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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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Alikhani A, Ahmadi N, Frouzanian M, Abdollahi A. Motor polyradiculoneuropathy as an unusual presentation of neurobrucellosis: a case report and literature review. BMC Infect Dis 2024; 24:491. [PMID: 38745172 PMCID: PMC11092037 DOI: 10.1186/s12879-024-09365-2] [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: 12/04/2023] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
Brucellosis, a zoonotic disease caused by Brucella species, poses a significant global health concern. Among its diverse clinical manifestations, neurobrucellosis remains an infrequent yet debilitating complication. Here, we present a rare case of neurobrucellosis with unusual presentations in a 45-year-old woman. The patient's clinical course included progressive lower extremity weakness, muscle wasting, and double vision, prompting a comprehensive diagnostic evaluation. Notable findings included polyneuropathy, elevated brucella agglutination titers in both cerebrospinal fluid and blood, abnormal EMG-NCV tests, and resolving symptoms with antibiotic therapy. The clinical presentation, diagnostic challenges, and differentiation from other neurological conditions are discussed. This case underscores the importance of considering neurobrucellosis in regions where brucellosis is prevalent and highlights this rare neurological complication's distinctive clinical and radiological features. Early recognition and appropriate treatment are crucial to mitigate the significant morbidity associated with neurobrucellosis.
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Affiliation(s)
- Ahmad Alikhani
- Infectious Diseases Department and Antimicrobial Resistance Research Center and Transmissible Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Noushin Ahmadi
- Infectious Diseases Department and Antimicrobial Resistance Research Center and Transmissible Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehran Frouzanian
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirsaleh Abdollahi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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3
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Rodríguez J, De Santis Arévalo J, Dennis VA, Rodríguez AM, Giambartolomei GH. Bystander activation of microglia by Brucella abortus-infected astrocytes induces neuronal death via IL-6 trans-signaling. Front Immunol 2024; 14:1343503. [PMID: 38322014 PMCID: PMC10844513 DOI: 10.3389/fimmu.2023.1343503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/29/2023] [Indexed: 02/08/2024] Open
Abstract
Inflammation plays a key role in the pathogenesis of neurobrucellosis where glial cell interactions are at the root of this pathological condition. In this study, we present evidence indicating that soluble factors secreted by Brucella abortus-infected astrocytes activate microglia to induce neuronal death. Culture supernatants (SN) from B. abortus-infected astrocytes induce the release of pro-inflammatory mediators and the increase of the microglial phagocytic capacity, which are two key features in the execution of live neurons by primary phagocytosis, a recently described mechanism whereby B. abortus-activated microglia kills neurons by phagocytosing them. IL-6 neutralization completely abrogates neuronal loss. IL-6 is solely involved in increasing the phagocytic capacity of activated microglia as induced by SN from B. abortus-infected astrocytes and does not participate in their inflammatory activation. Both autocrine microglia-derived and paracrine astrocyte-secreted IL-6 endow microglial cells with up-regulated phagocytic capacity that allows them to phagocytose neurons. Blocking of IL-6 signaling by soluble gp130 abrogates microglial phagocytosis and concomitant neuronal death, indicating that IL-6 activates microglia via trans-signaling. Altogether, these results demonstrate that soluble factors secreted by B. abortus-infected astrocytes activate microglia to induce, via IL-6 trans-signaling, the death of neurons. IL-6 signaling inhibition may thus be considered a strategy to control inflammation and CNS damage in neurobrucellosis.
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Affiliation(s)
- Julia Rodríguez
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Julia De Santis Arévalo
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Vida A Dennis
- Center for NanoBiotechnology Research and Department of Biological Sciences, Alabama State University, Montgomery, AL, United States
| | - Ana M Rodríguez
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo H Giambartolomei
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
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Moley CR, Chambers CA, Dadelahi AS, Ponzilacqua-Silva B, Abushahba MFN, Lacey CA, Franklin CL, Skyberg JA. Innate Lymphoid Cells and Interferons Limit Neurologic and Articular Complications of Brucellosis. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:1170-1184. [PMID: 37263343 PMCID: PMC10477959 DOI: 10.1016/j.ajpath.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
Brucellosis is a globally significant zoonotic disease. Human patients with brucellosis develop recurrent fever and focal complications, including arthritis and neurobrucellosis. The current study investigated the role of innate lymphoid cells (ILCs) in the pathogenesis of focal brucellosis caused by Brucella melitensis. After footpad infection, natural killer cells and ILC1 cells both limited joint colonization by Brucella. Mice lacking natural killer cells, and in particular mice lacking all ILCs, also developed marked arthritis after footpad infection. Following pulmonary infection, mice lacking adaptive immune cells and ILCs developed arthritis, neurologic complications, and meningitis. Adaptive immune cells and ILCs both limited colonization of the brain by Brucella following pulmonary infection. Transcriptional analysis of Brucella-infected brains revealed marked up-regulation of genes associated with inflammation and interferon responses, as well as down-regulation of genes associated with neurologic function. Type II interferon deficiency resulted in colonization of the brain by Brucella, but mice lacking both type I and type II interferon signaling more rapidly developed clinical signs of neurobrucellosis, exhibited hippocampal neuronal loss, and had higher levels of Brucella in their brains than mice lacking type II interferon signaling alone. Collectively, these findings indicate ILCs and interferons play an important role in prevention of focal complications during Brucella infection, and that mice with deficiencies in ILCs or interferons can be used to study pathogenesis of neurobrucellosis.
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Affiliation(s)
- Charles R Moley
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri; Laboratory for Infectious Disease Research, University of Missouri, Columbia, Missouri
| | - Catherine A Chambers
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri; Laboratory for Infectious Disease Research, University of Missouri, Columbia, Missouri
| | - Alexis S Dadelahi
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri; Laboratory for Infectious Disease Research, University of Missouri, Columbia, Missouri
| | - Bárbara Ponzilacqua-Silva
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri; Laboratory for Infectious Disease Research, University of Missouri, Columbia, Missouri
| | - Mostafa F N Abushahba
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri; Laboratory for Infectious Disease Research, University of Missouri, Columbia, Missouri; Department of Zoonoses, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Carolyn A Lacey
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri; Laboratory for Infectious Disease Research, University of Missouri, Columbia, Missouri
| | - Craig L Franklin
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri; Laboratory for Infectious Disease Research, University of Missouri, Columbia, Missouri
| | - Jerod A Skyberg
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri; Laboratory for Infectious Disease Research, University of Missouri, Columbia, Missouri.
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Sah PK, Lamichhane HK, Tariq EF, Saroj KC, Adhikari P. Hearing loss: an unusual presentation of neurobrucellosis: a case report. J Med Case Rep 2023; 17:129. [PMID: 36978194 PMCID: PMC10053093 DOI: 10.1186/s13256-023-03836-x] [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: 06/25/2020] [Accepted: 02/22/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Brucellosis is a zoonotic disease, caused by a Gram-negative coccobacillus of Brucella genus, transmitted to humans by animals, especially cattle. It rarely involves the nervous system (neurobrucellosis); only a few cases present with hearing loss. We report a case of neurobrucellosis, that presented with bilateral sensorineural hearing loss and mild to moderate persistent headache. To the best of our knowledge, this is the first well-documented case from Nepal. CASE PRESENTATION The patient was a 40-year-old Asian male shepherd from the western mountainous region of Nepal who came to the emergency department of Manipal Teaching Hospital, Pokhara in May, 2018 and did a follow-up for 6 months. He presented with high-grade fever, profuse sweating, headache, myalgia, and bilateral sensorineural hearing loss. His history of consuming raw milk of cattle, symptoms including persistent mild to moderate headache, bilateral hearing loss, and serological findings were suggestive of neurobrucellosis. Following treatment, the symptoms improved, including the complete recovery of hearing loss. CONCLUSION Hearing loss may be the manifestation of neurobrucellosis. Physicians should know about such presentations in brucella endemic areas.
