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Alkhunein A, Albraikan A, Alayed M, Althaqafi W, Alharbi M. Case report: Microangiopathic hemolytic anemia and thrombocytopenia in a child with Brucella infection. Front Pediatr 2023; 11:1139622. [PMID: 37397138 PMCID: PMC10311060 DOI: 10.3389/fped.2023.1139622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a diffused microvascular occlusive disorder characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and ischemic organ dysfunction. In addition, this condition has been linked to an absence or dysfunction of ADAMTS13. Although TTP can occur due to various factors, such as bacteria, viruses, autoimmune disorders, drugs, connective tissue conditions, and solid tumors, it is a rare hematological complication associated with brucellosis. We describe the first case of a 9-year-old boy with acquired TTP with undetectable ADAMTS-13 assay secondary to Brucella infection. After initiating antimicrobial therapy, symptoms and laboratory abnormalities improved dramatically, with no recurrence of TTP in subsequent follow-ups.
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Affiliation(s)
- Atheer Alkhunein
- Department of Pediatrics, King Abdullah Specialist Children Hospital, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Ahmed Albraikan
- Department of Pediatrics, King Abdullah Specialist Children Hospital, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Maria Alayed
- Department of Pediatrics, King Abdullah Specialist Children Hospital, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Wesam Althaqafi
- Department of Pediatrics, King Abdullah Specialist Children Hospital, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Musaed Alharbi
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdul-Aziz University for Health Science, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
- Department of Pediatric Infectious Diseases, King Abdullah Specialist Children Hospital, Ministry of National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
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Bala KA, Doğan M, Kaba S, Akbayram S, Aslan O, Kocaman S, Bayhan Gİ, Üstyol L, Demir N. The Syndrome of Inappropriate Secretion of Anti-Diuretic Hormone (SIADH) and Brucellosis. Med Sci Monit 2016; 22:3129-34. [PMID: 27590789 PMCID: PMC5019136 DOI: 10.12659/msm.899977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Our study aimed to demonstrate the frequency of the syndrome of inappropriate ADH secretion (SIADH) and associated factors during the course of brucellosis in children and adolescents. MATERIAL AND METHODS The study included children and adolescents aged 0-18 years old diagnosed with brucellosis between 2012 and 2014. The data were collected from patient charts. The diagnosis of brucellosis was made based on titrations >1:160 in standard Wright tube agglutination tests and/or positive culture tests. SIADH diagnosis was made based on the following criteria: euvolemic hyponatremia, serum Na+ <135 mmol/L, presence of serum hypoosmolarity (serum osmolarity <275 mOsm/L), increased urinary sodium (>25 mmol/L with normal dietary salt intake), low uric acid (<2 mg/dL), absence of kidney, thyroid or adrenal disease, and any anti-diuretic use. RESULTS The study included 160 children and adolescents with mean age of 9.58±3.95 years (range: 2-18 years) including 70 girls (43.8%) and 90 boys (56.2%). When the patients were stratified based on SIADH, it was found that SIADH was present in 35 patients (21.9%). SIADH was associated with elevated glucose (p<0.001), ALT (p<0.05), AST (p<0.05), LDH (p<0.001), CRP (p<0.001), and MPV (p<0.001); and decreased potassium (p<0.05), chloride (p<0.001), albumin (p<0.001), total protein (p<0.05), and hemoglobin (p<0.05) levels. CONCLUSIONS Our study reports on the frequency, clinical characteristics, predisposing factors, and management of SIADH that can develop in children and adolescents diagnosed with brucellosis.
