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Arazi F, Haddad M, Sheybani F, Farzadfard MT, Rezaeian MK. Neurobrucellosis: a retrospective cohort of 106 patients. Trop Med Health 2025; 53:9. [PMID: 39815371 PMCID: PMC11737133 DOI: 10.1186/s41182-025-00680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 01/01/2025] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND Neurobrucellosis, a serious central nervous system infection caused by Brucella species, presents significant challenges due to its diverse clinical manifestations and the risk of long-term complications and poor outcomes. Identifying predictors of adverse outcomes is critical for improving patient management and overall prognosis. OBJECTIVES This study aimed to evaluate the long-term morbidity and mortality associated with neurobrucellosis and to identify key predictors of adverse outcomes. METHODS We performed a retrospective cohort study of 106 neurobrucellosis patients treated at two major referral centers in Mashhad, Iran, from March 21, 2011, to March 20, 2022. We analyzed clinical, neuroimaging, and laboratory data, and estimated survival probabilities using Kaplan-Meier analysis. Long-term morbidity was evaluated using the Glasgow Outcome Scale. RESULTS The median age of the cohort was 30 years (IQR: 21.8-46.3). The median length of hospital stay was 11 days (IQR: 7-19.8), with an in-hospital mortality rate of 4.7% (n = 5). Survival probabilities were 92.2% (SE = 0.027) at 1 month and 90.1% (SE = 0.030) at 6 months. The median follow-up duration was 52 months (IQR: 35-77). At follow-up, 23.5% (n = 20) of patients had an unfavorable outcome based on the Glasgow Outcome Scale. Predictors of mortality included older age, altered level of consciousness, seizures, elevated body temperature on admission, and white matter changes on neuroimaging. CONCLUSION Neurobrucellosis is associated with significant long-term morbidity and mortality. Key predictors of mortality include older age, altered level of consciousness, seizures, elevated body temperature on admission, and white matter changes. Identifying these predictors can help in targeting therapeutic strategies and improving patient outcomes through early intervention and close monitoring.
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Affiliation(s)
- Fatemeh Arazi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahboubeh Haddad
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshte Sheybani
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Majid Khadem Rezaeian
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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2
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Deng L, Yu J, Li H, Zhang H. Brucella as a cause of severe sepsis: Case series and brief review. Am J Med Sci 2025; 369:116-121. [PMID: 39084524 DOI: 10.1016/j.amjms.2024.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 07/17/2024] [Accepted: 07/26/2024] [Indexed: 08/02/2024]
Abstract
Brucellosis is a serious public health problem worldwide and can affect any organ system. Due to brucellosis's variable clinical presentation, ranging from subclinical to fully symptomatic, and limited available information, it poses a diagnostic challenge. In this study, we reported a case series of patients with diverse presentations. In addition, we briefly described the pathophysiology and mechanisms of Brucella in the body. These case presentations will be valuable in increasing the awareness of physicians. A prompt diagnosis is crucial, as detecting some clues of the infection in its early stages can help avoid misdiagnoses.
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Affiliation(s)
- Linlin Deng
- Department of Clinical Laboratory, Nanchong Central Hospital, Sichuan, China.
| | - Jiazhen Yu
- Department of Clinical Laboratory, Nanchong Central Hospital, Sichuan, China
| | - Hongyan Li
- Department of Clinical Laboratory, Nanchong Central Hospital, Sichuan, China
| | - Hong Zhang
- Department of Clinical Laboratory, Nanchong Central Hospital, Sichuan, China
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3
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Fusetti C, Petri F, Murad MH, Merli S, Giorgi R, Rizzardini G, Gori A, Passerini M. Neurobrucellosis Presenting with Motor Damage or Hearing Loss, and Use of Steroids are Associated with a Higher Risk of Sequelae or Relapse: A Systematic Review of Individual Participant Data. Neurol Sci 2024; 45:5441-5448. [PMID: 38858237 PMCID: PMC11470871 DOI: 10.1007/s10072-024-07621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Neurobrucellosis presents diverse clinical challenges and risks of long-term complications. OBJECTIVE We aimed to assess the relationship between the duration of antibiotic therapy, clinical factors, and the outcome of neurobrucellosis with a case report combined with a systematic review of the literature. METHODS We present a case of a 31 years-old man successfully treated at our Institution. We then searched Ovid MEDLINE, Embase and Scopus for articles that encompassed neurobrucellosis cases, duration of treatment, and outcome. The primary outcome was to assess an association between the duration of treatment and the risk of sequelae or relapses. Univariate, multivariate and sensitivity analysis were carried out to define which variables affected the clinical outcome. Quality assessment was performed using a dedicated tool. RESULTS A total of 123 studies were included, totaling 221 patients. Median duration of treatment was 4 months (IQR 3 - 6), 69% patients recovered without sequelae, 27% had sequelae. Additionally, five patients had a relapse, and 4 patients died. Multivariate analysis found that the duration of treatment, age, and the use of ceftriaxone were not associated with a higher risk of sequelae or relapses. A significant association was found for corticosteroids use (OR 0.39, 95% IC 0.16 - 0.96, p = 0.038), motor impairment (OR 0.29, 95% IC 0.14 - 0.62, p = 0.002), and hearing loss (OR 0.037, 95% IC 0.01 - 0.11, p < 0.001). CONCLUSIONS This study highlights the variability in clinical presentations and treatment approaches for neurobrucellosis. Patients with factors indicating higher sequelae risk require meticulous follow-up.
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Affiliation(s)
- Chiara Fusetti
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Via Giovanni Battista Grassi N. 74, 20157, Milan, Italy
| | - Francesco Petri
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Via Giovanni Battista Grassi N. 74, 20157, Milan, Italy.
- Department of Medicine, Mayo Clinic, Division of Public Health, Infectious Diseases and Occupational Medicine, 200 1St St SW, Rochester, MN, 55905, USA.
| | - Mohammad H Murad
- Department of Medicine, Mayo Clinic, Division of Public Health, Infectious Diseases and Occupational Medicine, 200 1St St SW, Rochester, MN, 55905, USA
- Evidence-Based Practice Center, Mayo Clinic, 200 1St St SW, Rochester, MN, 55905, USA
| | - Stefania Merli
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Via Giovanni Battista Grassi N. 74, 20157, Milan, Italy
| | - Riccardo Giorgi
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Via Giovanni Battista Grassi N. 74, 20157, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Via Giovanni Battista Grassi N. 74, 20157, Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Via Giovanni Battista Grassi N. 74, 20157, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza N. 35, 20122, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Via Francesco Sforza N. 35, 20122, Milan, Italy
| | - Matteo Passerini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Via Giovanni Battista Grassi N. 74, 20157, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza N. 35, 20122, Milan, Italy
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Aslan Tuncay S, Akkoc G, Yilmaz S, Parlak B, Canizci Erdemli P, Dizi Isik A, Kepenekli E. Case Report: Brucellosis Mimicking Tuberculous Meningitis in a Child. Am J Trop Med Hyg 2024; 111:853-855. [PMID: 39137749 PMCID: PMC11448518 DOI: 10.4269/ajtmh.23-0715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 05/06/2024] [Indexed: 08/15/2024] Open
Abstract
Neurobrucellosis is rare in children, presenting with a variety of clinical manifestations, including meningitis, meningoencephalitis, cranial neuropathies, and intracranial mass-like lesions. We present a case of a 17-year-old girl admitted to the hospital in Istanbul for headache. Lumbar puncture showed elevated intracranial pressure, monocytic pleocytosis, elevated total protein, and hypoglycorrhachia. Brucella melitensis grew from the cerebrospinal fluid. The patient was treated with doxycycline, rifampin, amikacin, and ceftriaxone and showed persistent sensorineural hearing loss. It is essential to consider brucellosis in the differential diagnosis of infectious neurological disease in areas where the disease is endemic. Serologic tests and cultures are needed for diagnosis, and efforts need to be made to identify the infecting organism to the species level to guide zoonotic source control efforts.
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Affiliation(s)
- Sevgi Aslan Tuncay
- Marmara University School of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Gulsen Akkoc
- Marmara University School of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Seyhan Yilmaz
- Marmara University School of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Burcu Parlak
- Marmara University School of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Pinar Canizci Erdemli
- Marmara University School of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Aylin Dizi Isik
- Marmara University School of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Eda Kepenekli
- Marmara University School of Medicine, Department of Pediatric Infectious Diseases, Istanbul, Turkey
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Salcedo AS, Carreras X, Kobayashi T, Salinas JL, Muñoz S, Diaz N, Alave J. Case Report: Neurobrucellosis Presenting as Malignancy. Am J Trop Med Hyg 2024; 111:312-316. [PMID: 38861982 PMCID: PMC11310615 DOI: 10.4269/ajtmh.23-0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/01/2024] [Indexed: 06/13/2024] Open
Abstract
Neurobrucellosis, caused by Brucella species, is a zoonotic infection that may involve the central nervous system. Although uncommon, it can manifest as a solitary intracranial mass. We report a case of neurobrucellosis in a 25-year-old woman from Peru who presented with headache, weight loss, and right-side hemiparesis and paresthesia. A contrast-enhanced magnetic resonance imaging scan revealed an intracerebral mass in the left temporal lobe. Serum testing subsequently were positive. Brain biopsy demonstrated non-necrotizing granulomas without malignant cells. Neurobrucellosis should be considered in the differential diagnosis of brain space occupying lesions in endemic countries.
