Introduction

To the Editor. I read with interest the report on brucellosis in children by Nabi and Mir ^[1]. The objective of the study was to highlight brucellosis as a major cause of morbidity in the pediatric population of the Asir region. The authors mentioned paucity of data on its clinical pattern in Saudi children. This is true; however, they could have quoted two additional reports published from Saudi Arabia ^[2,3].

In our study of brucellosis in children in Gurayat, a small peripheral town in the northwestern region of Saudi Arabia, a total of 55 children were diagnosed over a period of one year from March 1988 to February 1989. A total of 23 cases were admitted to Gurayat General Hospital and comprised 1.4% of a total of 1672 pediatric admissions. An additional 32 children were diagnosed and treated in the outpatient clinic of the hospital during the same period. Thirty-one (56%) patients were male, all were Saudi nationals, mean age was 5.94 years (range 5 months to 12 years, median 6 years), and 26 (47%) were younger than five years of age (Table 1).

Table 1. Age distribution.

Brucellosis prevailed throughout the year, with 41 (75%) cases diagnosed during the summer months from March to August. All but one patient presented with unexplained fever for more than one week, 18 (32%) had arthralgia or arthritis. All the patients had a history of raw milk ingestion or close contact with sheep, goats, camels, or contact with infected family members. As in the previous studies, B. melitensis was the major pathogen on serological examination ^[1–3]. All the patients were treated with a combination of Septrin (trimethoprim) 7-10 mg/kg/day, sulfamethoxazole 30-50 mg/kg/day, and rifampicin 20 mg/kg/day. Duration of treatment was 4-6 weeks, with a longer duration being given to children with severe disease with or without arthritis. One child was given added injections of streptomycin for an initial period of two weeks. No child had any neurological or cardiac complications or death. One child required repeat admission because of relapse. Frequently, more than one family member was affected. In one family, six children were affected. One child presented four months following diagnosis in the other five siblings. I concur with the authors that rifampicin and trimethoprim are an encouraging combination therapy. In Gurayat there are 20,000 children, 40% of a total population of 50,000. This gives an annual incidence of 2.75/1000 children. Up to 20 or more cases may occur for each reported case ^[4], making the actual prevalence higher in this region.

Brucellosis is a preventable disease and in view of the magnitude of the problem in children, there is an urgent need for an effective control program. There is agreement that control of human brucellosis is through the control of it in animals. It has been found that widespread vaccination of sheep and goats has proven to be very effective in reducing human brucellosis. It is the veterinarian's responsibility to accept the challenge to control animal brucellosis, which in turn will control the disease in humans ^[5].