Summary
A study in 50 children suffering from acute brucellosis demonstrated that acute arthritis is a common and often predominant manifestation of the disease. The patients lived in an area where brucellosis is endemic: their ages ranged from six months to 12 years. All patients had a brucell agglutination titer of ⩾ 1:320 on admission. The knee and hip joints were most commonly affected with symptoms and findings from only one joint predominating. Associated findings of only moderately elevated ESR and normal leucocyte counts with relative lymphocytosis in the vast majority of the cases made it fairly easy to distinguish acute brucella arthritis from septic arthritis of other origin. A positive blood culture forBrucella melitensis was obtained in 35 of the patients. Treatment with tetracyclines, trimethoprim-sulphamethoxazole, with or without combination with streptomycin, resulted in a prompt recovery in all patients. No mortality was seen. Seven patients were readmitted with reinfections during a mean follow-up period of 13 months. Two patients with a history of prolonged fever, malaise and arthralgia were found to have osteomyelitis of the adjacent bone tissue. They also recovered without sequelae.
Zusammenfassung
In einer Studie an 50 Kindern mit akuter Brucellose stellte sich heraus, daß die akute Arthritis eine häufige und oft dominierende Manifestationsform dieser Infektionskrankheit darstellt. Alle betroffenen Kinder kamen aus einem Brucellose-Endemiegebiet. Das Alter der Patienten lag zwischen sechs Monaten und 12 Jahren. In allen Fällen fand sich bei Einweisung ein positiver Brucellose-Agglutinationstest mit Titerwerten von ⩾ 1:320. Die Arthritis verlief meist monoartikulär, am häufigsten waren Knie- und Hüftgelenke betroffen. Die Unterscheidung der akuten Brucella-Arthritis von einer septischen Arthritis anderer Genese wurde dadurch erleichtert, daß sich in der überwiegenden Mehrzahl der Kinder nur eine mäßige Beschleunigung der BKS bei normalen Gesamtleukozytenwerten mit relativer Lymphozytose entwickelte. Bei 35 Patienten wurdeBrucella melitensis aus Blutkulturen angezüchtet. Alle Patienten sprachen prompt auf eine Behandlung mit Tetracyclinen oder Trimethoprim-Sulfamethoxazol allein oder in Kombination mit Streptomycin an. Keines der Kinder verstarb. Bei sieben Kindern war wegen einer Reinfektion, die durchschnittlich 13 Monate nach der Ersterkrankung auftrat, nochmals eine stationäre Behandlung erforderlich. Bei zwei Patienten fand sich als Ursache von anhaltendem Fieber, schlechtem Allgemeinbefinden und Gelenkschmerzen eine Osteomyelitis im benachbarten Knochengewebe. Auch bei diesen Kindern erfolgte eine Heilung ohne Folgeschäden.
Similar content being viewed by others
Literature
Crosby, E., Llosa, L., Quesada, M. M., Carrillo, C., Gotuzzo, E. Hematologic changes in brucellosis. J. Infect. Dis. 150 (1984) 419–424.
Feiz, J., Sabbaghian, H., Miralai, M. Brucellosis due toBrucella melitensis in children. Clin. Pediatr. 17 (1978) 904–907.
Kambal, A. M., Mahgoub, E. S., Jamjoom, G. A., Chowdhury, M. N. H. Brucellosis in Riyadh, Saudi Arabia. A microbiological and clinical study. Trans. R. Soc. Trop. Med. Hyg. 77 (1983) 820–824.
Makarem, E. H., Karjoo, R., Omidi, A. Frequency ofBrucella melitensis in Southern Iran. J. Trop. Pediatr. 28 (1982) 97–100.
Spink, W. W. The nature of brucellosis. The University of Minnesota Press, Minneapolis 1965, pp 175–180, 315–316.
Kennedy, J. C. Notes on case of chronic synovitis or bursitis due to organism of Mediterranean fever. J. Roy. Army M. Corps 2 (1904) 178–180.
Abrahams, M. A., Tylkowski, C. M. Brucella osteomyelitis of a closed femur fracture. Clin. Orthop. 195 (1985) 194–196
Adam, A., MacDonald, A., Mackenzie, I. G. Monoarticular brucellar arthritis in children. J. Bone Joint Surg. 56 (1974) 217.
Aguilar, J. A., Elvidge, A. R. Intervertebral disc disease caused by theBrucella organism. J. Neurosurg. 18 (1961) 27–33.
Bishop, W. A. Vertebral lesions in undulant fever. J. Bone Joint Surg. 21 (1939) 665–673.
Dynn, J., Bryan, D. M., Nugent, J. J., Robinson, R. A. Pyogenic infections of the sacro-iliac joint. Clin. Orthop. 118 (1976) 113–117.
Feldmann, J. L., Menkes, C. J., Weill, B., Delrieu, F., Delbarre, F. Les sacro-iléites infectieuses. Etude multicentrique sur 214 observations. Rév. Rhum. Mal. Ostéoartic. 48 (1981) 83–91
Glasgow, M. M. S. Brucellosis of the spine. Br. J. Surg. 63 (1976) 283–288.
Keenan, M. A., Guttman, G. G. Brucella osteomyelitis of the distal part of the femur. A case report. J. Bone Joint Surg. 64 (1982) 142–144.
Porat, S., Shapiro, M. Brucella arthritis of the sacro-iliac joint. Infection 12 (1984) 205–207.
Rotes-Querol, J. Osteo-articular sites of brucellosis. Ann. Rheum. Dis. 16 (1957) 63–68.
Ruyssen, S., Le Pennec, M. P., Perreau, M., Ghnassia, J. C., Grosbuis, S. Ostéite à brucelles chez l'enfant. Arch. Fr. Pédiatr. 40 (1983) 803–805.
Seal, P. V., Morris, C. A. Brucellosis of the carpus. J. Bone Joint Surg. 568 (1977) 327–330.
Shahar, E., Barzilay, Z., Shohet, I., Altman, G., Cohen, B. E. Elevated risk of osteoarticular complications in children with acuteBrucella melitensis infection. Acta Paediatr. Hung. 24 (1983) 263–267.
Steinberg, C. L. Brucellosis as a cause of sacro-iliac arthritis. J. Am. Med. Ass. 138 (1948) 15–19.
Kelly, P. J., Martin, W. J., Schirger, A., Weed, L. A. Brucellosis of the bones and joints. Experience with thirty-six patients. J. Am. Med. Assoc. 174 (1960) 347–353.
Gotuzzo, E., Alarcon, G. S., Bocanegra, T. S., Carrillo, C., Guerra, J. C., Rolando, I., Espinoza, L. R. Articular involvement in human brucellosis: A retrospective analysis of 304 cases. Semin. Arthritis Rheum. 12 (1982) 245–255.
Lubani, M., Sharda, D., Helin, I. Cardiac manifestations in brucellosis. Arch. Dis. Child. 61 (1986) 569–572.
Epidemiological annual report: Epidemiology unit, Ministry of Public Health, Kuwait, 1983.
Street, M. A. J. L. Jr., Grant, W. W., Alva, J. D. Brucellosis in childhood. Pediatrics 55 (1975) 416–420.
Samra, Y., Shaked, Y., Hertz, M., Altman, G. Brucellosis: Difficulties in diagnosis and report on 38 cases. Infection 11 (1983) 310–312.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lubani, M., Sharda, D. & Helin, I. Brucella arthritis in children. Infection 14, 233–236 (1986). https://doi.org/10.1007/BF01644269
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01644269