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Weli M, Moalla I, Feki W, Moalla N, Hsairi M, Trichelli S, Mahfoudh A, Mnif Z, Maalej B, Gargouri L. Neurobrucellosis Presenting as Vocal Cord Paralysis in an Infant. Indian J Pediatr 2024:10.1007/s12098-024-05194-y. [PMID: 38926220 DOI: 10.1007/s12098-024-05194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Manel Weli
- Department of Pediatrics B, Hedi Chaker University Hospital, Sfax, 3029, Tunisia
| | - Imene Moalla
- Department of Pediatrics B, Hedi Chaker University Hospital, Sfax, 3029, Tunisia.
| | - Wiem Feki
- Department of Radiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Nour Moalla
- Department of Radiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Manel Hsairi
- Department of Pediatrics B, Hedi Chaker University Hospital, Sfax, 3029, Tunisia
| | - Sahar Trichelli
- Department of Pediatrics B, Hedi Chaker University Hospital, Sfax, 3029, Tunisia
| | - Abdelmajid Mahfoudh
- Department of Pediatrics B, Hedi Chaker University Hospital, Sfax, 3029, Tunisia
| | - Zeineb Mnif
- Department of Radiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Bayene Maalej
- Department of Pediatrics B, Hedi Chaker University Hospital, Sfax, 3029, Tunisia
| | - Lamia Gargouri
- Department of Pediatrics B, Hedi Chaker University Hospital, Sfax, 3029, Tunisia
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Ishihara M, Abe S, Imaoka K, Nakagawa T, Kadota K, Oguro H, Nakajima H, Yamaguchi S, Nagai A. Meningoencephalomyelitis Caused by Brucella canis: A Case Report and Literature Review. Intern Med 2024; 63:1823-1827. [PMID: 37926538 DOI: 10.2169/internalmedicine.2664-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Human brucellosis, one of the most common zoonoses worldwide, is rare in Japan. Brucella canis is the specific pathogen of human brucellosis carried by dogs. According to an epidemiological study of B. canis infection in Japan, B. canis is the specific pathogen of human brucellosis in dogs. We herein report a rare case of meningoencephalomyelitis caused by B. canis in a 68-year-old Japanese man. Neurobrucellosis was diagnosed based on a serum tube agglutination test and abnormal cerebrospinal fluid findings. The patient was started on targeted treatment with a combination of doxycycline and streptomycin. Although extremely rare, neurobrucellosis should be considered in patients with a fever of unknown origin and unexplained neurological symptoms.
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Affiliation(s)
- Masaki Ishihara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Japan
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
| | - Satoshi Abe
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
| | - Koichi Imaoka
- Department of Veterinary Science, National Institute of Infectious Diseases, Japan
| | - Tomonori Nakagawa
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
- Department of Neurology, Masuda Red Cross Hospital, Japan
| | - Katsuhiko Kadota
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Juntendo University, Japan
| | - Hiroaki Oguro
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
- Department of Neurology, Heisei Memorial Hospital, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Shuhei Yamaguchi
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
- Shimane Prefecture Bureau, Shimane Prefectural Central Hospital, Japan
| | - Atsushi Nagai
- Department of Neurology, Faculty of Medicine, Shimane University, Japan
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Zhuang W, He T, Tuerheng J, He G, Wang BL, Yang YH, Zhang L, Dong XZ, Xi SY. Neurobrucellosis: laboratory features, clinical characteristics, antibiotic treatment, and clinical outcomes of 21 patients. BMC Infect Dis 2024; 24:485. [PMID: 38730327 PMCID: PMC11088156 DOI: 10.1186/s12879-024-09308-x] [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: 12/22/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Neurobrucellosis (NB) is a rare and serious complication of brucellosis. Its clinical manifestations vary, with no obvious specificity. At present, there is no clear clinical diagnosis or treatment for reference. In this study, we retrospectively analyzed the clinical data for 21 patients with NB to provide reference data for its further study. METHODS We analyzed the epidemiological and clinical manifestations, laboratory tests, imaging examinations, cerebrospinal fluid, and treatment plans of 21 patients diagnosed with NB in the Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China. RESULTS The ages of the patients ranged from 15 to 60 years old (mean age 40.1 ± 13.33 years), the male: female ratio was 4.25:1. Thirteen patients had a history of animal (sheep, cattle) contact, three had no history of animal contact, and the contact status of four was unknown. Brucella can invade various systems of the body and show multi-system symptoms, the main general manifestations were fever (66.67%), fatigue (57.14%) and functional urination or defecation disturbance (42.86%). The main nervous system manifestations were limb weakness (52.38%) and hearing loss (47.62%).The main positive signs of the nervous system included positive pathological signs (71.43%), sensory abnormalities (52.38%), limb paralysis (42.86%). Nervous system lesions mainly included spinal cord damage (66.67%), cranial nerve involvement (61.90%), central demyelination (28.57%) and meningitis (28.57%). In patients with cranial nerve involvement, 69.23% of auditory nerve, 15.38% of optic nerve and 15.38% of oculomotor nerve were involved. The blood of eight patients was cultured for Brucella, and three (37.5%) cultures were positive and five (63.5%) negative. The cerebrospinal fluid (CSF) of eight patients was cultured for Brucella, and two (25.00%) cultures were positive and six (75.00%) negative. Nineteen of the patients underwent a serum agglutination test (SAT), 18 (94.74%) of whom were positive and one (5.26%) of whom were negative. A biochemical analysis of the CSF was performed in 21 patients, and the results were all abnormal. Nineteen patients underwent magnetic resonance imaging (MRI). Twenty-one patients were treated with doxycycline and/or rifampicin, combined with ceftriaxone, quinolone, aminoglycoside, or minocycline. After hospitalization, 15 patients improved (71.43%), two patients did not recover, and the status of four patients was unknown. CONCLUSIONS The clinical manifestations, CSF parameters, and neurological imaging data for patients with NB show no significant specificity or correlations. When patients with unexplained neurological symptoms accompanied by fever, fatigue, and other systemic manifestations in a brucellosis epidemic area or with a history of contact with cattle, sheep, animals, or raw food are encountered in clinical practice, the possibility of NB should be considered. Treatment is based on the principles of an early, combined, and long course of treatment, and the general prognosis is good.