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Affiliation(s)
| | | | | | - K C Saroj
- Manipal Teaching Hospital, Pokhara, Nepal
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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: 1] [Impact Index Per Article: 0.5] [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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Dhar D, Jaipuriar RS, Mondal MS, Shunmugakani SP, Nagarathna S, Kumari P, Mahale R, Mailankody P, Mathuranath PS, Padmanabha H. Pediatric neurobrucellosis: a systematic review with case report. J Trop Pediatr 2022; 69:7008360. [PMID: 36708042 DOI: 10.1093/tropej/fmad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Pediatric neurobrucellosis represents a common anthropozoonosis in endemic areas but only anecdotal reports are available till date. Using appropriate search terms in the database platforms of MEDLINE, SCOPUS and Web of Sciences, we performed a systematic review of all the cases of pediatric neurobrucellosis published in the medical literature till date, in the light of a case report. The protocol was registered under PROSPERO (CRD42022333907). Our search strategy yielded 187 citations of which 51 citations were included. A total of 119 cases were reviewed. Of these cases, eight of them had insufficient data. The most common presentation was meningitis with or without encephalitis (n = 79, 71.2%). A high prevalence of cranial neuropathies (n = 22, 20.7%) was observed in the pediatric population in which abducens palsy was the most common (n = 9, 8.1%). Diagnosis was based on multimodal investigations including standard agglutination test (n = 44, 39.6%), Rose Bengal test (n = 37, 33.3%), blood culture (n = 23, 20.7%), serology (n = 20, 18.0%) and cerebrospinal fluid (CSF) culture (n = 11, 9.9%). Rifampicin-based triple drug regimen was the most commonly employed (83/102, 81.4%). Pediatric neurobrucellosis was associated with greater frequency of sequalae (5.4%), deafness (2.7%) and mortality (2.7%), when compared to that of general population. Neurobrucellosis mimics neuro-tuberculosis in various aspects. The review highlights several unique aspects of this entity in children. A high index of suspicion can ensure prompt diagnosis, timely initiation of management and favorable outcomes.
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Affiliation(s)
- Debjyoti Dhar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Ravi Shekhar Jaipuriar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Mahammad Samim Mondal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Siva Prakash Shunmugakani
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - S Nagarathna
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Pratima Kumari
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - P S Mathuranath
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Hansashree Padmanabha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
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Yusufoğlu E, Kobat SG, Keser S. A rare cause of pediatric oculomotor nerve palsy: neurobrucellosis. Heliyon 2022; 8:e12134. [DOI: 10.1016/j.heliyon.2022.e12134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
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Mirza B, Kanawi HM, Alkhatib T, Bukhari AF, Zawawi F. Neurobrucellosis Complicated by Sensorineural Hearing Loss: A Case Report. Cureus 2022; 14:e29482. [PMID: 36168649 PMCID: PMC9501761 DOI: 10.7759/cureus.29482] [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] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
Brucellosis is a zoonotic disease. It is also one of the neglected infectious diseases and is less well-known compared to other diseases. It is acquired from infected animals (cattle, sheep, goats, camels, pigs, or other animals) through the consumption of unpasteurized dairy products or contact with tissues or fluids. Sensory neural hearing loss (SNHL) in neurobrucellosis had been described in the literature, mostly as an incidental finding that otolaryngologists should consider in any patient with fever and a history of travel to the Middle East, Central or South America, or other brucellosis-endemic countries. We present a neurobrucellosis case with profound bilateral SNHL that was treated with combination antibiotic therapy for long periods of time and highlight the clinical course of the patient.
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Barad NH, Shah V, Agarwal G, Shah R. Syndrome of Tremor, Ataxia, Hearing Loss, and Seizure in a Young Adult: Think Neurobrucellosis. Mov Disord Clin Pract 2022; 9:S44-S48. [PMID: 36118516 PMCID: PMC9464998 DOI: 10.1002/mdc3.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | | | - Rechal Shah
- Nephrology departmentCims HospitalAhmedabadIndia
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11
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He Q, Liu J, Zhu Z, Tang Y, Long L, Hu K. Case report: Revealing a special and rare autoimmune GFAP astrocytopathy in the spinal cord succeeding Neurobrucellosis infection. Front Immunol 2022; 13:950522. [PMID: 35990675 PMCID: PMC9389076 DOI: 10.3389/fimmu.2022.950522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/08/2022] [Indexed: 01/18/2023] Open
Abstract
Brucellosis, a zoonosis, can cause an inflammatory response in most organs and continues to be a public health problem in some endemic areas, whereas neurobrucellosis is a morbid form of brucellosis that affects the central nervous system (CNS) with poor prognosis. Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is an autoimmune disease, and there have been no reports of a Brucella infection, leading to GFAP astrocytopathy. We report the case of a patient with a positive and high level of GFAP antibodies in the cerebrospinal fluid (CSF), following a Brucella infection. Although this patient did not show any responsible lesions in the diffusion sequence of the magnetic resonant imaging (MRI) scan, we found an evidence of thoracolumbar (T12) involvement on fluorodeoxyglucose (FDG) positron emission tomography (PET). The symptoms of spinal cord involvement were only partly relieved after initial treatment [doxycycline (0.1 g Bid) and rifampicin (0.6 g Qd) for 6 weeks]; however, they markedly improved after the subsequent immunosuppressive therapy [intravenous methylprednisolone (1,000 mg for 3 days)], followed by a 50% reduction from the preceding dose after 3 days, and subsequently, oral prednisone tablets (60 mg/day) was started, which was then gradually tapered [reduced to 10 mg/day every 1–2 weeks)]. The positive response to immunosuppressive therapy and treatment outcome strongly indicated the presence of an autoimmune neurological disease probably triggered by some infectious factors. Therefore, our findings reveal that a Brucella infection is one of the causes of autoimmune GFAP astrocytopathy, and when this infection is difficult to be identified by regular MRI, FDG PET can be used as a supplementary method for diagnosis and treatment.
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Affiliation(s)
- Qiang He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Junxian Liu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zehua Zhu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
| | - Kai Hu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Epileptic Disease of Hunan Province, Central South University, Changsha, China
- *Correspondence: Kai Hu,
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Neurobrucellosis presenting with the features of meningoencephalitis: A case report from Nepal. Ann Med Surg (Lond) 2022; 80:104278. [PMID: 36045869 PMCID: PMC9422267 DOI: 10.1016/j.amsu.2022.104278] [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: 05/19/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Brucellosis or Malta fever is a zoonotic disease caused by the Brucella species. Patients with neurobrucellosis may present with features of meningoencephalitis. Thus, a high degree of suspicion is required for the diagnosis in the endemic region. Case presentation A 13-year old female with a history of exposure to domestic animals presented with the features of meningoencephalitis (intermittent fever with chills and rigor and generalized tonic-clonic seizure). Clinical findings and investigations Examination revealed drowsy and lethargic patient with bilateral edema up to mid-shin. Neck rigidity was present. Lab findings include leukocytosis with neutrophilic and erythrocyte sedimentation rate (25 mm/hr). CECT of the brain revealed vasogenic edema. Routine CSF examination was insignificant for common bacterial, viral, fungal or tubercular etiology. CSF ELISA confirmed the presence of Brucella antibody. Conclusion When patients present with undulant fever, lethargy, seizure, or other features of meningitis/encephalitis, the diagnosis of neurobrucellosis must be considered after common pathological causes are ruled out. Brucellosis or Malta fever is a zoonotic disease caused by the Brucella species. Patients with Neurobrucellosis may present with features of meningoencephalitis. A high degree of suspicion is required for the diagnosis in the endemic region. Patients with undulant fever, seizure, or other features of meningoencephalitis should be tested for Neurobrucellosis.