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Affiliation(s)
| | | | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | | | - Nelson Diaz
- Universidad Peruana Union, Lima, Peru and Clinica Good Hope, Lima, Peru
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Tajerian A, Sofian M, Zarinfar N, Ramezani A. Manifestations, complications, and treatment of neurobrucellosis: a systematic review and meta-analysis. Int J Neurosci 2024; 134:256-266. [PMID: 35930502 DOI: 10.1080/00207454.2022.2100776] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Central nervous system involvement by Brucella species is the most morbid form of brucellosis disease. Studies on neurobrucellosis are scarce and limited to case reports and series. Brucella is unable to infect or harm neurons without the assistance of monocytes. This raises the question of whether ceftriaxone-based regimens are effective. METHODS The primary aim of this study was to identify, evaluate, and summarize the findings of all relevant individual studies in the past 30 years to help better understand the disease. To achieve this, a broad systematic search was undertaken to identify all relevant records. Epidemiological and clinical features of the disease were assessed by the pooled analysis of descriptive studies. Through a meta-analysis, the treatment period duration was compared between the ceftriaxone-based and oral regimens using Standardized mean differences to measure effect size. RESULTS 448 patients were included in the Meta-analyses from 5 studies. A moderate positive effect was found for ceftriaxone-based regimens over oral treatments, and there was a significant difference between these two groups (SMD 0.428, 95% CI -0.63 to -0.22, I 2 = 37.64). Neurobrucellosis has a different clinical picture in pediatric patients. The disease is less chronic in children. Fever, nausea and vomiting, fatigue, and abdominal pain were significantly more prevalent symptoms in children, and Convulsions, ascites, sensorineural hearing loss, and papilledema were significantly more prevalent signs in children than adults. CONCLUSION It is recommended to initiate the treatment of neurobrucellosis with IV ceftriaxone therapy in combination with oral therapy.
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Affiliation(s)
- Amin Tajerian
- Infectious Diseases Research Center (IDRC), Arak University of medical sciences, Arak, Iran
| | - Masoomeh Sofian
- Infectious Diseases Research Center (IDRC), Arak University of medical sciences, Arak, Iran
| | - Nader Zarinfar
- Infectious Diseases Research Center (IDRC), Arak University of medical sciences, Arak, Iran
| | - Amitis Ramezani
- Infectious Diseases Research Center (IDRC), Arak University of medical sciences, Arak, Iran
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Shirazinia M, Sheybani F, Naderi H, Haddad M, Hajipour P, Khoroushi F. Chronic meningitis in adults: a comparison between neurotuberculosis and neurobrucellosis. BMC Infect Dis 2024; 24:441. [PMID: 38664652 PMCID: PMC11046744 DOI: 10.1186/s12879-024-09345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In regions endemic for tuberculosis and brucellosis, distinguishing between tuberculous meningitis (TBM) and brucella meningitis (BM) poses a substantial challenge. This study investigates the clinical and paraclinical characteristics of patients with TBM and BM. METHODS Adult patients diagnosed with either TBM or BM who were admitted to two referral hospitals between March 2015 and October 2022, were included, and the characteristics of the patients were analyzed. RESULTS Seventy patients formed the study group, 28 with TBM and 42 with BM, were included. TBM patients had a 2.06-fold (95% CI: 1.26 to 3.37, P-value: 0.003) higher risk of altered consciousness and a 4.80-fold (95% CI: 1.98 to 11.61, P-value: < 0.001) higher risk of extra-neural involvement as compared to BM patients. Cerebrospinal fluid (CSF) analysis revealed a significantly higher percentage of polymorphonuclear leukocytes (PMN) in TBM compared to BM (Standardized mean difference: 0.69, 95% CI: 0.18 to 1.20, P-value: 0.008). Neuroimaging findings indicated higher risks of hydrocephalus (P-value: 0.002), infarction (P-value: 0.029), and meningeal enhancement (P-value: 0.012) in TBM compared to BM. Moreover, TBM patients had a 67% (95% CI: 21% to 131%, P-value:0.002) longer median length of hospital stay and a significantly higher risk of unfavorable outcomes (Risk ratio: 6.96, 95% CI: 2.65 to 18.26, p < 0.001). CONCLUSIONS Our study emphasizes that TBM patients displayed increased frequencies of altered consciousness, PMN dominance in CSF, extra-neural involvement, hydrocephalus, meningeal enhancement, and brain infarction. The findings emphasize the diagnostic difficulties and underscore the importance of cautious differentiation between these two conditions to guide appropriate treatment strategies.
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Affiliation(s)
- Matin Shirazinia
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshte Sheybani
- Department of Infectious Diseases and Tropical Medicine, Imam Reza Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Daneshgah Street, Mashhad, Iran.
| | - HamidReza Naderi
- Department of Infectious Diseases and Tropical Medicine, Imam Reza Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Daneshgah Street, Mashhad, Iran
| | - Mahboubeh Haddad
- Department of Infectious Diseases and Tropical Medicine, Imam Reza Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Daneshgah Street, Mashhad, Iran
| | - Pouria Hajipour
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Khoroushi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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8
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Yilmaz BZ, Metin Akcan Ö, Genceli M, Oltulu R. A Rare Pediatric Case of Neurobrucellosis With Cerebral Salt Wasting. Pediatr Infect Dis J 2024; 43:e20-e21. [PMID: 37922478 DOI: 10.1097/inf.0000000000004151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
The central nervous system involvement is a serious complication of brucellosis, which is known as neurobrucellosis, although rare. Here we report a 14-year-old case who developed neurobrucellosis and presented with cerebral salt wasting. As far as we know, our case is the first pediatric case of cerebral salt wasting caused by neurobrucellosis. Clinical manifestations of our patient have completely improved with treatment for Brucella.
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Affiliation(s)
- Busra Zeynep Yilmaz
- From the Department of Pediatrics, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Özge Metin Akcan
- Departments of Pediatric Infectious Diseases, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Mustafa Genceli
- Departments of Pediatric Infectious Diseases, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Refik Oltulu
- Departments of Ophthalmology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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Chen X, Yang FB, Liang JY. Brucellosis presenting with pancytopenia and hearing loss: A case report. World J Clin Cases 2023; 11:5187-5192. [PMID: 37583865 PMCID: PMC10424010 DOI: 10.12998/wjcc.v11.i21.5187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Brucellosis is one of the most common zoonotic infectious diseases in the world, with approximately 500000 new cases of human brucellosis diagnosed each year. Brucellosis can simulate various multi-system diseases, presenting atypical symptoms. Very few brucellosis cases with pancytopenia accompanied by a severe hearing loss have been reported. In the literature review, we could find only one similar case reported in the past. Moreover, this disease is easily misdiagnosed as a blood system disease leading to delayed treatment. Thus, it is important to improve clinicians' awareness of this disease. CASE SUMMARY A 64-year-old woman presented with dizziness and fatigue, accompanied by pancytopenia and severe hearing loss. Brucella melitensis was identified on blood culture. Anti-infective therapy with rifampicin (900 mg/d) and doxycycline (100 mg twice a day) was prescribed for 4 mo along with ceftriaxone 2 g/d for 1 mo. The patient showed a good response to antibiotic therapy. Her blood counts returned to normal followed by significant improvement in hearing. CONCLUSION Brucellosis should be considered in the differential diagnosis of patients presenting with pancytopenia and hearing loss.
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Affiliation(s)
- Xing Chen
- Department of Infection, Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
| | - Feng-Bo Yang
- Department of Otolaryngology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jian-Ying Liang
- Department of Infection, Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
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Ghanem-Zoubi N, Kagna O, Dabaja-Younis H, Atarieh M, Nasrallah E, Kassis I, Keidar Z, Paul M. The Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Management of Brucellosis: An Observational Cohort Study. Open Forum Infect Dis 2023; 10:ofac704. [PMID: 36686638 PMCID: PMC9846188 DOI: 10.1093/ofid/ofac704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
Background Diagnosis of focal infection in brucellosis is important to direct optimal treatment. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) may be helpful in this aspect. Methods The clinical and imaging data of all patients with brucellosis, who underwent FDG PET/CT as part of the investigation in Rambam Health Care Campus, where FDG PET/CT became the recommended imaging modality for suspected focal infection in brucellosis since 2016, were analyzed retrospectively. The detection of focal infection as well as management modification before and after FDG PET/CT were recorded. Results FDG PET/CT was performed in 30 episodes of brucellosis occurring in 27 patients: 20 primary episodes and 10 suspected relapse episodes. The mean age of the patients was 50 ± 15.07 years. Focal disease was diagnosed in 18 of 30 (60%) episodes, of which 8 (26.6%) were diagnosed for the first time by FDG PET/CT, all of whom had spinal infection, with a concomitant additional focus in 5. Overall, multifocal disease was diagnosed in 10 of 18 (55.5%) of patients with focal disease. Management modification following FDG PET/CT was recorded in 17 of 30 (56.6%) episodes, mainly by treatment extension in spinal infection and withholding treatment in patients with suspected relapse but no evidence of active disease by FDG PET/CT. Conclusions FDG PET/CT was found to be helpful in the diagnosis of focal infection in brucellosis. Multifocal disease seems more prevalent than previously described. The clinical impact of adding FDG PET/CT to the diagnostic workup of brucellosis should be evaluated in future studies.
