2 Be that as it may, it seems that human brucellosis is still a significant burden in Iran.3 Brucellosis is caused by organisms belonging to the genus Brucella, which is an aerobic and non-motile Gram-negative intracellular ROCK inhibition bacterium that does not

produce spores. This genus comprises seven species based on antigenic and host differences: B. melitensis (sheep and goats); B. abortus (cattle); B. suis (pigs); B. ovis (sheep); B. canis (dogs); B. neotomae (rats); and B. maris (marine mammals). Brucellosis is a febrile illness with a few vague systemic complaints, placing Inhibitors,research,lifescience,medical it in the differential diagnosis of many feverish diseases. Bone and joint involvements including arthritis, spondylitis, and osteomyelitis, are the most common complications

of brucellosis. Kennedy made the first Inhibitors,research,lifescience,medical report of the skeletal involvement of brucellosis in 1904, almost 20 years after the discovery of the Malta fever bacterium by Sir David Bruce.4 There are several published reports of the skeletal involvement of brucellosis from different regions; nonetheless, a consensus has yet to emerge as to the prevalence, Inhibitors,research,lifescience,medical location, and type of involvement in children. The purpose of the present study was to review and summarize the reports of the skeletal system involvement of B. melitensis in children. Methodology Inclusion Criteria Reviewed studies were of the observational type, exclusively in the age group of children, or studies that compared children and adults. As another requirement, the diagnosis of brucellosis had to be based on the presence of relevant clinical complaints associated with positive Inhibitors,research,lifescience,medical blood or bone marrow cultures or serology (positive Wright test

result of 1/160 or more). Due to the high virulence of B. melitensis, its tendency to produce skeletal complications, and its prevalence in the Middle East region, we restricted the review to articles that considered B. melitensis as their sole or most frequent etiologic agent. Search Engines To find the eligible Inhibitors,research,lifescience,medical articles, we employed the search engines of Google Scholar, PubMed, and Cochrane database. The following journal sites were also directly investigated: (1) International Journal of Infectious Diseases (2) Lancet: The Infectious Diseases Collection (3) The Pediatric Infectious Adenosine Disease Journal (4) Clinical Infectious Diseases Journal Keywords Search was done via the keywords of brucellosis, melitensis, children, arthritis, osteomyelitis, spondylitis, skeletal manifestations, and sacroiliitis in English and Persian. Search was performed on two separate occasions by two separate researchers from January 2009 until March 2012 on data that were published after 1980 (figure 1). Figure 1 The Moose flowchart for article screening Results Prevalence of Skeletal Complications Prevalence of the skeletal complications of brucellosis in the published articles varied from 11 to 85%.