Challenging diagnosis in the COVID-19 era: Pediatric brucellosis - a retrospective observational study

INTRODUCTION: Brucellosis is the most common bacterial zoonotic disease worldwide, with an annual incidence of half a million cases. It predominantly affects rural areas of developing countries, and the actual disease burden is likely much higher than reported. This study aims to retrospectively evaluate the demographic, laboratory, and clinical characteristics of pediatric brucellosis cases in the pre- and post-COVID-19 era.
METHODS: Between April 1, 2019, and April 1, 2021, all children under 18 diagnosed with brucellosis at our secondary care hospital were retrospectively examined. Clinical, laboratory, and demographic data were retrieved from electronic medical records.
RESULTS: Over the two-year study period, 59 children were diagnosed with brucellosis. The most common symptoms at presentation were arthralgia (81.4%) and fever (37.3%), with nearly two-thirds of the patients presenting as afebrile. Blood cultures were performed for 21 (35.6%) patients, with nine yielding positive results (42.9%). Patients with bacteremia were more likely to be admitted to the hospital and had higher C-reactive protein (CRP) levels and lower hemoglobin levels compared to non-bacteremic patients.
DISCUSSION AND CONCLUSION: The symptoms of COVID-19 and brucellosis in children overlap, making the diagnosis of brucellosis particularly challenging in areas with low prevalence. It is crucial not to overlook brucellosis in afebrile patients, given the high proportion of children with brucellosis who do not present with fever. CRP levels may be indicative of bacteremia and the need for hospital admission.