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  • Poster presentation
  • Open Access

Brucellosis – forgotten but not gone

  • 1,
  • 1,
  • 1 and
  • 1
Pediatric Rheumatology20086 (Suppl 1) :P140

https://doi.org/10.1186/1546-0096-6-S1-P140

  • Published:

Keywords

  • Primary Care
  • Family History
  • Pattern Recognition
  • Streptomycin
  • False Positive
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.

Table 1

Age (yrs)/Sex

9/F

16/M

11/M

Fever (weeks)

2

16

6

Musculoskeletal complaints

Cervical spine

Elbow knee hip ankle

Myalgia Calf pain

Other features

Cervical nodes

-

Cervical nodes Hepatomegaly

Endemic area

Travel

Resident

Resident

Unpasteurized milk ingestion

+

+

+

Family history

-

-

Mother and sib

WBC cumm/ESR mm/hr

8300/109

5900/50

7460/50

Sonography

Splenic abscesses

-

Mesenteric, paraaortic nodes

Serology

IgM +

IgM +

IgM and IgG +

Blood culture

Negative

Negative

Negative

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).

Authors’ Affiliations

(1)
Jaslok Hospital, Mumbai, India

Copyright

© Khubchandani et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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