title: Diagnostic and therapeutic challenges of childhood brucellosis in a nonendemic country.
abstract: OBJECTIVE
  We sought [corrected] to define the current epidemiology, clinical manifestations, and course of childhood brucellosis in the United States.
  
  
  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.
  
  
  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.
  
  
  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.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas, USA. mshen@seton.org
authors.forename: Mark W
authors.initials: MW
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000818:Animals; D017347:Brucella melitensis / Q000302:isolation & purification; D002006:Brucellosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D017058:Mexican Americans; D008800:Mexico; D008892:Milk / Q000382:microbiology; D012008:Recurrence; D013781:Texas / Q000453:epidemiology; D014195:Travel