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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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Du Y, Yang H, Jiang H, Du X. A Death Due to Neurobrucellosis - Linfen City, Shanxi Province, China, May 2021. China CDC Wkly 2021; 3:1144-1145. [PMID: 35036039 PMCID: PMC8742142 DOI: 10.46234/ccdcw2021.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/04/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yufeng Du
- Linfen Third People's Hospital, Linfen, Shanxi, China
| | - Hongxia Yang
- Shanxi Provincial Centre for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Hai Jiang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiufang Du
- Linfen Third People's Hospital, Linfen, Shanxi, China
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15
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Neurobrucellosis: Brief Review. Neurologist 2021; 26:248-252. [PMID: 34734902 DOI: 10.1097/nrl.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Brucella are small, nonmotile, intracellular, and aerobic gram-negative bacteria. Of the 10 species that currently form the genus Brucella, 5 were shown to be pathogenic in humans. REVIEW SUMMARY The epidemiology, clinical manifestations, diagnosis and imaging, and treatment of neurobrucellosis will be reviewed.Brucellosis's transmission to humans occurs by direct contact with contaminated animals. Older patients are at increased risk of nervous system involvement in brucellosis. Brucella spp. can lead to central nervous system involvement through direct damage via invasion of neural tissue or indirect damage caused by endotoxins or immune inflammatory reactions elicited by the presence of the bacteria in the body. Patients can have general nonspecific symptoms in addition to neurological and psychiatric symptoms. There are 4 diagnostic criteria for the diagnosis of neurobrucellosis, which include signs and symptoms suggestive of neurobrucellosis, a positive finding of Brucella spp. in the cerebrospinal fluid (CSF), and/or a positive titer of antibodies targeting brucella in the CSF, lymphocytosis with high protein levels and low glucose levels in CSF, and imaging findings (either cranial magnetic resonance imaging or computed tomography) peculiar to neurobrucellosis. For the treatment, a combined therapy is favored over monotherapy for the eradication of Brucella. Moreover, a multirouted therapy has been associated with increased treatment efficacy. The prognosis of neurobrucellosis is dependent on patients' clinical presentation: brucellar meningitis is associated with a good prognosis, whereas diffuse central nervous system involvement is associated with the development of long-term sequelae. CONCLUSIONS Neurobrucellosis affects patients globally and in endemic areas. Neurologists should familiarize themselves with its clinical presentation, diagnosis, and treatment to provide optimal care for their patients.
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Nepal G, Balayar R, Bhatta S, Acharya S, Gajurel BP, Karn R, Rajbhandari R, Paudel S, Gautam N, Shrestha A, Ojha R. Neurobrucellosis: A differential not to be missed in patients presenting with neuropsychiatric features. Clin Case Rep 2021; 9:e04190. [PMID: 34194775 PMCID: PMC8222759 DOI: 10.1002/ccr3.4190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022] Open
Abstract
When a patient presents with undulating fever and neuropsychiatric features, neurobrucellosis should be considered as a differential diagnosis. If diagnosed early, neurobrucellosis is a treatable disease with a favorable outcome.
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Affiliation(s)
- Gaurav Nepal
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Ramesh Balayar
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Suraj Bhatta
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Sulav Acharya
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineMaharajgunjNepal
| | | | - Ragesh Karn
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Reema Rajbhandari
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Sunanda Paudel
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Niraj Gautam
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Ashish Shrestha
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
| | - Rajeev Ojha
- Department of NeurologyTribhuvan University Teaching HospitalMaharajgunjNepal
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17
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Wen H, Jin D, Cai L, Wu T, Liu H. Neurobrucellosis with ischemic stroke and spinal cord involvement: a case report. BMC Neurol 2021; 21:129. [PMID: 33743640 PMCID: PMC7980546 DOI: 10.1186/s12883-021-02155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/11/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Brucellosis is a common zoonotic disease that may have a variety of clinical manifestations when it affects the nervous system. Ischemic stroke is a rare clinical symptom, but if it is not diagnosed and treated early, it may cause more severe consequences. CASE PRESENTATION We report a 38-year-old man presenting with hearing impairment for four years and sudden weakness of the right limb for two years, recurrent aphasia, and gradual weakness of bilateral lower limbs for nine months. He had bilateral positive Babinski's sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed ischemic infarcts in the pons and extensive enhancement of spinal meninges combined with spinal cord atrophy and ischemia. The tests revealed Brucella Rose Bengal positive in serum and CSF. Brucella culture in CSF was also positive. Next-generation sequencing (NGS) of CSF revealed positive for Brucella with 105 species were detected. He showed significant improvement with antibiotics at five months follow-up. CONCLUSIONS Neurobrucellosis may mimic stroke and transverse myelitis like syndromes. NB is a treatable infectious condition and should always be considered in the differentials, especially if there are risk factors, as in our case.
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Affiliation(s)
- Hongfeng Wen
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China
| | - Di Jin
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China
| | - Lina Cai
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China
| | - Tao Wu
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China
| | - Haichao Liu
- Department of Neurology, Aerospace Center Hospital, 100049, Beijing, China.
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18
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Patra S, Kalwaje Eshwara V, Pai AR, Varma M, Mukhopadhyay C. Evaluation of clinical, diagnostic features and therapeutic outcome of neurobrucellosis: a case series and review of literature. Int J Neurosci 2021; 132:1080-1090. [PMID: 33287603 DOI: 10.1080/00207454.2020.1860969] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM In this study, we aimed to discuss the clinical features, laboratory findings, treatment and outcome of seven cases of neurobrucellosis from a tertiary care center and review the available global literature. MATERIALS AND METHODS The diagnosis of neurobrucellosis was established using the following criteria in our setting: (1) signs and symptoms of neurological infection with examination of cerebrospinal fluid (CSF) revealing signs of meningitis, (2) isolation of Brucella spp. from blood and/or CSF and/or antibody titer ≥1:160 in serum using standard agglutination test (SAT) and/or the presence of anti-Brucella antibodies in CSF and/or detection of Brucella spp.-specific DNA from CSF using PCR. A literature search was performed to review previous cases of neurobrucellosis published worldwide during the last 30 years. RESULTS The proportion of neurobrucellosis was 2.8% in our setting. Fever with headache and altered sensorium were the major presenting complaints. Brucella melitensis was isolated from blood culture in 6 patients. From the literature search, a total of 221 cases of neurobrucellosis were reviewed and analyzed. Meningitis (32.6%), loss of hearing (25.8%) and encephalitis (14.9%) were the most common clinical features. Involvement of cranial nerves, polyradiculopathy and paraplegia were the major complications found in patients with neurobrucellosis. CONCLUSIONS Neurobrucellosis should always be considered in the differential diagnosis of befitting neurological, rheumatological, and neuropsychiatric presentations in endemic regions for brucellosis. To prevent morbidity and mortality associated with neurobrucellosis, a multimodal diagnostic approach is essential for early and accurate diagnosis and effective treatment.
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Affiliation(s)
- Sudipta Patra
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vandana Kalwaje Eshwara
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Aparna Ramakrishna Pai
- Department of Neurology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Center for Emerging and Tropical Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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19
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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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20
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Meshref M, Amro Y, Ebada MA. Neurobrucellosis: a Case Report with an Unusual Presentation. RECENT PATENTS ON ANTI-INFECTIVE DRUG DISCOVERY 2020; 16:PRI-EPUB-110035. [PMID: 32942980 DOI: 10.2174/1574891x15999200917153454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Brucellosis is a highly infectious multi-systemic zoonosis, and it is caused by Gram-negative bacteria, Brucella. Despite the low incidence of neurobrucellosis, it is the most dangerous consequence of brucellosis. CASE REPORT A 30-year-old Sudanese male patient presented to our hospital with a complaint of fever associated with confusion for three days. He had signs of meningeal irritation in the form of neck stiffness, positive Kernig's, and Lesage's sign. The computerized tomography of the brain was normal. The CSF analysis showed a clear colorless sample with normal tension, decreased glucose, and slightly increased CSF protein level. We reviewed his occupational history; the patient was a farmer with regular contact with cattle and camels. The patient had positive Brucella antibodies for both B.Abortus and B. melitensis with a high titer (1/640). As described in various patents, we administrated triple therapy for brucellosis for two weeks. A marked improvement of the conscious level was observed, and the patient was back to normal within a few days post-treatment. CONCLUSIONS We encourage physicians to consider the diagnosis of neurobrucellosis with any neurologic sign without a known cause. Our case highlights the importance of occupational history in clinical medicine.