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Affiliation(s)
- Keziban Aslı Bala
- Department of Pediatrics, Medical School, Yüzüncü Yil University, Van, Turkey
| | - Murat Doğan
- Department of Pediatrics, Medical School, Yüzüncü Yil University, Van, Turkey
| | - Sultan Kaba
- Department of Pediatrics, Medical School, Yüzüncü Yil University, Van, Turkey
| | - Sinan Akbayram
- Department of Pediatrics, Medical School, Yüzüncü Yil University, Van, Turkey
| | - Oktay Aslan
- Department of Pediatrics, Medical School, Yüzüncü Yil University, Van, Turkey
| | - Selami Kocaman
- Department of Pediatrics Division of Pediatric Infectious Diseases, Medical School, Yüzüncü Yil University, Van, Turkey
| | - Gülsüm İclal Bayhan
- Department of Pediatrics, Medical School, Yüzüncü Yil University, Van, Turkey
| | - Lokman Üstyol
- Department of Pediatrics, Medical School, Yüzüncü Yil University, Van, Turkey
| | - Nihat Demir
- Department of Pediatrics, Medical School, Yüzüncü Yil University, Van, Turkey
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Hematologic Findings in Children With Brucellosis: Experiences of 622 Patients in Eastern Turkey. J Pediatr Hematol Oncol 2016; 38:463-6. [PMID: 27299597 DOI: 10.1097/mph.0000000000000612] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the present study was to present the hematologic findings of 622 cases diagnosed with acute brucellosis. Medical records of children with brucellosis, admitted to Yuzuncu Yil University Hospital over a 6-year period, were analyzed retrospectively. Three hundred ninety-seven (63.8%) patients were male and 225 (36.2%) were female. The mean age was 11 years (range, 1 to 16 y). The mean hematologic values were as follows: hemoglobin 9.4 (3.4 to 17) g/dL, hematocrite 28% (12% to 50%), leukopenia 2.8 (1.1 to 33)×10/L, leukocytosis 13.7 (1.1 to 33)×10/L, and platelets 79 (3 to 972)×10/L. An overall 28.6% of patients were found to have anemia, alone or in combination with leukopenia or thrombocytopenia. Sixteen percent of patients had thrombocytopenia, 13.9% had leukopenia, 7.7% had pancytopenia, and 4% had both leukopenia and thrombocytopenia. Hematologic complications such as anemia, thrombocytopenia, and leukopenia are more frequently seen in acute brucellosis cases. However, acute brucellosis should also be considered in the differential diagnosis in the presence of other hematologic abnormalities such as severe thrombocytopenia, bicytopenia, and pancytopenia.
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Parlak M, Akbayram S, Doğan M, Tuncer O, Bayram Y, Ceylan N, Özlük S, Akbayram HT, Öner A. Clinical manifestations and laboratory findings of 496 children with brucellosis in Van, Turkey. Pediatr Int 2015; 57:586-9. [PMID: 25675977 DOI: 10.1111/ped.12598] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/29/2014] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Brucellosis is the most common zoonotic disease worldwide and remains an important human disease especially in developing countries. The aim of the present study was to evaluate clinical manifestations and laboratory findings of childhood brucellosis in Van province of Eastern Turkey. To our knowledge, this is the largest series of childhood brucellosis reported in the literature. METHODS In this retrospective study, 496 children with brucellosis were assessed for the clinical manifestations and laboratory findings from July 2009 through December 2013. The diagnosis of brucellosis was based on clinical findings and a standard tube agglutination test (titer ≥ 1:160). Data were analyzed using Minitab version 16. RESULTS The study included 496 children (boys, 60.5%) with a mean age of 10.0 ± 3.95 years (range, 1-16 years). The most frequent clinical symptoms were arthralgia (46.2%), fever (32.1%), and abdominal pain (17.1%) and the most common clinical signs were peripheral arthritis (10.1%), splenomegaly (2.2%) and hepatomegaly (1.8%). The most contagious seasons were summer and autumn (63.3%). Elevated lactate dehydrogenase and C-reactive protein and erythrocyte sedimentation rate were reported in 63.1%, 58.7%, and 55.2% of the patients, respectively. Anemia (20.4%), thrombocytopenia (15.5%), and leukopenia (12.1%) were the most common hematologic findings. CONCLUSIONS Brucellosis remains a serious public health problem in Turkey. The clinical and laboratory characteristics of childhood brucellosis have been described in order to assist clinicians in diagnosing and monitoring the disease.
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Affiliation(s)
- Mehmet Parlak
- Department of Medical Microbiology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Sinan Akbayram
- Department of Pediatric Disease, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Murat Doğan
- Department of Pediatric Disease, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Oğuz Tuncer
- Department of Pediatric Disease, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Yasemin Bayram
- Department of Medical Microbiology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Nesrin Ceylan
- Department of Pediatric Disease, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Suat Özlük
- Department of Medical Microbiology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Hatice Tuba Akbayram
- Department of Pediatric Disease, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
| | - Abdurrahman Öner
- Department of Pediatric Disease, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
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Eskazan AE, Dal MS, Kaya S, Dal T, Ayyildiz O, Soysal T. Two cases of autoimmune hemolytic anemia secondary to brucellosis: a review of hemolytic disorders in patients with brucellosis. Intern Med 2014; 53:1153-8. [PMID: 24881740 DOI: 10.2169/internalmedicine.53.0936] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Brucellosis is a worldwide zoonotic disease associated with hemolytic complications, including thrombotic microangiopathy (TMA) and hemolytic anemia. Autoimmune hemolytic anemia (AIHA) is a rare clinical presentation of this disease. In this report, we describe the cases of two patients with brucellosis who presented with Coombs-positive AIHA. We also include a review of the literature on the hemolytic complications of brucellosis. Both patients were successfully treated with a combination of doxycycline and rifampicin in addition to steroids. In the medical literature, there are several cases of TMA associated with brucellosis, although only a few cases of Coombs test-positive AIHA have been reported. Antibiotic therapy is the mainstay of treatment, and the selection of antibiotics and duration of treatment do not differ between brucellosis patients with and without hemolysis. Although rare, the potential for brucellosis should always be kept in mind in patients who present with hemolysis, especially those living in areas where brucellosis is endemic.