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Affiliation(s)
- Wei Zhuang
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing, China
| | - Tao He
- Department of Pharmacy, Eye Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianyekai Tuerheng
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing, China
| | - Guang He
- Clinical Medicine of Traditional Chinese and Western Medicine, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Bao-Li Wang
- Department of Pharmacy, Eye Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi-Heng Yang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Lan Zhang
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing, China
| | - Xian-Zhe Dong
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing, China.
| | - Sheng-Yan Xi
- Department of Traditional Chinese Medicine, School of Medicine, Xiang'an Hospital, Xiamen University, Xiamen, China.
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Liu Y, Gu Y. Case report: A case of abrupt stroke as the first symptom of neurobrucellosis. Front Neurol 2023; 14:1066042. [PMID: 36908632 PMCID: PMC9992872 DOI: 10.3389/fneur.2023.1066042] [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: 10/10/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
Acute cerebral infarction caused by small artery inflammatory disease, which is triggered by neurobrucellosis, is a rare condition that can be easily misdiagnosed. Neurobrucellosis is a rare complication of brucellosis that can present clinically as meningitis, meningoencephalitis, myelitis, neuritis, or psychosis. In this study, we report the case of a patient with neurobrucellosis who was hospitalized in the First People's Hospital of Lianyungang in September 2022; the primary symptom was weakness in the left limb for 14 h. The patient was discharged after receiving symptomatic and anti-Brucella medication.
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Affiliation(s)
- Ying Liu
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, China
| | - Yan Gu
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, China
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Palackdkharry CS, Wottrich S, Dienes E, Bydon M, Steinmetz MP, Traynelis VC. The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis). PLoS One 2022; 17:e0274634. [PMID: 36178925 PMCID: PMC9524710 DOI: 10.1371/journal.pone.0274634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND & IMPORTANCE This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare "iatrogenic chronic meningitis" causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. METHODS The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. RESULTS Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. DISCUSSION & CONCLUSION DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.
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Affiliation(s)
| | - Stephanie Wottrich
- Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America
| | - Erin Dienes
- Arcsology®, Mead, Colorado, United States of America
| | - Mohamad Bydon
- Department of Neurologic Surgery, Orthopedic Surgery, and Health Services Research, Mayo Clinic School of Medicine, Rochester, Minnesota, United States of America
| | - Michael P. Steinmetz
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine Neurologic Institute, Cleveland, Ohio, United States of America
| | - Vincent C. Traynelis
- Department of Neurosurgery, Rush University School of Medicine, Chicago, Illinois, United States of America
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Béjaoui A, Ben Abdallah I, Maaroufi A. Brucella spp. Contamination in Artisanal Unpasteurized Dairy Products: An Emerging Foodborne Threat in Tunisia. Foods 2022; 11:foods11152269. [PMID: 35954037 PMCID: PMC9367864 DOI: 10.3390/foods11152269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Brucellosis is a worldwide zoonotic disease transmitted to humans, predominantly by the consumption of contaminated raw milk and dairy products. This study aimed to investigate the occurrence of Brucella spp. in 200 raw milk, ricotta, and artisan fresh cheese samples, collected from individual marketing points in four districts in Tunisia. Samples were analyzed for the presence of Brucella spp. by IS711-based real-time PCR assay. Positive samples were further analyzed by qPCR for B. melitensis and B. abortus species differentiation. The DNA of Brucella spp. was detected in 75% of the samples, B. abortus was detected in 31.3%, and B. melitensis was detected in 5.3% of positive samples. A percentage of 49.3% of samples co-harbored both species, while 14% of the Brucella spp. positive samples were not identified either as B. abortus or B. melitensis. High contamination rates were found in ricotta (86.2%), cheese (69.6%), and raw milk (72.5%) samples. The study is the first in Tunisia to assess the occurrence of Brucella spp. contamination in artisanal unpasteurized dairy products and showed high contamination rates. The detection of both B. abortus and B. melitensis highlights that zoonotic high-pathogen agent control remains a challenge for food safety and consumer health protection and could represent a serious emerging foodborne disease in Tunisia.