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Affiliation(s)
- Nesrin Ghanem-Zoubi
- Correspondence: Nesrin Ghanem-Zoubi, MD, Infectious Diseases Institute, Rambam Health Care Campus, Ha-Aliya 8 St, Haifa 3109601, Israel ()
| | - Olga Kagna
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel,Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Halima Dabaja-Younis
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel,Pediatric Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Menas Atarieh
- Internal Medicine Department A, Rambam Health Care Campus, Haifa, Israel
| | - Elias Nasrallah
- Pediatric Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Imad Kassis
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel,Pediatric Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Zohar Keidar
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel,Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
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11
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Ma C, Li H, Lu S, Li X, Wang S, Wang W. Ocular Lesions in Brucella Infection: A Review of the Literature. Infect Drug Resist 2022; 15:7601-7617. [PMID: 36579126 PMCID: PMC9791996 DOI: 10.2147/idr.s394497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Ocular lesions due to Brucella infection are uncommon and easily overlooked in clinical management, but must be differentiated from non-infectious eye diseases and treated promptly to protect the patient's vision. We reviewed the relevant literature and identified 47 patients with ocular complications of Brucella infection. Among them, 28 showed ocular neuropathy, 15 presented with uveitis, and four patients displayed other ocular symptoms. Ocular symptoms accompanying Brucella infection require prompt diagnosis and treatment. The main methods of diagnosis are intraocular fluid tests and blood tests. Early diagnosis and treatment with suitable antibiotics are central to protecting the patient's vision. Notably, in terms of mechanism of injury, Brucella infection is chronic and cannot be eliminated by phagocytes, and can cause damage to the eye by inducing autoimmune reactions, antigen-antibody complex production, release of endogenous and exogenous toxins, and bacterial production of septic thrombi in the tissues. In this review, we summarize the ocular symptoms, diagnosis, treatment and prognosis of Brucella infection, and discuss the mechanisms of Brucella in ocular lesions, providing a reference for the diagnosis and treatment of Brucella ocular lesions.
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Affiliation(s)
- Chao Ma
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Haoyu Li
- Department of Ophthalmology, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China,Hunan Clinical Research Centre of Ophthalmic Disease, Changsha, Hunan, People’s Republic of China
| | - Shuwen Lu
- Department of Ophthalmology, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People’s Republic of China
| | - Xian Li
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, England,School of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, England
| | - Shuai Wang
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Wenzhan Wang
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China,Correspondence: Wenzhan Wang, Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, Henan, 450052, People’s Republic of China, Tel +86 371-66278091, Email
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12
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Luan H, Liu K, Deng X, Sheng W, Mamat M, Guo H, Li H, Deng Q. One-stage posterior surgery combined with anti-Brucella therapy in the management of lumbosacral brucellosis spondylitis: a retrospective study. BMC Surg 2022; 22:394. [DOI: 10.1186/s12893-022-01847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
This study aimed to assess the clinical efficacy of one-stage posterior surgery combined with anti-Brucella therapy in the treatment of lumbosacral brucellosis spondylitis (LBS).
Methods
From June 2010 to June 2020, the clinical and radiographic data of patients with LBS treated by one-stage posterior surgery combined with anti-Brucella therapy were retrospectively analyzed. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) and Oswestry Disability Index scores (ODI) were used to evaluate the clinical outcomes. Frankel’s classification system was employed to access the initial and final neurologic function. Fusion of the bone grafting was classified by Bridwell’s grading system.
Results
A total of 55 patients were included in this study with a mean postoperative follow-up time of 2.6 ± 0.8 years (range, 2 to 5). There were 40 males and 15 females with a mean age of 39.8 ± 14.7 years (range, 27 to 57). The Brucella agglutination test was ≥ 1:160 in all patients, but the blood culture was positive in 43 patients (78.1%). A statistical difference was observed in ESR, CRP, VAS, ODI, and JOA between preoperative and final follow-up (P < 0.05). Neurological function was significantly improved in 20 patients with preoperative neurological dysfunction after surgery. According to Bridwell’s grading system, the fusion of bone grafting in 48 cases (87.2%) was defined as grade I, and grade II in 7 cases (12.7%). None of the infestation recurrences was observed.
Conclusion
One-stage posterior surgery combined with anti-Brucella therapy was a practical method in the treatment of LBS with severe neurological compression and spinal sagittal imbalance.
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13
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Tscherne A, Mantel E, Boskani T, Budniak S, Elschner M, Fasanella A, Feruglio SL, Galante D, Giske CG, Grunow R, Henczko J, Hinz C, Iwaniak W, Jacob D, Kedrak-Jablonska A, Jensen VK, Johansen TB, Kahlmeter G, Manzulli V, Matuschek E, Melzer F, Nuncio MS, Papaparaskevas J, Pelerito A, Solheim M, Thomann S, Tsakris A, Wahab T, Weiner M, Zoeller L, Zange S. Adaptation of Brucella melitensis Antimicrobial Susceptibility Testing to the ISO 20776 Standard and Validation of the Method. Microorganisms 2022; 10:1470. [PMID: 35889189 PMCID: PMC9316112 DOI: 10.3390/microorganisms10071470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 12/10/2022] Open
Abstract
Brucellosis, mainly caused by Brucella (B.) melitensis, is associated with a risk of chronification and relapses. Antimicrobial susceptibility testing (AST) standards for B. melitensis are not available, and the agent is not yet listed in the EUCAST breakpoint tables. CLSI recommendations for B. melitensis exist, but they do not fulfill the requirements of the ISO 20776 standard regarding the culture medium and the incubation conditions. Under the third EU Health Programme, laboratories specializing in the diagnostics of highly pathogenic bacteria in their respective countries formed a working group within a Joint Action aiming to develop a suitable method for the AST of B. melitensis. Under the supervision of EUCAST representatives, this working group adapted the CLSI M45 document to the ISO 20776 standard after testing and validation. These adaptations included the comparison of various culture media, culture conditions and AST methods. A Standard Operation Procedure was derived and an interlaboratory validation was performed in order to evaluate the method. The results showed pros and cons for both of the two methods but also indicate that it is not necessary to abandon Mueller-Hinton without additives for the AST of B. melitensis.
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Affiliation(s)
- Alina Tscherne
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany; (A.T.); (E.M.); (C.H.); (L.Z.)
- Division of Virology, Department of Veterinary Sciences, LMU Munich, Veterinärstrasse 13, 80539 Munich, Germany
| | - Enrico Mantel
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany; (A.T.); (E.M.); (C.H.); (L.Z.)
| | - Talar Boskani
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; (T.B.); (T.W.)
| | - Sylwia Budniak
- National Veterinary Research Institute, 57 Partyzantów Avenue, 24-100 Pulawy, Poland; (S.B.); (A.K.-J.); (M.W.)
| | - Mandy Elschner
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Bacterial Infections and Zoonoses, Naumburger Strasse 96a, 07743 Jena, Germany; (M.E.); (F.M.)
| | - Antonio Fasanella
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, 20 Manfredonia Street, 72121 Foggia, Italy; (A.F.); (D.G.); (V.M.)
| | - Siri L. Feruglio
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway; (S.L.F.); (V.K.J.); (T.B.J.); (M.S.)
| | - Domenico Galante
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, 20 Manfredonia Street, 72121 Foggia, Italy; (A.F.); (D.G.); (V.M.)
| | - Christian G. Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, 141 52 Stockholm, Sweden;
| | - Roland Grunow
- Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany; (R.G.); (D.J.)
| | - Judit Henczko
- National Public Health Center, Albert Flórián út 2-6, 1097 Budapest, Hungary;
| | - Christin Hinz
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany; (A.T.); (E.M.); (C.H.); (L.Z.)
| | | | - Daniela Jacob
- Highly Pathogenic Microorganisms, Centre for Biological Threats and Special Pathogens, Division 2 (ZBS 2), Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany; (R.G.); (D.J.)
| | - Agnieszka Kedrak-Jablonska
- National Veterinary Research Institute, 57 Partyzantów Avenue, 24-100 Pulawy, Poland; (S.B.); (A.K.-J.); (M.W.)
| | - Veronica K. Jensen
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway; (S.L.F.); (V.K.J.); (T.B.J.); (M.S.)
| | - Tone B. Johansen
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway; (S.L.F.); (V.K.J.); (T.B.J.); (M.S.)
| | - Gunnar Kahlmeter
- EUCAST Development Laboratory (EDL) for Bacteria, 351 85 Växjö, Sweden; (G.K.); (E.M.)
| | - Viviana Manzulli
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, 20 Manfredonia Street, 72121 Foggia, Italy; (A.F.); (D.G.); (V.M.)
| | - Erika Matuschek
- EUCAST Development Laboratory (EDL) for Bacteria, 351 85 Växjö, Sweden; (G.K.); (E.M.)
| | - Falk Melzer
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Bacterial Infections and Zoonoses, Naumburger Strasse 96a, 07743 Jena, Germany; (M.E.); (F.M.)
| | - Maria S. Nuncio
- National Institute of Health, Av. Padre Cruz, 1649-016 Lisbon, Portugal; (M.S.N.); (A.P.)
| | - Joseph Papaparaskevas
- Microbiology Department, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (J.P.); (A.T.)
| | - Ana Pelerito
- National Institute of Health, Av. Padre Cruz, 1649-016 Lisbon, Portugal; (M.S.N.); (A.P.)
| | - Margrete Solheim
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway; (S.L.F.); (V.K.J.); (T.B.J.); (M.S.)
| | | | - Athanasios Tsakris
- Microbiology Department, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (J.P.); (A.T.)
| | - Tara Wahab
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; (T.B.); (T.W.)
| | - Marcin Weiner
- National Veterinary Research Institute, 57 Partyzantów Avenue, 24-100 Pulawy, Poland; (S.B.); (A.K.-J.); (M.W.)
| | - Lothar Zoeller
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany; (A.T.); (E.M.); (C.H.); (L.Z.)
| | - Sabine Zange
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany; (A.T.); (E.M.); (C.H.); (L.Z.)
