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[Neurobrucellosis: clinical and therapeutic features]
P. Bellissima1, M.A. Turturici
1Divisione Malattie Infettive, Azienda Ospedaliera Gravina, Caltagirone, Catania, Italy.
Abstract:
Brucellosis is a common zoonosis endemic in many parts of the world. Neurologic involvement is a rare but serious complication and it occurs in 2 - 5% of cases. Neurologic signs can appear during the active phase of disease or later. Six cases of neurobrucellosis are described: meningoencephalitis in 2 cases, meningitis with brain abscess in 1 case, encephalomielitis in 3 cases. Diagnosis was made on the basis of history of the exposure to brucella, of serum and cerebrospinal fluid positive serology, of quantitative change in cerebrospinal fluid, on EEG, CT and MNR and favorable response to specific treatment (rifampin, rolitetracycline tirmethoprim-sulfamethoxazole). Neurobrucellosis should be suspected in case of neurological deficit in brucellosis endemic areas. Treatment of neurobrucellosis remains controversial: we recommend a regimen with rifampin 600 mg x 2 i.v. + tirmethoprim-sulfamethoxazole 2 ff x 2 i.v. for a period of 6-8 weeks.
Insights
Neurobrucellosis, a rare complication of brucellosis, can cause serious neurological issues. Early diagnosis and prompt treatment with antibiotics like rifampin and trimethoprim-sulfamethoxazole are crucial for favorable outcomes.
Area of Science:
- Infectious Diseases
- Neurology
- Zoonotic Diseases
Background:
- Brucellosis is a widespread zoonotic infection.
- Neurologic involvement (neurobrucellosis) is a rare but severe complication, affecting 2-5% of cases.
- Neurological symptoms can manifest during active disease or as delayed sequelae.
Purpose of the Study:
- To describe clinical presentations and diagnostic approaches for neurobrucellosis.
- To evaluate treatment outcomes for neurobrucellosis cases.
- To recommend a treatment regimen for neurobrucellosis.
Main Methods:
- Case series describing six patients with neurobrucellosis.
- Diagnostic methods included clinical history, exposure assessment, serum and cerebrospinal fluid (CSF) serology, CSF analysis, EEG, CT, and MRI.
- Treatment involved specific antibiotic regimens.
Main Results:
- The study detailed six cases of neurobrucellosis, including meningoencephalitis (2 cases), meningitis with brain abscess (1 case), and encephalomyelitis (3 cases).
- Diagnosis was confirmed by serological tests, CSF analysis, and neuroimaging.
- Patients showed a favorable response to antibiotic treatment.
Conclusions:
- Neurobrucellosis should be suspected in patients presenting with neurological deficits in endemic areas.
- A recommended treatment regimen includes intravenous rifampin and trimethoprim-sulfamethoxazole for 6-8 weeks.
- Prompt diagnosis and treatment are essential for managing this serious complication of brucellosis.