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Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Turkey
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Thrombotic microangiopathy in haematopoietic cell transplantation: an update. Mediterr J Hematol Infect Dis 2010; 2:e2010033. [PMID: 21776339 PMCID: PMC3134219 DOI: 10.4084/mjhid.2010.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Accepted: 10/29/2010] [Indexed: 12/17/2022] Open
Abstract
Allogeneic hematopoietic cell transplantation (HCT) represents a vital procedure for patients with various hematologic conditions. Despite advances in the field, HCT carries significant morbidity and mortality. A rare but potentially devastating complication is transplantation-associated thrombotic microangiopathy (TA-TMA). In contrast to idiopathic TTP, whose etiology is attributed to deficient activity of ADAMTS13, (a member of the A Disintegrin And Metalloprotease with Thrombospondin 1 repeats family of metalloproteases), patients with TA-TMA have > 5% ADAMTS13 activity. Pathophysiologic mechanisms associated with TA-TMA, include loss of endothelial cell integrity induced by intensive conditioning regimens, immunosuppressive therapy, irradiation, infections and graft-versus-host (GVHD) disease. The reported incidence of TA-TMA ranges from 0.5% to 75%, reflecting the difficulty of accurate diagnosis in these patients. Two different groups have proposed consensus definitions for TA-TMA, yet they fail to distinguish the primary syndrome from secondary causes such as infections or medication exposure. Despite treatment, mortality rate in TA-TMA ranges between 60% to 90%. The treatment strategies for TA-TMA remain challenging. Calcineurin inhibitors should be discontinued and replaced with alternative immunosuppressive agents. Daclizumab, a humanized monoclonal anti-CD25 antibody, has shown promising results in the treatment of TA-TMA. Rituximab or the addition of defibrotide, have been reported to induce remission in this patient population. In general, plasma exchange is not recommended.
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Kuperman AA, Baidousi A, Nasser M, Braester A, Nassar F. Microangiopathic Anemia of Acute Brucellosis - is it a True TTP? Mediterr J Hematol Infect Dis 2010; 2:e2010031. [PMID: 21415981 PMCID: PMC3033148 DOI: 10.4084/mjhid.2010.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Accepted: 09/23/2010] [Indexed: 11/08/2022] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a severe disease, potentially fatal, if not diagnosed and treated promptly. TTP is clinically characterized by the pentad of thrombocytopenia, Coombs-negative hemolytic anemia, fever, renal abnormalities and neurological disturbances. Advances in recent years have delineated the molecular mechanisms of acquired and hereditary TTP.Many infectious organisms have been reported to be associated with TTP, especially mycoplasma, but few cases of Brucella infection associated with thrombotic microangiopathy have been reported.We describe a young woman who presented with TTP after acute infection with both Brucella melitensis and Brucella abortus. The patient completely recovered following aggressive therapy with plasmapharesis, high-dose corticosteroids and appropriate antimicrobial therapy.Since measurement of ADAMTS13 activity and neutralizing antibodies is now available, and none of the reported cases of brucellosis with thrombotic microangiopathy (including the present report) were tested, for better understanding of this rare association, we recommend this work-up in future cases.
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Affiliation(s)
| | - Amjad Baidousi
- Department of Medicine “E”, Western Galilee Hospital, Naharia, IsraelAffiliated with the Bruce Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel
| | - Maher Nasser
- Department of Medicine “E”, Western Galilee Hospital, Naharia, IsraelAffiliated with the Bruce Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel
| | | | - Faris Nassar
- Department of Medicine “E”, Western Galilee Hospital, Naharia, IsraelAffiliated with the Bruce Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel
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