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14
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An Unusual Case of Neurobrucellosis Presenting as Acute Flaccid Paralysis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Sarmiento Clemente A, Amerson-Brown MH, Foster CE. An Adolescent With Neurobrucellosis Caused by Brucella abortus Cattle Vaccine Strain RB51. Pediatr Infect Dis J 2021; 40:e353-e355. [PMID: 34260490 DOI: 10.1097/inf.0000000000003200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present the case of an 18-year-old female with a 1-month history of fever, headache, and double vision, whose examination revealed papilledema and cranial nerve VI palsy. Blood cultures grew Brucella abortus cattle vaccine strain RB51, which is inherently resistant to rifampin. We discuss the management of the first known case of neurobrucellosis by this strain.
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Affiliation(s)
- Adriana Sarmiento Clemente
- From the Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Megan H Amerson-Brown
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Catherine E Foster
- From the Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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16
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Bosilkovski M, Keramat F, Arapović J. The current therapeutical strategies in human brucellosis. Infection 2021; 49:823-832. [PMID: 33650077 DOI: 10.1007/s15010-021-01586-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
Prompt and adequate treatment of human brucellosis continues to be the most important strategy in its management, as eradication of animal brucellosis is not possible so far, and there is no adequate vaccine for humans. The goal of antibrucellar treatment is to alleviate and shorten the symptomatic period and reduce complications, relapses, and chronicity. Contemporary trends in the treatment of human brucellosis are postulated on the ability of Brucellae to persist in host macrophages through the inhibition of phagolysosome fusion and to survive for prolonged periods intracellularly without restricting basic cellular functions. As a result of this and despite satisfactory antibiotic treatment, relapses and therapeutical failures are inevitable to a certain degree. The current principles for the treatment of brucellosis advocate for a long enough treatment duration combined with antimicrobial regimens that possess activity in the intracellular acidic environment. In the future, other antimicrobial agents, immunomodulation, decrease in the intracellular acidic environment, or development of agents that would act on well-defined molecular bacterial targets, might be incorporated to improve the therapeutical effects.
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Affiliation(s)
- Mile Bosilkovski
- Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, University Clinic for Infectious Diseases, Skopje, Republic of North Macedonia.
- Working Group On Zoonoses, International Society for Chemotherapy, Aberdeen, UK.
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Fariba Keramat
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jurica Arapović
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.
- Faculty of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina.
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17
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Kutlu M, Ergönül Ö. Neurobrucellosis. CURRENT CLINICAL NEUROLOGY 2021:95-110. [DOI: 10.1007/978-3-030-56084-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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18
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Abstract
Brucellosis is a common Zoonosis affecting half a million people annually. The most common mode of infection is by consuming unpasteurized milk or milk products. The general manifestations are those of fever with generalized symptoms. The nervous system is affected in 4-7% of cases. The manifestations are protean and include meningo-encephalitis as well as peripheral nervous system involvement. The diagnosis relies on culture, which is cumbersome and can be falsely negative. Agglutination tests for the various species of the organism are the mainstay for diagnosis. Treatment is for 3-6 months with combination therapy including Doxycycline, Rifampicin and ceftriaxone. The main issue is prevention and better animal husbandry.
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Affiliation(s)
- Raad Shakir
- Division of Brain Sciences, Imperial College, London, UK.
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19
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Powers HR, Nelson JR, Alvarez S, Mendez JC. Neurobrucellosis associated with feral swine hunting in the southern United States. BMJ Case Rep 2020; 13:13/12/e238216. [PMID: 33370950 DOI: 10.1136/bcr-2020-238216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although uncommon, Brucella infection can occur outside the areas of high endemicity, such as the USA. In the southern USA, hunters of wild swine are at risk for brucellosis. We present a case of a patient with fever, headache and constitutional symptoms that were ongoing for 11 months. He was diagnosed with neurobrucellosis. The patient was treated successfully with intravenous ceftriaxone, oral doxycycline and oral rifampin therapy. He had persistent neurological sequelae after completing treatment. This case illustrates the high index of suspicion needed to diagnose neurobrucellosis in a non-endemic country because initial symptoms can be subtle. The disease can be treated successfully, but long-lasting neurological sequelae are common.
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Affiliation(s)
- Harry Ross Powers
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Jared R Nelson
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Salvador Alvarez
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Julio C Mendez
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
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20
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Esmael A, Elsherif M, Elegezy M, Egilla H. Cognitive impairment and neuropsychiatric manifestations of neurobrucellosis. Neurol Res 2020; 43:1-8. [PMID: 32856546 DOI: 10.1080/01616412.2020.1812805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM This study aimed to reveal insight into the unclear areas of the diagnosis in neurobrucellosis and to decide the neuropsychiatric manifestations and cognitive impairment among patients with brucellosis. METHODS 82 patients with serologically confirmed brucellosis were included and divided into two groups according to the neuropsychiatric manifestations, the first group included 18 patients with neurobrucellosis and the second group included 64 patients with non-neurobrucellosis. Both groups were compared regarding the general symptoms and neurological symptoms and signs. Cognitive impairment in both groups was assessed by Montreal-Cognitive Assessment (MoCA), Wechsler Memory Scale-Revised (WMS-R), and forward and backward digital test. Also, depression and anxiety were assessed by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). RESULTS 18 (21.9%) patients were diagnosed as neurobrucellosis and 64 (78.1%) patients were diagnosed as non-neurobrucellosis. The mean age of the total patients was 34.91 ± 14.74, consisted of 45 males and 37. Most of the patients were living in rural areas 60 patients (74.4%). The most significantly higher neurological symptoms in neurobrucellosis patients were confusion and headache (P = 0.008 and P = 0.01, respectively). While the most significant higher neurological signs were loss of orientation (P = 0.009), muscle weakness (P = 0.04), neck rigidity (P < 0.05), pyramidal signs, and lost deep reflexes (P < 0.05). The neurobrucellosis patients had significantly impaired cognition in comparison with nonneurobrucellosis patients and more psychiatric signs like behavioral changes, anxiety, and depression (P < 0.001, P < 0.001, and P = 0.01, respectively). CONCLUSIONS Patients with neuropsychiatric manifestations and cognitive impairment should be considered for neurobrucellosis and should receive proper therapy.
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Affiliation(s)
- Ahmed Esmael
- Neurology Department, Mansoura University Hospital , Mansoura, Egypt
| | - Mohamed Elsherif
- Neurology Department, Mansoura University Hospital , Mansoura, Egypt
| | - Mohamed Elegezy
- Tropical Medicine Department, Mansoura University , Mansoura, Egypt
| | - Hosam Egilla
- Neurology Department, Mansoura University Hospital , Mansoura, Egypt
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21
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Ata F, Yousaf Z, Sharif MK, Abdallah A. Demyelinating steroid-responsive neurobrucellosis. BMJ Case Rep 2020; 13:13/3/e233798. [PMID: 32152068 DOI: 10.1136/bcr-2019-233798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Young man with acute onset nausea, vomiting, joint pain, abdominal pain, fever and weight loss was found to have gait ataxia and positive B rucella titres. He deteriorated despite appropriate antibiotics and developed confusion and disorientation. Lumbar puncture revealed lymphocytosis with high protein and low glucose. MRI showed diffuse demyelination. Pulse steroids resulted in rapid clinical, biochemical and radiological recovery.
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Affiliation(s)
- Fateen Ata
- Internal Medicine, Department of Medical Education, Hamad General Hospital,Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Internal Medicine, Department of Medical Education, Hamad General Hospital,Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Abdallah
- Internal Medicine, Department of Medical Education, Hamad General Hospital,Hamad Medical Corporation, Doha, Qatar
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22
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Fatani DF, Alsanoosi WA, Badawi MA, Thabit AK. Ceftriaxone use in brucellosis: A case series. IDCases 2019; 18:e00633. [PMID: 31534908 PMCID: PMC6744365 DOI: 10.1016/j.idcr.2019.e00633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/23/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022] Open
Abstract
Background Brucellosis is a zoonotic disease caused by Brucella spp. It can be either uncomplicated or complicated when it disseminates to other organs. Treatment for brucellosis involves a combination of at least two antibiotics, or more in complicated brucellosis. Limited data exist on the use of ceftriaxone in the clinical setting. Therefore, we present patient cases in which ceftriaxone was used in brucellosis treatment regimen. Methods Patients with documented brucellosis from January 2008 to December 2018 were evaluated for the use of ceftriaxone for treatment in King Abdulaziz Univeristy Hospital, Jeddah, Saudi Arabia. Patients’ data were evaluated retrospectively and are described. Results Out of 94 treated brucellosis patients, six patients received ceftriaxone 2 g IV every 12 h for therapy for varied durations. Four had neurobrucellosis, one had Brucella epididymo-orchitis and one had uncomplicated brucellosis. All six patients experienced clinical cure, though one neurobrucellosis patient had complications and one had ceftriaxone stopped after one week of therapy due to presumed antibiotic-induced fever. Conclusion Ceftriaxone represents a reasonable option for the treatment of complicated brucellosis when added to the initial regimen at a dose of 2 g IV every 12 h.
