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Brucellosis – forgotten but not gone
Pediatric Rheumatology volume 6, Article number: P140 (2008)
Brucellosis, a zoonotic infection, is transmitted to children primarily by consumption of unpasteurized milk products. It can present with symptom complexes that mimic common chronic arthritis/connective tissue disorders, notably Still's disease. We describe three children (Table 1) suffering from brucellosis, seen in the last year in our rheumatology services.
These cases reemphasize the need for pattern recognition in rheumatologic disease. All three were referred by primary care physicians with a working diagnosis of systemic onset JIA/autoimmune disorder. However the lack of a "perfect fit" for such diagnoses,(pattern of fever, absence of rash/serositis, normal white cell/platelet counts) led us to explore a history of travel/residence in endemic areas and ingestion of unpasteurized milk. A family history of similarly afflicted members in one case was also relevant.
Serology is helpful but false positives may occur in hyper-gammaglobulinemic states. Blood cultures take weeks and the organism is a fastidious one. All three children responded well to a combination of streptomycin (2 weeks) and doxycycline (6 weeks).
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Khubchandani, R., Khemani, C., Vishwanathan, V. et al. Brucellosis – forgotten but not gone. Pediatr Rheumatol 6, P140 (2008) doi:10.1186/1546-0096-6-S1-P140
- Primary Care
- Family History
- Pattern Recognition
- False Positive