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Affiliation(s)
- Mostafa Meshref
- Department of Neurology, King Khaled Hospital, Hail. Saudi Arabia
| | - Yara Amro
- Suzanne Mubarak Specialized Health Center, Syeda Zainab, Cairo. Egypt
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21
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A Case of Cerebral Granuloma and Optic Papillitis due to Brucella sp. Case Rep Infect Dis 2020; 2020:5216249. [PMID: 32733718 PMCID: PMC7383343 DOI: 10.1155/2020/5216249] [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: 12/21/2019] [Revised: 04/18/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
We document a case of a 24-year-old woman who presented with cerebral granuloma and optic papillitis associated to Brucella sp. infection, whose diagnosis was made with a brain biopsy and serology tests, with clinical improvement following specific antibiotic therapy. The patient was followed up for over a year without evidence of relapse.
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22
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Hassouneh L, Quadri S, Pichilingue-Reto P, Chaisavaneeyakorn S, Cutrell JB, Wetzel DM, Nijhawan AE. An Outbreak of Brucellosis: An Adult and Pediatric Case Series. Open Forum Infect Dis 2019; 6:ofz384. [PMID: 31660348 PMCID: PMC6790400 DOI: 10.1093/ofid/ofz384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022] Open
Abstract
Background Brucellosis is recognized as a neglected zoonotic disease and a major public health threat. The purpose of this study was to characterize epidemiological risk factors and healthcare utilization and compare clinical aspects of disease among adult and pediatric cases in North Texas. Methods A retrospective chart review of electronic medical records was completed at 3 large tertiary centers—Parkland Health and Hospital System, Clements University Hospital, and Children’s Medical Center—between January 1, 2007 and June 1, 2017. Demographic, clinical, and laboratory variables were collected. Cases were defined as confirmed or probable. Results Twenty-eight cases of brucellosis were identified: 26 confirmed (9 children, 17 adults) and 2 probable cases (1 child, 1 adult). Half (n = 14) were diagnosed in 2016 during an outbreak in Dallas County. Risk factors associated with infection were consumption of unpasteurized cheese (71%), recent travel (54%), close contact to a confirmed human brucellosis case (36%), and exposure to animals (11%). Median days of symptoms was 10 and 16 for children and adults, respectively. The majority (79%) of patients visited the emergency department before diagnosis and 93% were hospitalized. Fever was the most common symptom in children (80%) and adults (100%). Hepatitis (75% of children) and anemia (82% of adults) were the most common laboratory abnormalities. The most common complication in children was splenic lesions (40%), and the most common complication in adults was hepato/splenomegaly (39%). Conclusions The diagnosis of Brucella infection requires a high index of suspicion and should be considered in patients presenting with a febrile illness and a compatible exposure history.
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Affiliation(s)
- Linda Hassouneh
- Department of Pediatrics, Division of Pediatric Infectious Diseases UT Southwestern, Dallas, Texas.,Warren Alpert Medical Brown University, Providence, Rhode Island
| | - Syeda Quadri
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern, Dallas, Texas.,Franciscan Physician Network, Hammond, Indiana
| | | | - Sujittra Chaisavaneeyakorn
- Department of Pediatrics, Division of Pediatric Infectious Diseases UT Southwestern, Dallas, Texas.,St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James B Cutrell
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern, Dallas, Texas.,VA North Texas Healthcare System, Dallas
| | - Dawn M Wetzel
- Department of Pediatrics, Division of Pediatric Infectious Diseases UT Southwestern, Dallas, Texas
| | - Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern, Dallas, Texas
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23
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Rodríguez AM, Delpino MV, Miraglia MC, Giambartolomei GH. Immune Mediators of Pathology in Neurobrucellosis: From Blood to Central Nervous System. Neuroscience 2019; 410:264-273. [PMID: 31128159 DOI: 10.1016/j.neuroscience.2019.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 01/18/2023]
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24
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Mergen B, Sarici AM, Baltu F, Ozaras R, Adaletli I. An unusual presentation of sixth nerve palsy: neurobrucellosis. GMS OPHTHALMOLOGY CASES 2019; 9:Doc13. [PMID: 31157155 PMCID: PMC6533445 DOI: 10.3205/oc000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abducens nerve palsy is generally seen in older patients with diabetes and hypertension. It is relatively rare in young and otherwise healthy patients. An extensive differential diagnosis is considered in patients younger than 50 years of age who develop a sixth nerve palsy. We report here a 25-year-old patient from Turkey who was admitted with sixth nerve palsy as a component of neurobrucellosis. She was referred to our clinic because she had double vision and restricted right eye abduction. During the ophthalmic examination, both pupils were round and reactive to light and accommodation. Extraocular movements were intact with the exception that the right eye was unable to abduct. Magnetic resonance imaging revealed no pathology. She also had a diagnosis of brucellosis and her abducens nerve palsy was a form of clinical manifestation of neurobrucellosis. We conclude that neurobrucellosis should be considered in patients with sixth cranial nerve palsy especially in areas where brucellosis is endemic.
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Affiliation(s)
- Burak Mergen
- Deparment of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ahmet M Sarici
- Deparment of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatih Baltu
- Deparment of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Resat Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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25
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Ralston MSA, Murray MBP, Vela-Duarte D, Orjuela KD, Pastula DM. Neuroterrorism Preparedness for the Neurohospitalist. Neurohospitalist 2018; 9:151-159. [PMID: 31244972 DOI: 10.1177/1941874418806668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this review article, we highlight several potential biologic and chemical agents of "neuroterrorism" of which neurohospitalists should be aware: anthrax, botulism toxin, brucella, plague, smallpox, organophosphates and nerve agents, cyanide, and carfentanil. Such agents may have direct neurologic effects, resulting in encephalopathy, paralysis, and/or respiratory failure. Neurohospitalists should be on the lookout for abnormal neurologic syndrome clustering, especially among patients presenting to the emergency department. If use of such a "neuroterrorism" agent is suspected, the neurohospitalist should immediately consult with emergency department personnel, infection control, infectious disease physicians, and/or Poison Control to make sure the scene is safe and to stabilize and isolate patients if necessary. The neurohospitalist should also immediately contact their local and/or state health department (or alternatively the US Centers for Disease Control and Prevention Emergency Operations Center) to report their suspicions and to obtain guidance and assistance.
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Affiliation(s)
- Maj Samuel A Ralston
- Emory University School of Medicine, Atlanta, GA, USA.,United States Army, Army Medical Department (AMEDD) Center and School, Fort Sam Houston, TX, USA
| | - Maj Brian P Murray
- Emory University School of Medicine, Atlanta, GA, USA.,United States Air Force, Institute of Technology, Wright-Patterson AFB, OH, USA
| | - Daniel Vela-Duarte
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karen D Orjuela
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M Pastula
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Medicine (Infectious Diseases), University of Colorado School of Medicine, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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26
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27
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Miraglia MC, Rodriguez AM, Barrionuevo P, Rodriguez J, Kim KS, Dennis VA, Delpino MV, Giambartolomei GH. Brucella abortus Traverses Brain Microvascular Endothelial Cells Using Infected Monocytes as a Trojan Horse. Front Cell Infect Microbiol 2018; 8:200. [PMID: 29963502 PMCID: PMC6011031 DOI: 10.3389/fcimb.2018.00200] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/29/2018] [Indexed: 01/18/2023] Open
Abstract
Neurobrucellosis is an inflammatory disease caused by the invasion of Brucella spp. to the central nervous system (CNS). The pathogenesis of the disease is not well characterized; however, for Brucella to gain access to the brain parenchyma, traversing of the blood-brain barrier (BBB) must take place. To understand the CNS determinants of the pathogenesis of B. abortus, we have used the in vitro BBB model of human brain microvascular endothelial cells (HBMEC) to study the interactions between B. abortus and brain endothelial cells. In this study, we showed that B. abortus is able to adhere and invade HBMEC which was dependent on microtubules, microfilaments, endosome acidification and de novo protein synthesis. After infection, B. abortus rapidly escapes the endosomal compartment of HBMEC and forms a replicative Brucella-containing vacuole that involves interactions with the endoplasmic reticulum. Despite the ability of B. abortus to invade and replicate in HBMEC, the bacterium was unable by itself to traverse HBMEC, but could traverse polarized HBMEC monolayers within infected monocytes. Importantly, infected monocytes that traversed the HBMEC monolayer were a bacterial source for de novo infection of glial cells. This is the first demonstration of the mechanism whereby B. abortus is able to traverse the BBB and infect cells of the CNS. These results may have important implications in our understanding of the pathogenesis of neurobrucellosis.