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Affiliation(s)
- Daniah F Fatani
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Walaa A Alsanoosi
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mazen A Badawi
- Internal Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abrar K Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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23
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Inan A, Erdem H, Elaldi N, Gulsun S, Karahocagil MK, Pekok AU, Ulug M, Tekin R, Bosilkovski M, Kaya S, Haykir-Solay A, Demirdal T, Kaya S, Sunnetcioglu M, Sener A, Tosun S, Aydin E, Ural S, Yamazhan T, Muhcu M, Ayaslioglu E, Bilgic-Atli S, Erbay A, Ergen P, Kadanali A, Sahin S, Sahin-Horasan E, Avci A, Cag Y, Beeching NJ. Brucellosis in pregnancy: results of multicenter ID-IRI study. Eur J Clin Microbiol Infect Dis 2019; 38:1261-1268. [PMID: 30989418 DOI: 10.1007/s10096-019-03540-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/13/2019] [Indexed: 12/31/2022]
Abstract
Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p = 0.019), nausea and/or vomiting (p < 0.001), vaginal bleeding (p < 0.001), anemia (blood hemoglobin < 11 g/dL; p < 0.001), high level of serum aspartate aminotransferase (> 41 IU/L; p = 0.025), oligohydramnios on ultrasonography (p = 0.0002), history of taking medication other than Brucella treatment during pregnancy (p = 0.027), and Brucella bacteremia (p = 0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.
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Affiliation(s)
- Asuman Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Hakan Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey.
| | - Nazif Elaldi
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Serda Gulsun
- Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Mustafa K Karahocagil
- Department of Infectious Diseases and Clinical Microbiology, Yuzuncuyil University School of Medicine, Van, Turkey
| | - Abdullah U Pekok
- Department of Infectious Diseases and Clinical Microbiology, Pendik Medical Park Hospital, Istanbul, Turkey
| | - Mehmet Ulug
- Department of Infectious Diseases and Clinical Microbiology, Private Umut Hospital, Eskisehir, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Sivas, Turkey
| | - Mile Bosilkovski
- Department of Infectious Diseases and Febrile Conditions, Skopje Medical Faculty, Skopje, Republic of Macedonia
| | - Safak Kaya
- Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Asli Haykir-Solay
- Department of Infectious Diseases and Clinical Microbiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Tuna Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Selcuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Mahmut Sunnetcioglu
- Department of Infectious Diseases and Clinical Microbiology, Yuzuncuyil University School of Medicine, Van, Turkey
| | - Alper Sener
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Selma Tosun
- Department of Infectious diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Emsal Aydin
- Department of Infectious Diseases and Clinical Microbiology, Kafkas University School of Medicine, Kars, Turkey
| | - Serap Ural
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Tansu Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - Murat Muhcu
- Department of Obstetrics and Gynecology, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ergin Ayaslioglu
- Department of Infectious Diseases and Clinical Microbiology, Kirikkale University School of Medicine, Kırıkkale, Turkey
| | - Seval Bilgic-Atli
- Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Ayse Erbay
- Department of Infectious Diseases and Clinical Microbiology, Bozok University School of Medicine, Yozgat, Turkey
| | - Pinar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ayten Kadanali
- Department of Radiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Suzan Sahin
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Elif Sahin-Horasan
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - Ali Avci
- Department of Urology, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yakup Cag
- Department of Infectious Diseases and Clinical Microbiology, Turkish Health Sciences University, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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24
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Abstract
Human brucellosis, one of the most common zoonoses worldwide, rarely occurs in Japan, and only a few chronic cases have been reported. We herein report the case of a 39-year-old Japanese woman with chronic human brucellosis, considered a Brucella canis infection, that persisted for 19 years. Her medical history and fever pattern suggested chronic brucellosis, and the diagnosis was made based on the results of a serum tube agglutination test (SAT). After undergoing combination therapy with streptomycin and doxycycline, she achieved symptomatic relief and showed negative SAT results. Even in non-endemic areas, chronic brucellosis is an important differential diagnosis in patients with long-term persistent fatigue or a fever.
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Affiliation(s)
- Naoki Kawakami
- Department of Respiratory Medicine, Tsuchiura Kyodo Hospital, Japan
| | - Yoko Wakai
- Department of Respiratory Medicine, Tsuchiura Kyodo Hospital, Japan
| | - Kazuhito Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo Hospital, Japan
| | - Koichi Imaoka
- Laboratory of Reservoir Control of Zoonosis, Department of Veterinary Science, National Institute of Infectious Diseases, Japan
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Abstract
PURPOSE Neurobrucellosis (NB) is a rare complication of brucellosis. NB presents with avariety of clinical manifestations, and the symptoms are always atypical. Our aim was to analyze the demographic characteristics, clinical manifestations, laboratory findings, imaging findings, treatments and outcomes of patients with NB. MATERIAL AND METHOD We retrospectively reviewed the data from 17 patients with NB hospitalized at the Chinese People's Liberation Army General Hospital between 1 January 2005 and 31 October 2016. RESULTS The following symptoms were recorded: 10/17 (59%) patients had fever, and 9/17 (53%) patients had a disorder affecting urination and defecation. Involvement of the cranial nerves was documented in 12/17 (71%) patients. The positivity rates of the tests were as follows: serum standard tube agglutination (STA), 15/17 (88.2%); cerebrospinal fluid STA, 10/17 (59%). The radiologic findings were categorized into four types: normal, white matter changes, vascular insult and inflammatory changes. Patients were treated with different combinations of rifampicin, doxycycline, ceftriaxone sodium and sulphamethoxazole for a total of six months. Two (12%) patients deteriorated, and two (12%) patients were lost to follow-up. The remaining patients (76%) were cured, but sequelae occurred in six patients. CONCLUSIONS NB should be kept in mind in patients with autonomic dysfunction, especially disorders of urination and defecation. Hearing loss due to vestibulocochlear nerve injury seems to be typical for NB. The high incidence of sequelae may be related to a long disease course and the involvement of the central nervous system. Early detection, diagnosis and treatment could decrease mortality and sequelae.
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Affiliation(s)
- Na Zheng
- a Department of Neurology , General Hospital of the People's Liberation Army , Beijing , China
| | - Wei Wang
- a Department of Neurology , General Hospital of the People's Liberation Army , Beijing , China
| | - Jia-Tang Zhang
- a Department of Neurology , General Hospital of the People's Liberation Army , Beijing , China
| | - Ya Cao
- a Department of Neurology , General Hospital of the People's Liberation Army , Beijing , China
| | - Long Shao
- a Department of Neurology , General Hospital of the People's Liberation Army , Beijing , China
| | - Jiao-Jiao Jiang
- a Department of Neurology , General Hospital of the People's Liberation Army , Beijing , China
| | - Xu-Sheng Huang
- a Department of Neurology , General Hospital of the People's Liberation Army , Beijing , China
| | - Cheng-Lin Tian
- a Department of Neurology , General Hospital of the People's Liberation Army , Beijing , China
| | - Sheng-Yuan Yu
- a Department of Neurology , General Hospital of the People's Liberation Army , Beijing , China
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Despotopoulos S, Akinosoglou K, Tzimas T, Akritidis N, Gogos C. Diagnosis of neurobrucellosis in resource-limited real-world settings: A case-series of 8 patients. J Neurol Sci 2017; 379:293-295. [DOI: 10.1016/j.jns.2017.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/11/2017] [Accepted: 06/15/2017] [Indexed: 11/27/2022]
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The clinical features of 590 patients with brucellosis in Xinjiang, China with the emphasis on the treatment of complications. PLoS Negl Trop Dis 2017; 11:e0005577. [PMID: 28459811 PMCID: PMC5426775 DOI: 10.1371/journal.pntd.0005577] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/11/2017] [Accepted: 04/17/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study aims to analyze the clinical characteristics and treatment outcomes of 590 patients with brucellosis in Xinjiang, China. METHODOLOGY AND PRINCIPAL FINDINGS The clinical characteristics, laboratory findings, complications and prognosis of 590 patients infected with brucellosis were retrospectively analyzed. These patients had a mean age of 44.24 ± 15.83 years with 60.5% having a history of close contacting with cattle and sheep. Of them, 53.6% (316 /590) were in acute phase and 21.5% were in chronic phase. Agglutination test showed 98.5% positive with 34% blood culture positive of Brucella. The major symptoms were fatigue (91%), hyperhidrosis(88.1%), fever(86.9%), and joint pain(81%) with 29.8% having enlarged liver, 26.1% having enlarged spleen and 23.2% having osteoarticular complications. Combination of doxycycline plus rifampicin for 12 weeks was an effective regimen for patients without complications. The 3-drug regimen (doxycycline+rifampicin+levofloxacin) for 12 weeks was recommended for these with complications. There were 6 patients died (1.02%) with overall relapse rate of 5.98%. CONCLUSIONS Brucellosis is mostly associated with contacting with domestic animal production in Xinjiang, China. Clinical symptoms include fever, fatigue, hyperhidrosis, and joint pain with common complication of osteoarticular involvement. Three-drug-regimen of doxycycline+rifampicin+levofloxacin for 12 weeks was effective for these patients with complications.
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Zhang J, Chen Z, Xie L, Zhao C, Zhao H, Fu C, Chen G, Hao Z, Wang L, Li W. Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection. ACTA ACUST UNITED AC 2017; 50:e5712. [PMID: 28380194 PMCID: PMC5423737 DOI: 10.1590/1414-431x20165712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/20/2016] [Indexed: 01/14/2023]
Abstract
A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.
