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Paediatric neurobrucellosis: case report and literature review
Y K Habeeb1, A K Al-Najdi, S A Sadek
1Department of Paediatrics, Adan Hospital, Kuwait.
Abstract:
Neurological complications are rare in childhood brucellosis: there are only 33 reported cases. In children, neurobrucellosis is usually of acute presentation involving the central nervous system. We report our experience with an 8-year-old boy with brucella meningitis who demonstrated a Jarisch-Herxheimer-like reaction, i.e. initial clinical deterioration following the commencement of antibrucella treatment, associated with increased pleocytosis and shift from lymphocytic to polymorphic predominance and an already increased CSF lactate. These CSF findings have not been previously described. The patient recovered completely after 3 months' therapy consisting of rifampicin, doxycycline and gentamicin. Paediatric neurobrucellosis therapy should be a combination of three antibrucella antibiotic that include an aminoglycoside; for a period of 8-12 weeks, steroids may be added to treat complications. The prognosis of neurobrucellosis in children is usually good.
Insights
Childhood neurobrucellosis, a rare central nervous system complication, can present with a Jarisch-Herxheimer-like reaction. Prompt triple-antibiotic therapy ensures a good prognosis in pediatric cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Neurobrucellosis is a rare neurological complication of brucellosis, particularly in children.
- Cases in pediatric populations typically present with acute central nervous system involvement.
Observation:
- This report details an 8-year-old boy with brucella meningitis.
- He experienced a Jarisch-Herxheimer-like reaction, marked by initial clinical worsening after antibiotic initiation.
Findings:
- The patient exhibited increased cerebrospinal fluid (CSF) pleocytosis and a shift from lymphocytic to polymorphonuclear predominance.
- Notably, elevated CSF lactate was observed, with these specific CSF changes being previously undescribed in pediatric neurobrucellosis.
Implications:
- Effective treatment involves a combination of three antibiotics, including an aminoglycoside, for 8-12 weeks.
- Corticosteroids may be beneficial for managing complications, and the overall prognosis for pediatric neurobrucellosis is generally favorable.