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Affiliation(s)
- María C Miraglia
- Instituto de Inmunología, Genética y Metabolismo, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ana M Rodriguez
- Instituto de Inmunología, Genética y Metabolismo, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Paula Barrionuevo
- Instituto de Medicina Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas-Academia Nacional de Medicina, Buenos Aires, Argentina
| | - Julia Rodriguez
- Instituto de Inmunología, Genética y Metabolismo, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Kwang S Kim
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vida A Dennis
- Center for NanoBiotechnology Research and Department of Biological Sciences, Alabama State University, Montgomery, AL, United States
| | - M Victoria Delpino
- Instituto de Inmunología, Genética y Metabolismo, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo H Giambartolomei
- Instituto de Inmunología, Genética y Metabolismo, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Buenos Aires, Argentina
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28
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N T, B N, O O, D D, J B. Anti-Brucella activity of Caryopteris mongolica Bunge root extract against Brucella melitensis infection in mice. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:144. [PMID: 29724202 PMCID: PMC5934838 DOI: 10.1186/s12906-018-2220-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/26/2018] [Indexed: 01/08/2023]
Abstract
Background The current treatment for human brucellosis requires a combination of antibiotics for long periods of time, and the reported incidence and prevalence of the disease vary widely in nomadic livestock of Mongolia. The objective of the present study was to evaluate the in vivo antibacterial activity of the C. mongolica root extract against B. melitensis. Methods In this study, we used of 6 groups of mice (n = 5). Five groups of BALB/c mice were inoculated intraperitoneally with the M16 strain of B. melintensis, as follows: (i) one group was used for pretreatment monitoring; (ii) the control group was administered 2% Tween 80 and was used as the non-treatment group; and the other three groups were treated with one oral gavage per day for 21 days with (iii) doxycycline (2 mg/day), (iv) doxycycline (1 mg/day) with root extract (20 mg/day), and (v) C. mongolica root extract (20 mg/day). The one group that was kept non-infected was used as a healthy control group. Results This study demonstrated that daily treatment with doxycycline alone and in combination with C. mongolica root extract significantly reduced splenic infection at the end of treatment. However, the spleen index of both the doxycycline-treated and the combination-treated groups of mice decreased by approximately 50% compared to that of the healthy control mouse group. Treatment with the C. mongolica root extract resulted in a 1.47log reduction in splenic infection compared to the non-treatment group, and the spleen index of the C. mongolica-treated group of mice was the same as that of the normal mouse group. In all treatment groups, neutrophil phagocytic activity significantly decreased, and all treatment groups demonstrated splenic regeneration. Conclusions The present study showed that the C. mongolica root extract may be useful in the treatment of brucellosis patients, in combination with doxycycline or other antibiotics, to reduce the toxicity of high-dosage antibiotics, to prevent the development of antibiotic resistance and to prevent Brucella infection.
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29
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Nashi S, Preethish-Kumar V, Maji S, Chandrashekar N, Polavarapu K, Kashinkunti C, Bhattacharya K, Saini J, Nalini A. Case Report: Neurobrucellosis with Plastered Spinal Arachnoiditis: A Magnetic Resonance Imaging-Based Report. Am J Trop Med Hyg 2018; 98:800-802. [PMID: 29345223 PMCID: PMC5930921 DOI: 10.4269/ajtmh.17-0828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/03/2017] [Indexed: 03/27/2024] Open
Abstract
Diffuse spinal arachnoiditis in neurobrucellosis is a rare manifestation. We report a boy aged 17, presenting with hearing impairment and recurrent vomiting for 18 months, weight loss for 12 months, dysphagia, dysarthria, hypophonia for 6 months, and gait unsteadiness for 5 months. He had bilateral 5th (motor) to 12th cranial nerve palsy, wasting and weakness of limbs, fasciculations, absent tendon reflexes, and positive Babinski's sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed extensive enhancing exudates in cisterns and post-contrast enhancement of bilateral 5th, 6th, 7th, and 8th nerves. Spine showed clumping with contrast enhancement of the cauda equina roots and encasement of the cord with exudates. Serum and CSF were positive for anti-Brucella antibodies. He showed significant improvement with antibiotics. At 4 months follow-up, MRI demonstrated near complete resolution of cranial and spinal arachnoiditis. It is important to recognize such rare atypical presentations of neurobrucellosis.
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Affiliation(s)
- Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sayani Maji
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nagarathna Chandrashekar
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chetan Kashinkunti
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kajari Bhattacharya
- Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Sharma PP, Murali MV, Hamdi T. Neurobrucellosis Presenting as Pseudotumor Cerebri: First Report from Oman. Oman Med J 2017; 32:507-509. [PMID: 29218128 DOI: 10.5001/omj.2017.96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A ten-year-old boy presented to the hospital with body ache and joint pains for two months and headache, vomiting, and skin rash for three days. He was drowsy and lethargic at admission. Physical examination revealed bilateral papilledema. There were no cranial nerve involvement, neuromotor deficit, or signs of meningeal irritation. Computed tomography and magnetic resonance imaging of the brain did not reveal any evidence of cerebral edema or space occupying lesion. In view of the high endemicity of brucellosis in the area, Brucella agglutination test (BAT) was done at the time of admission and was negative. However, on the eighth day of admission, blood culture showed growth of Brucella melitensis. A repeat BAT at this time was strongly positive with a titer of 1:1 280. The initial one was negative due to prozone phenomenon caused by very high antibody titers. A diagnosis of neurobrucellosis with pseudotumor cerebri was made. He was treated with gentamicin, rifampicin, and septrin along with acetazolamide for raised intracranial pressure. The boy responded well to therapy and made a complete clinical recovery with resolution of papilledema. In areas endemic for brucellosis, a high index of suspicion for neurobrucellosis should be entertained in any child presenting with diverse neurological signs.
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Affiliation(s)
- Padam P Sharma
- Department of Pediatrics, Armed Forces Hospital Salalah, Salalah, Oman
| | - Mangudi V Murali
- Department of Pediatrics, Armed Forces Hospital Salalah, Salalah, Oman
| | - Tahsin Hamdi
- Department of Pediatrics, Armed Forces Hospital Salalah, Salalah, Oman
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Vafaeimanesh J, Shahamzeh A, Bagherzadeh M. Neurobrucellosis in systemic lupus erythematosus. CASPIAN JOURNAL OF INTERNAL MEDICINE 2017; 8:119-122. [PMID: 28702153 PMCID: PMC5494048 DOI: 10.22088/cjim.8.2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Brucellosis is a zoonotic infection which is endemic in many countries. It is a multisystem disease which may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is an uncommon complication of brucellosis. Case presentation: A 25-year-old woman with a history of lupus for 5 months referred to the emergency ward of Shahid Beheshti Hospital of Qom due to vertigo, drop attack and a convulsion episode from the previous day. She was unable to move at initial evaluation, and her upper and lower extremities were spastic. She had blurred vision one day after admission. Based on her past history and suspecting neurological pulmonary presentations, treatment with immunosuppressive drugs was started and brain MRI was performed. According to the MRI mode and endemic area, neurobrucellosis was suspected and 2ME and Wright tests were performed. Wight test was 1.5120 while 2ME test was 1.640 which were strongly positive. So, with neurobrucellosis diagnosis, the patient was treated but unfortunately 4 days later, after respiratory apnea, she was pronounced dead. Conclusion: In endemic areas for brucellosis, neurobrucellosis should always be kept in mind in the differential diagnosis of neurological and psychiatric cases that are encountered.