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Affiliation(s)
- J Zhang
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - Z Chen
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - L Xie
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - C Zhao
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - H Zhao
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - C Fu
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - G Chen
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - Z Hao
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - L Wang
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - W Li
- Department of Clinical Laboratory, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
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Fillatre P, Crabol Y, Morand P, Piroth L, Honnorat J, Stahl JP, Lecuit M. Infectious encephalitis: Management without etiological diagnosis 48hours after onset. Med Mal Infect 2017; 47:236-251. [PMID: 28314470 PMCID: PMC7131623 DOI: 10.1016/j.medmal.2017.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 12/18/2022]
Abstract
Introduction The etiological diagnosis of infectious encephalitis is often not established 48 hours after onset. We aimed to review existing literature data before providing management guidelines. Method We performed a literature search on PubMed using filters such as “since 01/01/2000”, “human”, “adults”, “English or French”, and “clinical trial/review/guidelines”. We also used the Mesh search terms “encephalitis/therapy” and “encephalitis/diagnosis”. Results With Mesh search terms “encephalitis/therapy” and “encephalitis/diagnosis”, we retrieved 223 and 258 articles, respectively. With search terms “encephalitis and corticosteroid”, we identified 38 articles, and with “encephalitis and doxycycline” without the above-mentioned filters we identified 85 articles. A total of 210 articles were included in the analysis. Discussion Etiological investigations must focus on recent travels, animal exposures, age, immunodeficiency, neurological damage characteristics, and potential extra-neurological signs. The interest of a diagnosis of encephalitis for which there is no specific treatment is also to discontinue any empirical treatments initially prescribed. Physicians must consider and search for autoimmune encephalitis.
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Affiliation(s)
- P Fillatre
- Service de maladies infectieuses et réanimation médicale, CHU Pontchaillou, 35000 Rennes, France
| | - Y Crabol
- Médecine interne, CHBUA site de Vannes, 56017 Vannes, France
| | - P Morand
- Virologie, CHU Grenoble Alpes, 38043 Grenoble cedex 9, France
| | - L Piroth
- Infectiologie, CHU de Dijon, 21000 Dijon, France
| | - J Honnorat
- Inserm U1028, CNRS UMR5292, équipe neuro-oncologie et neuro-inflammation (Oncoflam), centre de recherche en neurosciences (CRNL), université Lyon 1, 69500 Bron, France
| | - J P Stahl
- Service d'infectiologie, CHU de Grenoble, 38043 Grenoble cedex 9, France.
| | - M Lecuit
- Institut Pasteur, Biology of Infection Unit, CNR CCOMS Listeria, Inserm U1117, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker-Enfants-Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France
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Blanc-Gruyelle AL, Lemaire X, Guaguere A, Sotto A, Senneville E, Lavigne JP. Un cas de brucellose atypique. Med Mal Infect 2017; 47:164-166. [DOI: 10.1016/j.medmal.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/05/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
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Brucellosis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Milburn J, Shatti D, Manji H, Everitt A. Progressive weakness and intermittent low-grade fever in a Libyan man. Pract Neurol 2016; 16:462-465. [DOI: 10.1136/practneurol-2016-001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/04/2022]
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Lima JIDS, Canelas CFG, Veiga ASDSBT, Carvalho DMM. Neurobrucellosis and venous sinus thrombosis: an uncommon association. Rev Soc Bras Med Trop 2016; 49:383-5. [DOI: 10.1590/0037-8682-0288-2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/07/2015] [Indexed: 11/21/2022] Open
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Erdem H, Senbayrak S, Meriç K, Batirel A, Karahocagil MK, Hasbun R, Sengoz G, Karsen H, Kaya S, Inal AS, Pekok AU, Celen MK, Deniz S, Ulug M, Demirdal T, Namiduru M, Tekin R, Guven T, Parlak E, Bolukcu S, Avci M, Sipahi OR, Ozturk-Engin D, Yaşar K, Pehlivanoglu F, Yilmaz E, Ates-Guler S, Mutlu-Yilmaz E, Tosun S, Sirmatel F, Sahin-Horasan E, Akbulut A, Oztoprak N, Cag Y, Kadanali A, Turgut H, Baran AI, Gul HC, Sunnetcioglu M, Haykir-Solay A, Denk A, Inan A, Ayaz C, Ulcay A, Kose S, Agalar C, Elaldi N. Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study. Infection 2016; 44:623-31. [PMID: 27138335 DOI: 10.1007/s15010-016-0901-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes. METHODS Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain. RESULTS A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000-0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.3-2.7, p = 0.0001) were associated with diffuse inflammation. CONCLUSIONS In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
| | - Seniha Senbayrak
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Kaan Meriç
- Department of Radiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Batirel
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Kasım Karahocagil
- Department of Infectious Diseases and Clinical Microbiology, Yuzuncuyil University School of Medicine, Van, Turkey
| | - Rodrigo Hasbun
- Department of Infectious Diseases, Medical School, The University of Texas Health Science Center at Houston, Houston, USA
| | - Gonul Sengoz
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Hasan Karsen
- Department of Infectious Diseases and Clinical Microbiology, Harran University, School of Medicine, Sanliurfa, Turkey
| | - Selçuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Ayşe Seza Inal
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University School of Medicine, Adana, Turkey
| | - Abdullah Umut Pekok
- Department of Infectious Diseases and Clinical Microbiology, Private Erzurum Sifa Hospital, Erzurum, Turkey
| | - Mustafa Kemal Celen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Secil Deniz
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ulug
- Department of Infectious Diseases and Clinical Microbiology, Private Umit Hospital, Eskisehir, Turkey
| | - Tuna Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Mustafa Namiduru
- Department of Infectious Diseases and Clinical Microbiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Tumer Guven
- Department of Infectious Diseases and Clinical Microbiology, Ankara Atatürk Training & Research Hospital, Ankara, Turkey
| | - Emine Parlak
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology, Bezmi Alem Vakif University School of Medicine, Istanbul, Turkey
| | - Meltem Avci
- Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Oguz Reşat Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Bezmi Alem Vakif University School of Medicine, Istanbul, Turkey
| | - Derya Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Yaşar
- Department of Infectious Diseases and Clinical Microbiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Filiz Pehlivanoglu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Emel Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Uludag University School of Medicine, Bursa, Turkey
| | - Selma Ates-Guler
- Department of Infectious Diseases and Clinical Microbiology, Sutcu Imam University School of Medicine, Kahramanmaras, Turkey
| | - Esmeray Mutlu-Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Selma Tosun
- Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Fatma Sirmatel
- Department of Infectious Diseases and Clinical Microbiology, Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Elif Sahin-Horasan
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - Ayhan Akbulut
- Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey
| | - Nefise Oztoprak
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training ad Research Hospital, Istanbul, Turkey
| | - Ayten Kadanali
- Department of Infectious Diseases and Clinical Microbiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Turgut
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ali Irfan Baran
- Department of Infectious Diseases and Clinical Microbiology, Yuzuncuyil University School of Medicine, Van, Turkey
| | - Hanefi Cem Gul
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Mahmut Sunnetcioglu
- Department of Infectious Diseases and Clinical Microbiology, Yuzuncuyil University School of Medicine, Van, Turkey
| | - Asli Haykir-Solay
- Department of Infectious Diseases and Clinical Microbiology, Igdir State Hospital, Igdir, Turkey
| | - Affan Denk
- Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey
| | - Asuman Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Celal Ayaz
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Asim Ulcay
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Canan Agalar
- Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Nazif Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey
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Zhao S, Cheng Y, Liao Y, Zhang Z, Yin X, Shi S. Treatment Efficacy and Risk Factors of Neurobrucellosis. Med Sci Monit 2016; 22:1005-12. [PMID: 27018084 PMCID: PMC4815993 DOI: 10.12659/msm.897947] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study aimed to analyze the risk factors and treatment efficacy of neurobrucellosis. MATERIAL/METHODS A cross-sectional epidemiologic survey was carried out in 557 patients with brucellosis by specially trained neurologic clinicians. Sixty-six patients with neurobrucellosis were treated with doxycycline, rifampicin, and ceftriaxone sodium as standard medication and evaluated for efficacy on a regular basis. RESULTS (1) Symptoms improved in most patients after 6 weeks of treatment, which demonstrated a favorable efficacy. (2) Cross-sectional epidemiologic survey suggested that sex, nationality, and regional distribution were not related to nervous system damage in patients with brucellosis (P>0.05), whereas age and duration of disease were related factors. Increased age as well as a prolonged duration of disease were risk factors for nervous system damage in patients with brucellosis (P<0.05). CONCLUSIONS (1) Doxycycline, rifampicin, and third-generation cephalosporins should be considered both standard and first-choice medications for neurobrucellosis. Treatment should last for at least 6 weeks. Standardized, sufficient, and combined medication is recommended for better efficacy and prognosis. (2) Age and duration of disease are risk factors for neurobrucellosis, whereas sex, nationality, and regional distribution are not. Older patients with a prolonged duration of disease are more likely to develop neurobrucellosis.
