BRUCELLOSIS

Brucellosis, caused by B. melitensis in India is a zoonotic disease of cattle, with humans infected by ingestion of contaminated animal products, e.g. unpasturized milk. It is a major public health problem in adults specially cattle-handlers, but rare in children.

Clinical manifestations begin after 3-4 weeks of incubation period, with a triad of: (a) prolonged fever, (b) arthralgia, and (c) hepatosplenomegaly. Constitutional features, e.g. GIT upset, sore throat, headache/lethargy and rash may be present. Invasive brucellosis, e.g. osteomyelitis, meningitis or endocarditis is extremely rare in children.

Diagnosis rests on clinical suspicion in prolonged pyrexia with rising serological titers, i.e. serum agglutination test on acute and convalescent sera. It is confirmed by culture or PCR.

Treatment: Doxycycline (PO 2-4 mg/kg/day q24hr) with Streptomycin (IM 15-30 mg/kg/day q24hr) or Rifampicin (PO 15-20 mg/kg/day q24hr) is the drug of choice for older children, while younger ones may be treated by cotrimoxazole with rifampicin, for 6 weeks. Invasive brucellosis requires at least 4-6 months therapy with three drugs-doxycycline, streptomycin and rifampicin.

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