Brucellosis – forgotten but not gone

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

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).