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Affiliation(s)
- Shigang Zhao
- Department of Neurology, Affiliated Hospital, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Yan Cheng
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Yali Liao
- Department of Neurology, Affiliated Hospital, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Zhelin Zhang
- Department of Neurology, Affiliated Hospital, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Xuhua Yin
- Department of Neurology, Affiliated Hospital, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Shujun Shi
- Department of Neurology, Affiliated Hospital, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
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Erdem H, Ak O, Elaldi N, Demirdal T, Hargreaves S, Nemli SA, Cag Y, Ulug M, Naz H, Gunal O, Sirmatel F, Sipahi OR, Alpat SN, Ertem-Tuncer G, Sozen H, Evlice O, Meric-Koc M, Dogru A, Koksaldi-Motor V, Tekin R, Ozdemir D, Ozturk-Engin D, Savasci U, Karagoz E, Cekli Y, Inan A. Infections in travellers returning to Turkey from the Arabian peninsula: a retrospective cross-sectional multicenter study. Eur J Clin Microbiol Infect Dis 2016; 35:903-10. [PMID: 26964538 PMCID: PMC7087946 DOI: 10.1007/s10096-016-2614-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/17/2016] [Indexed: 11/17/2022]
Abstract
Mass gatherings pooling people from different parts of the world—the largest of which is to Mecca, Saudi Arabia, for Hajj—may impose risks for acquisition and dissemination of infectious diseases. A substantial number of pilgrims to Hajj and Umrah are Turkish citizens (456,000 in 2014) but data are lacking on scale of the problem. We did a retrospective cross-sectional multicenter study in Turkey to explore the range of infections among inpatients who had recently returned from the Arabian Peninsula. Our inclusion criteria were patients who had acquired an infection during their trip to an Arabian Peninsula country, or who became symptomatic within 1 week of their return. The data were collected retrospectively for January 1, 2013 and March 1, 2015. 185 Turkish patients were recruited to the study across 15 referral centers with travel associated infectious diseases after returning from Arabian Peninsula countries (predominantly Saudi Arabia 163 [88.1 %] for religious purposes 162 [87.5 %]). Seventy four (40.0 %) of them were ≥ 65 years old with numerous comorbidities including diabetes (24.3 %) and COPD (14.1 %). The most common clinical diagnosis was respiratory tract infections (169 [91.5 %]), followed by diarrheal diseases (13 [7 %]), and there was one case of MERS-CoV. Patients spent a median of 5 (3–7) days as hospital inpatients and overall mortality was 1.1 %. Returning travellers from the Arabian Peninsula present as inpatients with a broad range of infectious diseases similar to common community acquired infections frequently seen in daily medical practices in Turkey.
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Affiliation(s)
- H Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
| | - O Ak
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - N Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - T Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - S Hargreaves
- International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, Commonwealth Building, Hammersmith Campus, London, UK
| | - S A Nemli
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Y Cag
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - M Ulug
- Department of Infectious Diseases and Clinical Microbiology, Private Umit Hospital, Eskisehir, Turkey
| | - H Naz
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - O Gunal
- Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - F Sirmatel
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University, Bolu, Turkey
| | - O R Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - S N Alpat
- Department of Infectious Diseases and Clinical Microbiology, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - G Ertem-Tuncer
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - H Sozen
- Department of Infectious Diseases and Clinical Microbiology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - O Evlice
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - M Meric-Koc
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Izmit, Turkey
| | - A Dogru
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - V Koksaldi-Motor
- Tayfur Ata Sokmen School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University, Hatay, Turkey
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - D Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Duzce University School of Medicine, Konuralp, Duzce, Turkey
| | - D Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - U Savasci
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - E Karagoz
- Department of Infectious Diseases and Clinical Microbiology, Military Hospital, Van, Turkey
| | - Y Cekli
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Yilmaz S, Avcu G, Beyazal M, Arslan M. A rare cause of seizures: brucellar brain abscess. Braz J Infect Dis 2016; 20:310-1. [PMID: 26945105 PMCID: PMC9425404 DOI: 10.1016/j.bjid.2015.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/18/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sanem Yilmaz
- Yuzuncu Yil University, Medical Faculty, Department of Pediatrics, Division of Child Neurology, Van, Turkey.
| | - Gulhadiye Avcu
- Ege University, Medical Faculty, Department of Pediatrics, Division of Pediatric Infectious Diseases, Izmir, Turkey
| | - Mehmet Beyazal
- Yuzuncu Yil University, Medical Faculty, Department of Radiology, Van, Turkey
| | - Mehmet Arslan
- Yuzuncu Yil University, Medical Faculty, Department of Neurosurgery, Van, Turkey
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Teke TA, Koyuncu H, Oz FN, Metin O, Bayhan GI, Aydın ZGG, Kaman A, Tanır G. Neurobrucellosis in children: Case series from Turkey. Pediatr Int 2015; 57:578-81. [PMID: 25522124 DOI: 10.1111/ped.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/07/2014] [Accepted: 08/12/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is an uncommon and serious complication of pediatric brucellosis. METHODS We describe seven cases of neurobrucellosis. RESULTS Ataxia (one patient), diplopia (one patient) and hearing loss (one patient) were among the neurological signs and symptoms. The most common diagnoses were acute meningitis and meningoencephalitis. Five of the patients fully recovered, one was lost to follow up and the other had hearing loss as a sequela. CONCLUSION Neurobrucellosis should be kept in mind in patients with any neurological or neuropsychiatric diseases who live in endemic areas of brucellosis.
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Affiliation(s)
- Türkan Aydın Teke
- Department of Infectious Disease, Dr Sami Ulus Maternity and Children's Research and Education Hospital, Ankara, Turkey
| | - Hilal Koyuncu
- Department of Pediatrics, Dr Sami Ulus Maternity and Children's Research and Education Hospital, Ankara, Turkey
| | - Fatma Nur Oz
- Department of Infectious Disease, Dr Sami Ulus Maternity and Children's Research and Education Hospital, Ankara, Turkey
| | - Ozge Metin
- Department of Infectious Disease, Dr Sami Ulus Maternity and Children's Research and Education Hospital, Ankara, Turkey
| | - Gülsüm Iclal Bayhan
- Department of Infectious Disease, Dr Sami Ulus Maternity and Children's Research and Education Hospital, Ankara, Turkey
| | - Zeynep Gökçe Gayretli Aydın
- Department of Infectious Disease, Dr Sami Ulus Maternity and Children's Research and Education Hospital, Ankara, Turkey
| | - Ayşe Kaman
- Department of Infectious Disease, Dr Sami Ulus Maternity and Children's Research and Education Hospital, Ankara, Turkey
| | - Gönül Tanır
- Department of Infectious Disease, Dr Sami Ulus Maternity and Children's Research and Education Hospital, Ankara, Turkey
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Erdem H, Senbayrak S, Gencer S, Hasbun R, Karahocagil MK, Sengoz G, Karsen H, Kaya S, Civljak R, Inal AS, Pekok AU, Celen MK, Deniz S, Ulug M, Demirdal T, Namiduru M, Tekin R, Guven T, Parlak E, Bolukcu S, Avci M, Sipahi OR, Nayman-Alpat S, Yaşar K, Pehlivanoğlu F, Yilmaz E, Ates-Guler S, Mutlu-Yilmaz E, Tosun S, Sirmatel F, Şahin-Horasan E, Akbulut A, Johansen IS, Simeon S, Batirel A, Öztoprak N, Cag Y, Catroux M, Hansmann Y, Kadanali A, Turgut H, Baran AI, Gul HC, Karaahmetoglu G, Sunnetcioglu M, Haykir-Solay A, Denk A, Ayaz C, Kose S, Gorenek L. Tuberculous and brucellosis meningitis differential diagnosis. Travel Med Infect Dis 2015; 13:185-91. [PMID: 25801665 DOI: 10.1016/j.tmaid.2015.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/18/2015] [Accepted: 02/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM. METHOD BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups. RESULTS The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently. CONCLUSIONS When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries.
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Affiliation(s)
- Hakan Erdem
- GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
| | - Seniha Senbayrak
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Serap Gencer
- Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Rodrigo Hasbun
- The University of Texas Health Science Center at Houston, Medical School, Department of Infectious Diseases, USA
| | - Mustafa Kasim Karahocagil
- Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey
| | - Gonul Sengoz
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Hasan Karsen
- Harran University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sanliurfa, Turkey
| | - Selçuk Kaya
- Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - Rok Civljak
- Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Department of Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ayşe Seza Inal
- Cukurova University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey
| | - Abdullah Umut Pekok
- Private Erzurum Sifa Hospital, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
| | - Mustafa Kemal Celen
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - Secil Deniz
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Mehmet Ulug
- Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - Tuna Demirdal
- Katip Celebi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Mustafa Namiduru
- Gaziantep University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Gaziantep, Turkey
| | - Recep Tekin
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - Tumer Guven
- Ankara Atatürk Training & Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Emine Parlak
- Ataturk University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
| | - Sibel Bolukcu
- Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Meltem Avci
- Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Oğuz Reşat Sipahi
- Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Saygin Nayman-Alpat
- Osmangazi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - Kadriye Yaşar
- Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Filiz Pehlivanoğlu
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Emel Yilmaz
- Uludag University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - Selma Ates-Guler
- Sutcu Imam University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kahramanmaras, Turkey
| | - Esmeray Mutlu-Yilmaz
- Samsun Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - Selma Tosun
- Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Fatma Sirmatel
- Izzet Baysal University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey
| | - Elif Şahin-Horasan
- Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey
| | - Ayhan Akbulut
- Firat University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey
| | | | - Soline Simeon
- University Hospital of Pontchaillou, Department of Infectious and Tropical Diseases, Rennes, France
| | - Ayşe Batirel
- Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Nefise Öztoprak
- Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - Yasemin Cag
- Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Melanie Catroux
- Poitiers University Hospital, Department of Infectious Diseases, France
| | - Yves Hansmann
- University Hospital, Department of Infectious Diseases, Strasbourg, France
| | - Ayten Kadanali
- Umraniye Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Huseyin Turgut
- Pamukkale University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Denizli, Turkey
| | - Ali Irfan Baran
- Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey
| | - Hanefi Cem Gul
- Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Gokhan Karaahmetoglu
- GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Mahmut Sunnetcioglu
- Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey
| | - Asli Haykir-Solay
- Igdir State Hospital, Department of Infectious Diseases and Clinical Microbiology, Igdir, Turkey
| | - Affan Denk
- Firat University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey
| | - Celal Ayaz
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - Sukran Kose
- Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Levent Gorenek
- GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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Bardak-Ozcem S, Sipahi OR. An updated approach to healthcare-associated meningitis. Expert Rev Anti Infect Ther 2014; 12:333-42. [PMID: 24512210 DOI: 10.1586/14787210.2014.890049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Among hospital-associated infections, healthcare-associated central nervous system infections are quite important because of high morbidity and mortality rates. The causative agents of healthcare-associated meningitis differ according to the status of immune systems and underlying diseases. The most frequent agents are Gram-negative bacilli (Pseudomonas spp., Acinetobacter spp., Escherichia coli and Klebsiella pneumoniae) and Gram-positive cocci (Staphylococcus aureus and coagulase-negative staphylococci). There are currently several problems in the treatment strategies of healthcare-associated meningitis due to a globally increasing resistance problem. Strategies targeting multidrug-resistant pathogens are especially limited. This review focuses on healthcare-associated meningitis and the current treatment strategies with a particular focus on methicillin-resistant Staphylococcus aureus (MRSA) meningitis.
