity of the disease in Saudi Arabia.
Doxycycline+rifampin Older group 2 Brucellosis should be treated using a combination
Aminoglycoside+doxycycline+ Older group 1 therapy; otherwise, patients would be at high risk for
7,25
rifampin+ceftriaxone relapse or treatment failure. In this study, the relapse
Aminoglycoside+trimethoprim/ Younger group 1 rate was very low at 1%, and no fatality has been reported.
sulfamethoxazole+ceftriaxone In addition, the patients were successfully treated by the
Trimethoprim/sulfamethoxazole+rifampin Younger group 1 various regimens used. The most commonly prescribed
Trimethoprim/sulfamethoxazole+rifampin Older group 1 regimens were those comprised of an aminoglycoside,
Doxycycline Younger group 1 trimethoprim/sulfamethoxazole, and rifampin, as
well as a regimen comprised an aminoglycoside with
Notes: The younger group includes those who were ≤8 years old, trimethoprim/sulfamethoxazole. The former regimen has
whereas the older group includes those who were >8 years old. Three
patients received treatment as indicated in their medical records, but been recommended in the Saudi guidelines for patients
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antibiotics were not identified. <8 years. Of note, ciprofloxacin and doxycycline were only

Table 3. End‑of‑therapy outcome variables
Outcome Total (n=20) Younger group (n=9) Older group (n=11)
Temperature (°C) 36.8±0.2 (36.5 – 37) 36.7±0.3 (36.5 – 37) 36.8±0.2 (36.5 – 37)
White blood cells count (cells/mm ) 7±2 (3.1 – 9.9) 6.9±2.3 (3.1 – 9.6) 7.1±1.7 (4.9 – 9.9)
3
C-reactive protein (mg/L) 4.9±2.9 (3 – 13.1) 5±1.8 (3 – 7.8) 4.8±3.5 (3 – 13.1)
Erythrocyte sedimentation rate (mm/h) 14.8±13.3 (3 – 42) 16.7±17.4 (3 – 42) 12.2±4.4 (8 – 17)
a
ALT (U/L ) 28.4±11 (12 – 46) 32.1±10.6 (17 – 46) 23.5±10.3 (12 – 39)
a
AST (U/L ) 29.7±16.7 (9 – 64) 36.6±17.9 (17 – 64) 20.5±10 (9 – 35)
Brucella melitensis antibody titer (median [IQR]) b 1:320 [1:80 – >1:1280] 1:240 [1:80 – >1:1280] 1:320 [1:80 – >1:1280]
Brucella abortus antibody titer (median [IQR]) b 1:320 [1:80 – >1:1280] 1:200 [1:80 – >1:1280] 1:640 [1:80 – >1:1280]
Days of therapy c 45.7±32 (7 – 120) 40±22.3 (7 – 72) 51.4±40 (7 – 120)
Length of stay d 25.7±19.6 (7 – 67) 34.4±22 (9 – 67) 14.8±9.8 (7 – 29)
Notes: Data are presented as (mean±SD, range) unless otherwise specified. Data are presented as mean±SD (range) or n (%), except for the antibody
titers, which are presented as median (interquartile range). Data were available from 14 patients (eight in the younger group and six in the older
a
group). Data were available from 15 patients (eight in the younger group and seven in the older group). Data were available from 18 patients (nine
c
b
in the younger group and nine in the older group). Data were available for the nine admitted patients (five in the younger group and four in the
d
older group).
Abbreviations: ALT: Alanine transaminase; AST: Aspartate transaminase; IQR: Interquartile range; SD: Standard deviation.
Volume 2 Issue 1 (2025) 74 doi: 10.36922/mi.4634