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Affiliation(s)
- Jamshid Vafaeimanesh
- Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran.,Gastrointestinal and liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Bagherzadeh
- Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
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Rodríguez AM, Delpino MV, Miraglia MC, Costa Franco MM, Barrionuevo P, Dennis VA, Oliveira SC, Giambartolomei GH. Brucella abortus-activated microglia induce neuronal death through primary phagocytosis. Glia 2017; 65:1137-1151. [PMID: 28398652 DOI: 10.1002/glia.23149] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/13/2017] [Accepted: 03/22/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Ana M. Rodríguez
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), CONICET, Universidad de Buenos Aires; Buenos Aires Argentina
| | - M. Victoria Delpino
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), CONICET, Universidad de Buenos Aires; Buenos Aires Argentina
| | - M. Cruz Miraglia
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), CONICET, Universidad de Buenos Aires; Buenos Aires Argentina
| | - Miriam M. Costa Franco
- Department of Biochemistry and Immunology; Institute of Biological Sciences, Federal University of Minas Gerais; Belo Horizonte-Minas Gerais Brazil
| | - Paula Barrionuevo
- Instituto de Medicina Experimental (CONICET-Academia Nacional de Medicina); Buenos Aires Argentina
| | - Vida A. Dennis
- Center for Nano Biotechnology Research and Department of Biological Sciences; Alabama State University; Montgomery AL
| | - Sergio C. Oliveira
- Department of Biochemistry and Immunology; Institute of Biological Sciences, Federal University of Minas Gerais; Belo Horizonte-Minas Gerais Brazil
| | - Guillermo H. Giambartolomei
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), CONICET, Universidad de Buenos Aires; Buenos Aires Argentina
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Acharya KP, Kaphle K, Shrestha K, Garin Bastuji B, Smits HL. Review of brucellosis in Nepal. Int J Vet Sci Med 2016; 4:54-62. [PMID: 33195685 DOI: 10.1016/j.ijvsm.2016.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 10/21/2016] [Accepted: 10/25/2016] [Indexed: 11/16/2022] Open
Abstract
Brucellosis is an abortifacient zoonotic disease that remains prominent in third world countries like Nepal. Brucellosis poses a public health concern, because its incidence in livestock can present substantial economic and health burdens for herders and health professionals. Several cases of bovine and human brucellosis have been reported and the prevalence is higher among livestock than among humans in Nepal. Lack of awareness, unhealthy food habit, traditional husbandry practices, and a lack of surveillance and immunization have been the major factors in maintaining a vicious cycle of propagation of the disease in human and animals. The aim of this paper is to evaluate the current status of the disease, the mechanism of infection, and pathogenesis, its zoonotic potential, diagnostic advances, treatment regimens, and the preventive measures that can be adopted in managing human brucellosis in under-developed countries such as Nepal.
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Affiliation(s)
- Krishna Prasad Acharya
- Ecole d'Ingenieurs de Purpan, Toulouse, France
- Agriculture and Forestry University (AFU), Rampur, Chitwan, Nepal
- Institute of Agriculture and Animal Science (IAAS), Tribhuvan University (TU), Kathmandu, Nepal
| | - Krishna Kaphle
- Institute of Agriculture and Animal Science (IAAS), Tribhuvan University (TU), Kathmandu, Nepal
| | | | - Bruno Garin Bastuji
- European & International Affairs Department Agence Nationale de Sécurité Sanitaire de l'alimentation, de l'environnement et du travail French Agency for Food, Environmental & Occupational Health & Safety (ANSES)
| | - Henk L Smits
- KIT Biomedical Research, Royal Tropical Institute/Koninklijk Instituut voor de Tropen, Amsterdam, The Netherlands
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Acharya KP, Niroula N, Kaphle K. Review of Brucellosis in Nepal. Epidemiol Health 2016; 38:e2016042. [PMID: 27703129 PMCID: PMC5425907 DOI: 10.4178/epih.e2016042] [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: 03/29/2016] [Accepted: 09/30/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of this paper is to evaluate the current status of the disease, the mechanism of infection, and pathogenesis, its zoonotic potential, diagnostic advances, treatment regimens, and the preventive measures that can be adopted in managing human brucellosis in under-developed countries such as Nepal. METHODS We performed a systematic review of all the available literture through Google Scholar, PubMed, Gideon Informatics, World Health Organization and other legitimate sources. Other secondary informations were collected from the government agencies such as department of livestock services and Ministry of Health. The obtained information was then re-analysed and summarized. RESULTS Few publications have addressed brucellosis in Nepal and most of those publications have focused on bovine brucellosis with sparse information available on brucellosis in humans and small ruminants. Brucella abortus is the most predominant causative agent followed by B. suis. B. abortus is predominant in cattle accounting for a substantial portion of bovine abortion in the country. Lack of awareness, unhealthy food habit, traditional husbandry practices, and a lack of surveillance and immunization have been the major factors in maintaining a vicious cycle of propagation of the disease in human and animals. Unfortunately, nothing has been done to identify the species of Brucella at the biovar level. CONCLUSIONS Although brucellosis has been reported to be endemic in Nepal, neither the distribution nor the economic and public health impact of this disease is well characterized. Robust and well-designed nationwide survey is warranted to assess the prevalence and distribution of disease in livestock and humans. Such data would facilitate the design of appropriate control programmes.
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Affiliation(s)
| | - Nirajan Niroula
- Institute of Agriculture and Animal Science, Tribhuwan University, Chitwan, Nepal
| | - Krishna Kaphle
- Institute of Agriculture and Animal Science, Tribhuwan University, Chitwan, Nepal
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Acharya KP. Brucellosis in Nepal - A Potential Threat to Public Health Professionals. CURRENT HEALTH SCIENCES JOURNAL 2016; 42:396-407. [PMID: 30581595 PMCID: PMC6269619 DOI: 10.12865/chsj.42.04.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/18/2016] [Indexed: 11/18/2022]
Abstract
Brucellosis is a prominent zoonotic disease affecting humans and animals which with the lack of proper diagnosis and treatment remains dangerous in third world countries like Nepal. Currently, Brucellosis poses a public health concern, whose incidences among entire herds of animals can present substantial economic and health burdens for herders and health professionals. Additionally, factors such as close contact with animals, poor animal husbandry, and unhygienic feeding habits can exacerbate the spread of Brucella and related zoonotic agents. In Nepal, serious cases of bovine and even human brucellosis have been reported, although the topic is yet to be extensively reviewed. This paper evaluates the literatures on human and animal brucellosis in Nepal and other countries, with an emphasis on the impact of Brucella outbreaks on public health professionals. Herein, we summarize the current status of the disease, the mechanism of infection, pathogenesis, zoonotic potential, diagnostic advances, treatment regimens, and the preventive measures that can be adopted in managing human brucellosis in under-developed countries such as Nepal.