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Affiliation(s)
- Selin Bardak-Ozcem
- Infectious Diseases and Clinical Microbiology Clinic, Dr. Burhan Nalbantoglu State Hospital, Nicosia, Turkish Republic of Northern Cyprus
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Erdem H, Elaldi N, Ak O, Gulsun S, Tekin R, Ulug M, Duygu F, Sunnetcioglu M, Tulek N, Guler S, Cag Y, Kaya S, Turker N, Parlak E, Demirdal T, Ataman Hatipoglu C, Avci A, Bulut C, Avci M, Pekok A, Savasci U, Kaya S, Sozen H, Tasbakan M, Guven T, Bolukcu S, Cesur S, Sahin-Horasan E, Kazak E, Denk A, Gonen I, Karagoz G, Haykir Solay A, Alici O, Kader C, Senturk G, Tosun S, Turan H, Baran A, Ozturk-Engin D, Bozkurt F, Deveci O, Inan A, Kadanali A, Sayar M, Cetin B, Yemisen M, Naz H, Gorenek L, Agalar C. Genitourinary brucellosis: results of a multicentric study. Clin Microbiol Infect 2014; 20:O847-53. [DOI: 10.1111/1469-0691.12680] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 01/15/2023]
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Ozturk-Engin D, Erdem H, Gencer S, Kaya S, Baran AI, Batirel A, Tekin R, Celen MK, Denk A, Guler S, Ulug M, Turan H, Pekok AU, Mermut G, Kaya S, Tasbakan M, Tulek N, Cag Y, Inan A, Yalci A, Ataman-Hatipoglu C, Gonen I, Dogan-Celik A, Bozkurt F, Gulsun S, Sunnetcioglu M, Guven T, Duygu F, Parlak E, Sozen H, Tosun S, Demirdal T, Guclu E, Karabay O, Uzun N, Gunal O, Diktas H, Haykir-Solay A, Erbay A, Kader C, Aydin O, Erdem A, Elaldi N, Kadanali A, Yulugkural Z, Gorenek L, Altındis M, Bolukcu S, Agalar C, Ormeci N. Liver involvement in patients with brucellosis: results of the Marmara study. Eur J Clin Microbiol Infect Dis 2014; 33:1253-62. [PMID: 24557334 DOI: 10.1007/s10096-014-2064-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/20/2014] [Indexed: 12/27/2022]
Abstract
Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with ≥5 times of the upper limit of normal for aminotransferases, total bilirubin level ≥2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.
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Affiliation(s)
- D Ozturk-Engin
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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A Rare presentation of neurobrucellosis in a child with Recurrent transient ischemic attacks and pseudotumor cerebri (A case report and review of literature). IRANIAN JOURNAL OF CHILD NEUROLOGY 2014; 8:65-9. [PMID: 24949055 PMCID: PMC4058069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 05/13/2013] [Accepted: 05/25/2013] [Indexed: 11/13/2022]
Abstract
Brucellosis is a multi-system infectious disease that presents with various manifestations and complications. Neurobrucellosis is an uncommon but serious presentation of brucellosis that can be seen in all stages of the disease. High index of suspicion, especially in endemic areas is essential to prevent morbidity from this disease. The case was an 11- year -old female patient who was admitted with a severe headache that was worsening over a period of 2 months. The day after each attack, she experienced transient right hemiparesia that was lasting less than one hour (TIA) as well as blurred vision and bilateral papilledema. Laboratory findings revealed serum agglutination Wright test positive at 1/320 and 2ME test positive at 1/160. A lumbar puncture showed a clear CSF with increased opening pressure (32 cmH2O), CSF examination was within normal range (pseudotumor cerebri).To our knowledge, there has been no report for recurrent TIA in pediatric neurobrucellosis in the base of pseudotumor cerebri. In endemic areas like Iran, unexplained neurological signs or symptoms should be evaluated for brucellosis.
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Munckhof WJ, Jennison AV, Bates JR, Gassiep I. First report of probable neurobrucellosis in Australia. Med J Aust 2013; 199:423-5. [DOI: 10.5694/mja12.11561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 07/31/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Wendy J Munckhof
- Infection Management Service, Princess Alexandra Hospital, Brisbane, QLD
| | - Amy V Jennison
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, QLD
| | - John R Bates
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, QLD
| | - Ian Gassiep
- Infection Management Service, Princess Alexandra Hospital, Brisbane, QLD
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Kesav P, Vishnu VY, Khurana D. Is neurobrucellosis the Pandora's Box of modern medicine? Clin Infect Dis 2013; 57:1056-7. [PMID: 23804193 DOI: 10.1093/cid/cit398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Praveen Kesav
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Guven T, Ugurlu K, Ergonul O, Celikbas AK, Gok SE, Comoglu S, Baykam N, Dokuzoguz B. Neurobrucellosis: clinical and diagnostic features. Clin Infect Dis 2013; 56:1407-12. [PMID: 23446629 DOI: 10.1093/cid/cit072] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We describe the neurological involvement in brucellosis and revisited diagnostic criteria for neurobrucellosis. METHODS Patients with laboratory-confirmed brucellosis who were consequently hospitalized were observed prospectively in a brucellosis-endemic region. The neurobrucellosis was diagnosed by any one of the following criteria: (1) symptoms and signs consistent with neurobrucellosis; (2) isolation of Brucella species from cerebrospinal fluid (CSF) and/or presence of anti-Brucella antibodies in CSF; (3) the presence of lymphocytosis, increased protein, and decreased glucose levels in CSF; or (4) diagnostic findings in cranial magnetic resonance imaging or CT. RESULTS Lumbar puncture was performed in 128 laboratory-confirmed brucellosis cases who had neurological symptoms and signs, and 48 (37.5%) were diagnosed as neurobrucellosis. The sensitivity of tube agglutination (TA) in CSF was 0.94, specificity 0.96, positive predictive value 0.94, and negative predictive value 0.96. Brucella bacteria were isolated from CSF in 7 of 48 patients (15%). The mean age of 48 neurobrucellosis patients was 42 years (SD, 19 years), and 16 (33%) were female. The most common neurological findings were agitation (25%), behavioral disorders (25%), muscle weakness (23%), disorientation (21%), and neck rigidity (17%). Cranial nerves were involved in 9 of 48 patients (19%). One patient was left with a sequela of peripheral facial paralysis and 2 patients with sensorineural hearing loss. CONCLUSIONS Patients with severe and persistent headache and other neurologic symptoms and signs should be considered for neurobrucellosis in endemic regions and to possibly receive longer therapy than 6 weeks. Brucella TA with Coombs test in CSF is sensitive and specific by using a cutoff of ≥1:8.
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Affiliation(s)
- Tumer Guven
- Infectious Diseases and Clinical Microbiology Clinic, Ataturk Training and Research Hospital, Ankara, Turkey
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Erdem H, Kilic S, Sener B, Acikel C, Alp E, Karahocagil M, Yetkin F, Inan A, Kecik-Bosnak V, Gul H, Tekin-Koruk S, Ceran N, Demirdal T, Yilmaz G, Ulu-Kilic A, Ceylan B, Dogan-Celik A, Nayman-Alpat S, Tekin R, Yalci A, Turban V, Karaoglan I, Yilmaz H, Mete B, Batirel A, Ulcay A, Dayan S, Seza Inal A, Ahmed S, Tufan Z, Karakas A, Teker B, Namiduru M, Savasci U, Pappas G. Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study. Clin Microbiol Infect 2013; 19:E80-6. [DOI: 10.1111/1469-0691.12092] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 10/15/2012] [Accepted: 10/31/2012] [Indexed: 11/29/2022]
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Complicated brucellar spondylodiscitis: experience from an endemic area. Rheumatol Int 2012; 33:2909-12. [DOI: 10.1007/s00296-012-2555-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 10/21/2012] [Indexed: 12/13/2022]
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