{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T07:00:48Z","timestamp":1794553248781,"version":"4.9.1"},"reference-count":41,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,5,1]]},"abstract":"<jats:p>OBJECTIVE. We sought to define the current epidemiology, clinical manifestations, and course of childhood brucellosis in the United States.<\/jats:p><jats:p>METHODS. A retrospective chart review was performed of 20 patients who received a diagnosis of brucellosis over a period of 13 years at a large, tertiary care children's hospital in Dallas, Texas. Diagnostic criteria, epidemiology, clinical presentations, and outcomes were recorded.<\/jats:p><jats:p>RESULTS. Ninety-five percent of the patients had a recent history of either travel to Mexico or ingestion of unpasteurized milk products from Mexico. Fever was an initial complaint in 80% of the patients, and 50% of the patients presented with arthritis. Diagnosis was made via the identification of Brucella melitensis in the blood cultures of 18 patients. Five patients experienced relapse, and 3 experienced treatment failure.<\/jats:p><jats:p>CONCLUSIONS. Childhood brucellosis in the United States is now an imported disease, primarily from Mexico. In the context of this epidemiologic link, the diagnosis should be entertained for a patient who presents with signs of systemic inflammation and arthritis. Therapeutic challenges remain.<\/jats:p>","DOI":"10.1542\/peds.2007-1874","type":"journal-article","created":{"date-parts":[[2008,5,1]],"date-time":"2008-05-01T14:30:12Z","timestamp":1209652212000},"page":"e1178-e1183","source":"Crossref","is-referenced-by-count":40,"title":["Diagnostic and Therapeutic Challenges of Childhood Brucellosis in a Nonendemic Country"],"prefix":"10.1542","volume":"121","author":[{"given":"Mark W.","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Texas Medical Branch, Austin, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2008,5,1]]},"reference":[{"key":"2021120908255732600_R1","doi-asserted-by":"crossref","unstructured":"Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis.\u20082006;6(2):91\u201399","DOI":"10.1016\/S1473-3099(06)70382-6"},{"key":"2021120908255732600_R2","doi-asserted-by":"crossref","unstructured":"Taylor JP, Perdue JN. The changing epidemiology of human brucellosis in Texas, 1977\u20131986. Am J Epidemiol.\u20081989;130(1):160\u2013165","DOI":"10.1093\/oxfordjournals.aje.a115308"},{"key":"2021120908255732600_R3","doi-asserted-by":"crossref","unstructured":"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.\u20081994;170(5):1216\u20131223","DOI":"10.1093\/infdis\/170.5.1216"},{"key":"2021120908255732600_R4","doi-asserted-by":"crossref","unstructured":"Chang MH, Glynn MK, Groseclose SL. Endemic, notifiable bioterrorism-related diseases, United States, 1992\u20131999. Emerg Infect Dis.\u20082003;9(5):556\u2013564","DOI":"10.3201\/eid0905.020477"},{"key":"2021120908255732600_R5","doi-asserted-by":"crossref","unstructured":"Fosgate GT, Carpenter TE, Chomel BB, Case JT, DeBess EE, Reilly KF. Time-space clustering of human brucellosis, California, 1973\u20131992. Emerg Infect Dis.\u20082002;8(7):672\u2013678","DOI":"10.3201\/eid0807.010351"},{"key":"2021120908255732600_R6","doi-asserted-by":"crossref","unstructured":"Ragan VE. The Animal and Plant Health Inspection Service (APHIS) brucellosis eradication program in the United States. Vet Microbiol.\u20082002;90(1\u20134):11\u201318","DOI":"10.1016\/S0378-1135(02)00240-7"},{"key":"2021120908255732600_R7","unstructured":"Hopkins RS, Jajosky RA, Hall PA, et al. Summary of notifiable diseases: United States, 2003. MMWR Morb Mortal Wkly Rep.\u20082005;52(54):1\u201385"},{"key":"2021120908255732600_R8","doi-asserted-by":"crossref","unstructured":"Luna-Marti\u0301nez JE, Mejia-Teran C. Brucellosis in Mexico: current status and trends. Vet Microbiol.\u20082002;90(1\u20134):19\u201330","DOI":"10.1016\/S0378-1135(02)00241-9"},{"key":"2021120908255732600_R9","unstructured":"Kahler SC. Brucella melitensis infection discovered in cattle for first time, goats also infected. J Am Vet Med Assoc Online. March 1, 2000. Available at: www.avma.org\/onlnews\/javma\/mar00\/s030100b.asp. Accessed June 21, 2007"},{"key":"2021120908255732600_R10","doi-asserted-by":"crossref","unstructured":"Arnow PM, Smaron M, Ormiste V. Brucellosis in a group of travelers to Spain. JAMA.