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Affiliation(s)
- K P Acharya
- Animal Science Instructor,Shree Himganga Higher Secondary School, Ramechhap, Nepal; Institute of Agriculture and Animal Science, Tribhuwan University, Rampur, Chitwan, Nepal
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The role of NLRP3 and AIM2 in inflammasome activation during Brucella abortus infection. Semin Immunopathol 2016; 39:215-223. [PMID: 27405866 DOI: 10.1007/s00281-016-0581-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/04/2016] [Indexed: 01/18/2023]
Abstract
The innate immune system is essential for the detection and elimination of bacterial pathogens. Upon inflammasome activation, caspase-1 cleaves pro-IL-1β and pro-IL-18 to their mature forms IL-1β and IL-18, respectively, and the cell undergoes inflammatory death termed pyroptosis. Here, we reviewed recent findings demonstrating that Brucella abortus ligands activate NLRP3 and AIM2 inflammasomes which lead to control of infection. This protective effect is due to the inflammatory response caused by IL-1β and IL-18 rather than cell death. Brucella DNA is sensed by AIM2 and bacteria-induced mitochondrial reactive oxygen species is detected by NLRP3. However, deregulation of pro-inflammatory cytokine production can lead to immunopathology. Nervous system invasion by bacteria of the genus Brucella results in an inflammatory disorder termed neurobrucellosis. Herein, we discuss the mechanism of caspase-1 activation and IL-1β secretion in glial cells infected with B. abortus. Our results demonstrate that the ASC inflammasome is indispensable for inducing the activation of caspase-1 and secretion of IL-1β upon infection of astrocytes and microglia with Brucella. Moreover, our results demonstrate that secretion of IL-1β by Brucella-infected glial cells depends on NLRP3 and AIM2 and leads to neurobrucellosis. Further, the inhibition of the host cell inflammasome as an immune evasion strategy has been described for bacterial pathogens. We discuss here that the bacterial type IV secretion system VirB is required for inflammasome activation in host cells during infection. Taken together, our results indicate that Brucella is sensed by ASC inflammasomes mainly NLRP3 and AIM2 that collectively orchestrate a robust caspase-1 activation and pro-inflammatory response.
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WITHDRAWN: Acute brucellosis in Nepal: Research and prospects. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] 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: 16] [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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Miraglia MC, Costa Franco MM, Rodriguez AM, Bellozi PMQ, Ferrari CC, Farias MI, Dennis VA, Barrionuevo P, de Oliveira ACP, Pitossi F, Kim KS, Delpino MV, Oliveira SC, Giambartolomei GH. Glial Cell-Elicited Activation of Brain Microvasculature in Response to Brucella abortus Infection Requires ASC Inflammasome-Dependent IL-1β Production. THE JOURNAL OF IMMUNOLOGY 2016; 196:3794-805. [PMID: 26983788 DOI: 10.4049/jimmunol.1500908] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 02/18/2016] [Indexed: 01/18/2023]
Abstract
Blood-brain barrier activation and/or dysfunction are a common feature of human neurobrucellosis, but the underlying pathogenic mechanisms are largely unknown. In this article, we describe an immune mechanism for inflammatory activation of human brain microvascular endothelial cells (HBMEC) in response to infection with Brucella abortus Infection of HBMEC with B. abortus induced the secretion of IL-6, IL-8, and MCP-1, and the upregulation of CD54 (ICAM-1), consistent with a state of activation. Culture supernatants (CS) from glial cells (astrocytes and microglia) infected with B. abortus also induced activation of HBMEC, but to a greater extent. Although B. abortus-infected glial cells secreted IL-1β and TNF-α, activation of HBMEC was dependent on IL-1β because CS from B. abortus-infected astrocytes and microglia deficient in caspase-1 and apoptosis-associated speck-like protein containing a CARD failed to induce HBMEC activation. Consistently, treatment of CS with neutralizing anti-IL-1β inhibited HBMEC activation. Both absent in melanoma 2 and Nod-like receptor containing a pyrin domain 3 are partially required for caspase-1 activation and IL-1β secretion, suggesting that multiple apoptosis-associated speck-like protein containing CARD-dependent inflammasomes contribute to IL-1β-induced activation of the brain microvasculature. Inflammasome-mediated IL-1β secretion in glial cells depends on TLR2 and MyD88 adapter-like/TIRAP. Finally, neutrophil and monocyte migration across HBMEC monolayers was increased by CS from Brucella-infected glial cells in an IL-1β-dependent fashion, and the infiltration of neutrophils into the brain parenchyma upon intracranial injection of B. abortus was diminished in the absence of Nod-like receptor containing a pyrin domain 3 and absent in melanoma 2. Our results indicate that innate immunity of the CNS set in motion by B. abortus contributes to the activation of the blood-brain barrier in neurobrucellosis and IL-1β mediates this phenomenon.
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Affiliation(s)
- M Cruz Miraglia
- Institute of Immunology, Genetics and Metabolism (National Scientific and Technical Research Council/University of Buenos Aires), Clinical Hospital José de San Martín, Faculty of Medicine, University of Buenos Aires, Buenos Aires C1120AAR, Argentina
| | - Miriam M Costa Franco
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte-Minas Gerais 31270-901, Brazil
| | - Ana M Rodriguez
- Institute of Immunology, Genetics and Metabolism (National Scientific and Technical Research Council/University of Buenos Aires), Clinical Hospital José de San Martín, Faculty of Medicine, University of Buenos Aires, Buenos Aires C1120AAR, Argentina
| | - Paula M Q Bellozi
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte-Minas Gerais 31270-901, Brazil
| | - Carina C Ferrari
- Leloir Institute Foundation, Biochemical Research Institute of Buenos Aires/National Scientific and Technical Research Council, Buenos Aires C1405BWE, Argentina
| | - Maria I Farias
- Leloir Institute Foundation, Biochemical Research Institute of Buenos Aires/National Scientific and Technical Research Council, Buenos Aires C1405BWE, Argentina
| | - Vida A Dennis
- Center for NanoBiotechnology Research, Alabama State University, Montgomery, AL 36104; and
| | - Paula Barrionuevo
- Institute of Immunology, Genetics and Metabolism (National Scientific and Technical Research Council/University of Buenos Aires), Clinical Hospital José de San Martín, Faculty of Medicine, University of Buenos Aires, Buenos Aires C1120AAR, Argentina
| | - Antonio C P de Oliveira
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte-Minas Gerais 31270-901, Brazil
| | - Fernando Pitossi
- Leloir Institute Foundation, Biochemical Research Institute of Buenos Aires/National Scientific and Technical Research Council, Buenos Aires C1405BWE, Argentina
| | - Kwang Sik Kim
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - M Victoria Delpino
- Institute of Immunology, Genetics and Metabolism (National Scientific and Technical Research Council/University of Buenos Aires), Clinical Hospital José de San Martín, Faculty of Medicine, University of Buenos Aires, Buenos Aires C1120AAR, Argentina
| | - Sergio Costa Oliveira
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte-Minas Gerais 31270-901, Brazil
| | - Guillermo H Giambartolomei
- Institute of Immunology, Genetics and Metabolism (National Scientific and Technical Research Council/University of Buenos Aires), Clinical Hospital José de San Martín, Faculty of Medicine, University of Buenos Aires, Buenos Aires C1120AAR, Argentina;
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Oueslati I, Berriche A, Ammari L, Abdelmalek R, Kanoun F, Kilani B, Tiouiri Benaissa H. Epidemiological and clinical characteristics of neurobrucellosis case patients in Tunisia. Med Mal Infect 2016; 46:123-30. [PMID: 26897309 DOI: 10.1016/j.medmal.2016.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/25/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to identify epidemiological, clinical, therapeutic, diagnostic, and outcome characteristics of neurobrucellosis case patients in Tunisia. PATIENTS AND METHODS We conducted a retrospective and descriptive study over a 17-year period (January 1997-December 2013). We included all neurobrucellosis patients hospitalized in the infectious disease department of La Rabta Hospital of Tunis during the study period. RESULTS A total of 13 patients were included in the study: 9 men and 4 women. Mean age was 31.6 years. Six patients presented with meningitis, three with encephalitis, two with meningoencephalitis, and two with meningo-myeloradiculitis. All patients had a lumbar puncture performed. Eleven patients had an abnormal cerebrospinal fluid (CSF) (84.6%): lymphocytic pleocytosis in seven patients, high level of CSF proteins in 11, and low level of CSF glucose in seven. All patients had a positive Brucella serological test in blood. A Brucella serological test was also performed in CSF and was positive for 10 patients (77%). A total of nine patients had a cerebral CT scan and/or MRI performed and abnormalities were observed in six patients. Antibiotic therapy was prescribed to all patients: a combination of rifampicin and co-trimoxazole (n=9) or doxycycline (n=4) for an average duration of eight months. Two patients also received steroids. A positive outcome was observed in 10 patients. Three patients were lost to follow up. CONCLUSION Brucellosis may be severe when neurological involvement occurs. Brucellosis should be considered in the event of any neurological involvement associated with suggestive epidemiological features.
