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Hematologic Manifestations of Brucellosis in Children

Justman, Naphtali, MMedSc1, 2; Fruchtman, Yariv, MD1, 2; Greenberg, David, MD1, 2; Shalom, Ben-Shimol, MD1, 2

The Pediatric Infectious Disease Journal: January 11, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/INF.0000000000001900
Pathogenesis and Host Response: PDF Only

Background: Brucellosis is a common zoonosis in the Bedouin population of southern Israel. Limited data exist for the rate and risk factors of hematologic complication of brucellosis in children. We assessed anemia, leukopenia, thrombocytopenia and pancytopenia in childhood brucellosis in southern Israel.

Methods: Our medical center is the sole hospital in southern-Israel. All medical files of brucellosis, 2005-2014, identified through positive blood cultures or International Classification of Diseases 9th revision (ICD9) coding with positive serology, were reviewed retrospectively.

Results: Overall, 511 brucellosis episodes were identified; 42% (N = 214) with ≥1 cytopenia, including 13% (N = 68) anemia, 28% (N=144) leukopenia, 14% (N = 74) thrombocytopenia and 2% (N = 9) pancytopenia.

Overall, 99.8% of episodes were in Bedouin children and 70% in males. In 79% of episodes, blood culture was positive for Brucella melitensis. Acute infections comprised 84% of all episodes.

In univariate analysis, older age (10.49 ± 4.81 vs. 9.25 ± 4.89 years), fever (92% vs. 78%), positive blood culture (84% vs. 75%) and IgM≥1:640 levels (50% vs. 39%) were associated with cytopenia. In contrast, arthralgia was associated with non-cytopenic episodes. In multivariate analyses, older age (odds ratio, OR = 1.063) and fever (OR = 3.127) were associated with cytopenia.

Conclusions: Brucellosis is commonly presented with cytopenia, especially in bacteremic episodes with fever. However, pancytopenia is uncommon and its finding should alert the physician to look for other possible etiologies.

1The Pediatric Infectious Disease Unit, Soroka University Medical Center

2The Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka University Medical Center, Beer-Sheva, Israel

Sources of support: None

Authors’ disclosures: None

Corresponding author: Shalom Ben-Shimol, MD, Pediatric Infectious Disease Unit Soroka University Medical Center, Beer-Sheva 84101, Israel. Tel: +972-8 6400547; Fax: +972-8 6232334; E-mail:

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