\u20081984;251(4):505\u2013507","DOI":"10.1001\/jama.251.4.505"},{"key":"2021120908255732600_R11","doi-asserted-by":"crossref","unstructured":"Young EJ, Corbel MJ. Brucellosis: epidemiology and prevalence worldwide. In: Brucellosis: Clinical and Laboratory Aspects. Boca Raton, FL: CRC Press; 1989:25\u201340","DOI":"10.1201\/9781003068518-5"},{"key":"2021120908255732600_R12","doi-asserted-by":"crossref","unstructured":"Shaalan MA, Memish ZA, Mahmoud SA, et al. Brucellosis in children: clinical observations in 115 cases. Int J Infect Dis.\u20082002;6(3):182\u2013186","DOI":"10.1016\/S1201-9712(02)90108-6"},{"key":"2021120908255732600_R13","doi-asserted-by":"crossref","unstructured":"al-Eissa YA, Kambal AM, al-Nasser MN, al-Habib SA, al-Fawaz IM, al-Zamil FA. Childhood brucellosis: a study of 102 cases. Pediatr Infect Dis J.\u20081990;9(2):74\u201379","DOI":"10.1097\/00006454-199002000-00002"},{"key":"2021120908255732600_R14","doi-asserted-by":"crossref","unstructured":"Madkour MM. Childhood brucellosis. In: Madkour's Brucellosis. 2nd ed. Berlin, Germany: Springer; 2001:205\u2013220","DOI":"10.1007\/978-3-642-59533-2_20"},{"key":"2021120908255732600_R15","doi-asserted-by":"crossref","unstructured":"Young EJ. An overview of human brucellosis. Clin Infect Dis.\u20081995;21(2):283\u2013289; quiz 290","DOI":"10.1093\/clinids\/21.2.283"},{"key":"2021120908255732600_R16","doi-asserted-by":"crossref","unstructured":"Eren S, Bayam G, Ergonul O, et al. Cognitive and emotional changes in neurobrucellosis. J Infect.\u20082006;53(3):184\u2013189","DOI":"10.1016\/j.jinf.2005.10.029"},{"key":"2021120908255732600_R17","doi-asserted-by":"crossref","unstructured":"Young DA. Florence Nightingale's fever. BMJ.\u20081995;311(7021):1697\u20131700","DOI":"10.1136\/bmj.311.7021.1697"},{"key":"2021120908255732600_R18","doi-asserted-by":"crossref","unstructured":"Geyik MF, Gur A, Nas K, et al. Musculoskeletal involvement of brucellosis in different age groups: a study of 195 cases. Swiss Med Wkly.\u20082002;132(7\u20138):98\u2013105","DOI":"10.57187\/smw.2002.09900"},{"key":"2021120908255732600_R19","doi-asserted-by":"crossref","unstructured":"al-Eissa YA, Kambal AM, Alrabeeah AA, Abdullah AM, al-Jurayyan NA, al-Jishi NM. Osteoarticular brucellosis in children. Ann Rheum Dis.\u20081990;49(11):896\u2013900","DOI":"10.1136\/ard.49.11.896"},{"key":"2021120908255732600_R20","doi-asserted-by":"crossref","unstructured":"Benjamin B, Annobil SH, Khan MR. Osteoarticular complications of childhood brucellosis: a study of 57 cases in Saudi Arabia. J Pediatr Orthop.\u20081992;12(6):801\u2013805","DOI":"10.1097\/01241398-199211000-00019"},{"key":"2021120908255732600_R21","doi-asserted-by":"crossref","unstructured":"Yagupsky P. Detection of Brucellae in blood cultures. J Clin Microbiol.\u20081999;37(11):3437\u20133442","DOI":"10.1128\/JCM.37.11.3437-3442.1999"},{"key":"2021120908255732600_R22","doi-asserted-by":"crossref","unstructured":"Street L Jr, Grant WW, Alva JD. Brucellosis in childhood. Pediatrics.\u20081975;55(3):416\u2013421","DOI":"10.1542\/peds.55.3.421"},{"key":"2021120908255732600_R23","unstructured":"Baysallar M, Aydogan H, Kilic A, Kucukkaraaslan A, Senses Z, Doganci L. Evaluation of the BacT\/ALERT and BACTEC 9240 automated blood culture systems for growth time of Brucella species in a Turkish tertiary hospital. Med Sci Monit.\u20082006;12(7):BR235\u2013BR238"},{"key":"2021120908255732600_R24","unstructured":"Spink WW. The Nature of Brucellosis. Minneapolis, MN: University of Minnesota Press; 1956"},{"key":"2021120908255732600_R25","unstructured":"Karakukcu M, Patiroglu T, Ozdemir MA, Gunes T, Gumus H, Karakukcu C. Pancytopenia, a rare hematologic manifestation of brucellosis in children. J Pediatr Hematol Oncol.\u20082004;26(12):803\u2013806"},{"key":"2021120908255732600_R26","doi-asserted-by":"crossref","unstructured":"Shalev H, Abramson O, Levy J. Hematologic manifestations of brucellosis in children. Pediatr Infect Dis J.\u20081994;13(6):543\u2013545","DOI":"10.1097\/00006454-199406000-00017"},{"key":"2021120908255732600_R27","unstructured":"Joint FAO\/WHO expert committee on brucellosis. World Health Organ Tech Rep Ser.\u20081986;740:1\u2013132"},{"key":"2021120908255732600_R28","doi-asserted-by":"crossref","unstructured":"Hasanjani Roushan MR, Mohraz M, Hajiahmadi M, Ramzani A, Valayati AA. Efficacy of gentamicin plus doxycycline versus streptomycin plus doxycycline in the treatment of brucellosis in humans. Clin Infect Dis.