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Soares CN, Angelim AIM, Brandão CO, Santos RQ, Mehta R, Silva MTTD. Neurobrucellosis: the great mimicker. Rev Soc Bras Med Trop 2022; 55:e05672021. [PMID: 35416876 PMCID: PMC9009883 DOI: 10.1590/0037-8682-0567-2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/25/2022] [Indexed: 11/22/2022] Open
Abstract
Neurobrucellosis is caused by bacteria of the genus Brucella and is responsible for several clinical manifestations, making diagnosis challenging. The most common route of infection is through the consumption of unpasteurized or raw dairy products such as fresh milk, butter, and cheese. As neurological complications can develop chronically, they are frequently misdiagnosed as other infections, such as tuberculosis. This report reviews the clinical manifestations, diagnostic approach, treatment, and prognosis of neurobrucellosis, illustrating a case of chronic intracranial hypertension and meningoencephalitis secondary to brucellosis. The clinical presentation of brucellosis can mimic several systemic diseases, resulting in diagnostic delays and clinical complications. A high degree of suspicion is required, and neurobrucellosis should always be considered in the differential diagnosis of chronic meningitis.
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Affiliation(s)
| | | | | | - Roberto Queiroz Santos
- Hospital Federal dos Servidores do Estado, Departamento de Radiologia, Rio de Janeiro, RJ, Brasil
| | - Ravi Mehta
- Imperial College London, Department of Infectious Diseases, London, England
| | - Marcus Tulius Teixeira da Silva
- Instituto de Doenças Infecciosas Evandro Chagas, Laboratório de Pesquisa Clínica em Neuroinfecções, Rio de Janeiro, RJ, Brasil
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Lemnouer A, Frikh M, Maleb A, Ahizoune A, Bourazza A, Elouennass M. Brucellosis: A cause of meningitis not to neglect. IDCases 2017; 10:97-99. [PMID: 29062710 PMCID: PMC5645168 DOI: 10.1016/j.idcr.2017.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 12/01/2022] Open
Abstract
Brucellosis is the most frequent bacteria zoonosis in the world, with more than half a million new cases each year [1]. It is also the most significant zoonos in the edge of the Mediterranean Sea [2]. This zoonosis is capable of affecting humans and cause polymorphic clinical manifestations. In Morocco, the southern regions are the main affected areas [3]. We are reporting the observation of a 17-year-old male patient, who presented a febrile meningeal syndrome for 9 months without sensitivo-motor deficit. Tuberculosis is frequently evoked in such clinical presentations because Morocco is an endemic country, brucellosis is therefore often forgotten. The results of lumbar puncture, magnetic resonance imaging (MRI) and especially serology aided to conclude to a neuro-brucellosis. The outcome was favourable with antibiotic therapy.
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Affiliation(s)
- Abdelhay Lemnouer
- Department of Bacteriology - Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Mohammed Frikh
- Department of Bacteriology - Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Adil Maleb
- Laboratory of Microbiology, Mohammed VI University Hospital / Faculty of Medicine and Pharmacy (University Mohammed the first), Oujda, Morocco
| | - Aziz Ahizoune
- Department of Neurology - Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Ahmed Bourazza
- Department of Neurology - Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
| | - Mostafa Elouennass
- Department of Bacteriology - Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy (University Mohammed V), Rabat, Morocco
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Feki I, Abbes W, Sakka S, Bouchhima I, Mhiri C, Masmoudi J. [A psychiatric disorder reveals a neurobrucellosis]. Presse Med 2016; 45:1197-1200. [PMID: 27816344 DOI: 10.1016/j.lpm.2016.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/22/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Inès Feki
- CHU Hédi Chaker, service de psychiatrie A, Sfax, Tunisie.
| | - Wafa Abbes
- CHU Hédi Chaker, service de psychiatrie A, Sfax, Tunisie
| | - Salma Sakka
- CHU Habib Bourguiba, service de neurologie, Sfax, Tunisie
| | - Imen Bouchhima
- CHU Habib Bourguiba, service de neurologie, Sfax, Tunisie
| | - Chokri Mhiri
- CHU Habib Bourguiba, service de neurologie, Sfax, Tunisie
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