Original Article

Brucellosis in Adults and Children: A 10-Year Case Series at Two Large Academic Hospitals in Houston, Texas

Authors: Jose A. Serpa, MD, MS, Sheena Knights, MD, Dimitrios Farmakiotis, MD, Judith Campbell, MD


Objectives: Brucellosis is one of the most common zoonoses worldwide. Most cases in the United States occur among travelers or immigrants from endemic regions, mostly Central America. In this study, we aimed at describing and comparing the epidemiology and clinical presentation of brucellosis in pediatric and adult patients at two large tertiary care centers in Houston, Texas.

Methods: We identified patients diagnosed as having brucellosis between January 2000 and December 2009 by searching electronic medical records and reviewing microbiology records for positive cultures. Cases were defined as those with a positive blood culture for Brucella sp, a serum agglutination titer ≥1:80 (or both positive blood culture and serum agglutination titer ≥1:80), along with an epidemiologic risk factor and clinical presentation that is consistent with brucellosis.

Results: Six adult and 12 pediatric cases were identified; 13 of 18 (72%) cases were immigrants, mostly from Central America. The median ages for adult and pediatric patients were 53 and 3 years old, respectively. Ingestion of unpasteurized milk products was frequently reported. Common clinical features included fever (83%), arthralgias or arthritis (67%), and hepatosplenomegaly (61%). Positive blood cultures were more frequently reported among children than adults (83% vs 33%, P = 0.03). The most common laboratory finding was mildly elevated transaminases. Three adults (50%) but no children developed thrombocytopenia (P = 0.02). Relapsed infection was a frequent occurrence.

Conclusions: In the southern United States, brucellosis is an important consideration in the differential diagnosis of immigrants presenting with undifferentiated fever and joint complaints. A careful history often reveals an epidemiologic risk factor such as ingestion of unpasteurized dairy products.

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1. Pappas G, Papadimitriou P, Akritidis N, et al. The new global map of human brucellosis. Lancet Infect Dis 2006;6:91-99.
2. Corbel MJ. Brucellosis in humans and animals. http://www.who.int/csr/resources/publications/Brucellosis.pdf. Published 2006. Accessed March 25, 2018.
3. Mantur BG, Amarnath SK, Shinde RS. Review of clinical and laboratory features of human brucellosis. Indian J Med Microbiol 2007;25:188-202.
4. Pappas G, Akritidis N, Bosilkovski M, et al. Brucellosis. N Engl J Med 2005;352:2325-2336.
5. Chomel BB, DeBess EE, Mangiamele DM, et al. Changing trends in the epidemiology of human brucellosis in California from 1973 to 1992: a shift toward foodborne transmission. J Infect Dis 1994;170:1216-1223.
6. Troy SB, Rickman LS, Davis CE. Brucellosis in San Diego: epidemiology and species-related differences in acute clinical presentations. Medicine (Baltimore) 2005;84:174-187.
7. Logan LK, Jacobs NM, McAuley JB, et al. A multicenter retrospective study of childhood brucellosis in Chicago, Illinois from 1986 to 2008. Int J Infect Dis 2011;15:e812-e817.
8. Shen MW. Diagnostic and therapeutic challenges of childhood brucellosis in a nonendemic country. Pediatrics 2008;121:e1178-83.
9. Neunert C, Lim W, Crowther M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011;117:4190-4207.
10. Texas Department of State Health Services. 2015 Texas annual report. Reported disease rates. https://www.dshs.texas.gov/IDCU/data/annual/2000s/2015-Texas-Annual-Report.xls. Published November 29, 2017. Accessed December 1, 2017.
11. Brucella in raw milk prompts health warning in Texas. JAMA 2017;318:1533.
12. Texas Department of State Health Services. Brucellosis contracted from consumption of raw milk. https://www.dshs.texas.gov/news/releases/2017/HealthAlert-08142017.aspx. Published August 14, 2017. Accessed December 1, 2017.
13. Franco-Paredes C, Chastain D, Taylor P, et al. Boar hunting and brucellosis caused by Brucella suis. Travel Med Infect Dis 16:18-22.
14. Centers for Disease Control and Prevention. Brucella suis infection associated with feral swine hunting-three states, 2007-2008. MMWR Morb Mortal Wkly Rep 2009;58:618-621.
15. Dean AS, Crump L, Greter H, et al. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis 2012;6:e1929.
16. Karaman K, Akbayram S, Bayhan GI, et al. Hematologic findings in children with brucellosis: experiences of 622 patients in eastern Turkey. J Pediatr Hematol Oncol 2016;38:463-466.
17. Young EJ, Tarry A, Genta RM, et al. Thrombocytopenic purpura associated with brucellosis: report of 2 cases and literature review. Clin Infect Dis 2000;31:904-909.
18. Akbayram S, Dogan M, Akgun C, et al. An analysis of children with brucellosis associated with isolated thrombocytopenia. Clin Appl Thromb Hemost 2011;17:E36-E38.
19. Espinosa BJ, Chacaltana J, Mulder M, et al. Comparison of culture techniques at different stages of brucellosis. Am J Trop Med Hyg 2009;80:625-627.
20. Andriopoulos P, Tsironi M, Deftereos S, et al. Acute brucellosis: presentation, diagnosis, and treatment of 144 cases. Int J Infect Dis 2007;11:52-57.
21. Chusid MJ. Fever of unknown origin in childhood. Pediatr Clin North Am 2017;64:205-230.
22. Solí Garcia del Pozo J, Solera J. Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis. PLoS One 2012;7:e32090.
23. Hasanjani Roushan MR, Moulana Z, Mohseni Afshar Z, et al. Risk factors for relapse of human brucellosis. Glob J Health Sci 2015;8:77-82.