\u20082006;42(8):1075\u20131080","DOI":"10.1086\/501359"},{"key":"2021120908255732600_R29","doi-asserted-by":"crossref","unstructured":"Solera J, Espinosa A, Martinez-Alfaro E, et al. Treatment of human brucellosis with doxycycline and gentamicin. Antimicrob Agents Chemother.\u20081997;41(1):80\u201384","DOI":"10.1128\/AAC.41.1.80"},{"key":"2021120908255732600_R30","doi-asserted-by":"crossref","unstructured":"Solera J, Rodriguez-Zapata M, Geijo P, et al. Doxycycline-rifampin versus doxycycline-streptomycin in treatment of human brucellosis due to Brucella melitensis. The GECMEI Group. Grupo de Estudio de Castilla-la Mancha de Enfermedades Infecciosas. Antimicrob Agents Chemother.\u20081995;39(9):2061\u20132067","DOI":"10.1128\/AAC.39.9.2061"},{"key":"2021120908255732600_R31","doi-asserted-by":"crossref","unstructured":"Colmenero JD, Fernandez-Gallardo LC, Agundez JA, Seden\u0303o J, Beni\u0301tez J, Valverde E. Possible implications of doxycycline-rifampin interaction for treatment of brucellosis. Antimicrob Agents Chemother.\u20081994;38(12):2798\u20132802","DOI":"10.1128\/AAC.38.12.2798"},{"key":"2021120908255732600_R32","unstructured":"Lubani MM, Dudin KI, Sharda DC, et al. A multicenter therapeutic study of 1100 children with brucellosis. Pediatr Infect Dis J.\u20081989;8(2):75\u201378"},{"key":"2021120908255732600_R33","doi-asserted-by":"crossref","unstructured":"Khuri-Bulos NA, Daoud AH, Azab SM. Treatment of childhood brucellosis: results of a prospective trial on 113 children. Pediatr Infect Dis J.\u20081993;12(5):377\u2013381","DOI":"10.1097\/00006454-199305000-00005"},{"key":"2021120908255732600_R34","doi-asserted-by":"crossref","unstructured":"Sa\u0301nchez-Tamayo T, Colmenero JD, Martinez-Cortes F, et al. Failure of short-term antimicrobial therapy in childhood brucellosis. Pediatr Infect Dis J.\u20081997;16(3):323\u2013324","DOI":"10.1097\/00006454-199703000-00012"},{"key":"2021120908255732600_R35","unstructured":"El Miedany YM, El Gaafary M, Baddour M, Ahmed I. Human brucellosis: do we need to revise our therapeutic policy?J Rheumatol.\u20082003;30(12):2666\u20132672"},{"key":"2021120908255732600_R36","doi-asserted-by":"crossref","unstructured":"Hall WH. Modern chemotherapy for brucellosis in humans. Rev Infect Dis.\u20081990;12(6):1060\u20131099","DOI":"10.1093\/clinids\/12.6.1060"},{"key":"2021120908255732600_R37","unstructured":"Hughes ML. Mediterranean, Malta or Undulant Fever. New York, NY: McMillan and Co; 1897:150"},{"key":"2021120908255732600_R38","doi-asserted-by":"crossref","unstructured":"Madkour MM. Treatment. In: Madkour's Brucellosis. 2nd ed. Berlin, Germany: Springer; 2001:241\u2013261","DOI":"10.1007\/978-3-642-59533-2_24"},{"key":"2021120908255732600_R39","doi-asserted-by":"crossref","unstructured":"Mantur BG, Akki AS, Mangalgi SS, Patil SV, Gobbur RH, Peerapur BV. Childhood brucellosis: a microbiological, epidemiological and clinical study. M Trop Pediatr.\u20082004;50(3):153\u2013157","DOI":"10.1093\/tropej\/50.3.153"},{"key":"2021120908255732600_R40","doi-asserted-by":"crossref","unstructured":"Sharda DC, Lubani M. A study of brucellosis in childhood. Clin Pediatr (Phila).\u20081986;25(10):492\u2013495","DOI":"10.1177\/000992288602501002"},{"key":"2021120908255732600_R41","doi-asserted-by":"crossref","unstructured":"Feiz J, Sabbaghian H, Miralai M. Brucellosis due to B. melitensis in children: clinical and epidemiologic observations on 95 patients studied in central Iran. Clin Pediatr (Phila).\u20081978;17(12):904\u2013907","DOI":"10.1177\/000992287801701210"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/121\/5\/e1178\/1175268\/zpe005080e1178.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/121\/5\/e1178\/1175268\/zpe005080e1178.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T01:50:36Z","timestamp":1684374636000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/121\/5\/e1178\/73435\/Diagnostic-and-Therapeutic-Challenges-of-Childhood"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,5,1]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2008,5,1]]},"published-print":{"date-parts":[[2008,5,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2007-1874","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,5,1]]}}}