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Affiliation(s)
- I Oueslati
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - A Berriche
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie.
| | - L Ammari
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - R Abdelmalek
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - F Kanoun
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - B Kilani
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - H Tiouiri Benaissa
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
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Dreshaj S, Shala N, Dreshaj G, Ramadani N, Ponosheci A. Clinical Manifestations in 82 Neurobrucellosis Patients from Kosovo. Mater Sociomed 2016; 28:408-411. [PMID: 28144188 PMCID: PMC5239658 DOI: 10.5455/msm.2016.28.408-411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Central nervous system involvement is a serious complication of brucellosis with various incidence and various clinical presentations. PATIENTS AND METHODS Hospitalized patients in University Clinical Centre, Clinic for Infectious diseases in Prishtina, with laboratory-confirmed brucellosis, were analyzed, a brucellosis-endemic region. Among the 648 confirmed cases with brucellosis during the period 1991- 2013, 82 patients (12.65%) were diagnosed with neurobrucellosis. The clinical manifestations in patients with neurobrucellosis were evaluated and compared with brucellosis patients. RESULTS The major presentations among the brucellosis patients were headache, fever, sweating, nausea, weight loss and arthralgia, while from CNS predominant complains were: headache, vomiting, tremor, low back pain, hearing loss and visual disturbance. The mean age of 82 neurobrucellosis patients was 31.46 years with age distribution 12-71 years, from them 5 (6.1%), younger than 16 years, with a non-significant predominance of women (53.65%). The most common neurological findings were radiculopathies of legs (41.46%) neck rigidity (46.34%), agitation (25,6%), behavioral disorders (18.3%), disorientation (19.5%) and stroke (1.22%). Cranial nerves were involved in 20 of 82 patients (24.4%). Neurological consequences were evidenced in 5 (6.1%) patients. Three patients leave hospital with consequences of peripheral facial paresis, two with sensorineural hearing loss and one with left hemiparesis. Headache, nausea and vomiting and weight loss are significantly (p<0.001) more frequent complains in neurobrucellosis patients compare to patients with brucellosis. On the other hand, as regard to the physical findings and complications, meningeal signs and splenomegaly are significantly more frequent in neurobrucellosis (p<0.01) whereas the hepatomegaly and lymphadenopathy were more frequent (p<0.01) in brucellosis patients. Different significant correlations were observed among specific complains too. CONCLUSIONS Our findings in regard to the specific associations of physical and clinical features in brucellosis patients in Kosovo, may serve as an indication for neurobrucellosis. In endemic areas for brucellosis patients complaining in radiculopathies, persistent headache, facial palsy, hearing loss or presenting stroke without risk factors, should be considered for screening for neurobrucellosis.
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Affiliation(s)
- Shemsedin Dreshaj
- University of Prishtina, Faculty of Medicine, Clinic of Infectious Diseases, Prishtina University Clinical Centre, Kosovo
| | - Nexhmedin Shala
- University of Prishtina, Faculty of Medicine, Clinic of Neurology, Prishtina University Clinical Centre, Kosovo
| | | | - Naser Ramadani
- University of Prishtina, Faculty of Medicine, Institute of Public Health, Prishtina, Kosovo
| | - Albina Ponosheci
- University of Prishtina, Faculty of Medicine, Clinic of Infectious Diseases, Prishtina University Clinical Centre, Kosovo
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Kim EJ, Lee SJ, Ahn EY, Ryu DG, Choi YH, Kim TH. Relapsed Brucellosis Presenting as Neurobrucellosis with Cerebral Vasculitis in a Patient Previously Diagnosed with Brucellar Spondylitis: A Case Report. Infect Chemother 2015; 47:268-71. [PMID: 26788412 PMCID: PMC4716280 DOI: 10.3947/ic.2015.47.4.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/04/2014] [Accepted: 08/05/2014] [Indexed: 11/24/2022] Open
Abstract
Brucellosis is a multisystem disease with various clinical symptoms. Neurobrucellosis is a rare but serious manifestation of brucellosis. A 60-year-old man with a previous diagnosis of brucellar spondylitis presented with sudden onset of aphasia and numbness of the right upper extremity. Cerebral angiography showed diffuse narrowing and dilatation on the distal branches of both the anterior cerebral artery (ACA) and the left middle cerebral artery (MCA) which indicated cerebral vasculitis, and the patient's Brucella agglutinin titer was 1:1280. After combined antimicrobial and steroid therapy was started, the patient's condition improved significantly, and he was discharged after 1 month. Antimicrobial therapy was continued for 16 months on an outpatient basis, and the last Brucella agglutinin titer was 1:40. To our knowledge, this is the first case of relapsed neurobrucellosis with vasculitis in Korea to have been treated successfully.
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Affiliation(s)
- Eun Jung Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Jin Lee
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Eun Young Ahn
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yu Hee Choi
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Hyun Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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Amiri RS, Hanif H, Ahmadi A, Amirjamshidi A. Brucella-related multiple cerebral aneurysms: Report of a case and review of the literature. Surg Neurol Int 2014; 5:152. [PMID: 25396074 PMCID: PMC4228499 DOI: 10.4103/2152-7806.143365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/12/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Mycotic cerebral aneurysms are uncommon. We intend to report the first case of multiple mycotic cerebral aneurysms due to Brucella infection that were treated surgically. CASE DESCRIPTION A 34-year-old man with neurobrucellosis presented with intracerebral haemorrhage (ICH). Three mycotic aneurysms were detected in the vicinity of middle cerebral artery (MCA). Medical treatment failed to treat them and aneurysms had to be managed surgically. CONCLUSION Brucella-related cerebral mycotic aneurysm has rarely been reported. This is the first report of three mycotic aneurysms occurring in a young man with neurobrucellosis treated surgically.
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Affiliation(s)
- Rouzbeh Shams Amiri
- Department of Neurosurgery, Imam Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamed Hanif
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Ali Ahmadi
- Department of Pathology, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
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Tugcu B, Nacaroglu SA, Coskun C, Kuscu DY, Onder F. Chronic Meningitis Complicating Intracranial Hypertension in Neurobrucellosis: A Case Report. Semin Ophthalmol 2014; 30:429-31. [DOI: 10.3109/08820538.2013.874472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pappas G, Akritidis N, Christou L. Treatment of neurobrucellosis: what is known and what remains to be answered. Expert Rev Anti Infect Ther 2014; 5:983-90. [DOI: 10.1586/14787210.5.6.983] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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47
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Parlak M, Güdücüoğlu H, Bayram Y, Çıkman A, Aypak C, Kılıç S, Berktaş M. Identification and determination of antibiotic susceptibilities of Brucella strains isolated from patients in van, Turkey by conventional and molecular methods. Int J Med Sci 2013; 10:1406-11. [PMID: 23983603 PMCID: PMC3753419 DOI: 10.7150/ijms.6565] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/13/2013] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In this study, we aimed to identify biovars of Brucella strains isolated from clinical specimens taken from brucellosis patients from the Eastern Anatolia region as well determine the susceptibility of these isolates to tigecycline and azithromycin, drugs that may serve as alternatives to the conventional drugs used in the therapy. MATERIALS AND METHODS Seventy-five Brucella spp. isolates were included in the study. All strains were identified by both conventional and molecular methods. Brucella Multiplex PCR kit (FC-Biotech, Code: 0301, Turkey) and B. melitensis biovar typing PCR kit (FC-Biotech, Code: 0302, Turkey) were used for molecular typing. Antimicrobial susceptibilities of all strains were determined by E-tests. RESULTS By conventional biotyping, 73 strains were identified as B. melitensis biovar 3 and two strains as B. abortus biovar 3. Molecular typing results were compatible with conventional methods. The MIC50 and MIC90 values of doxycycline were 0.047 and 0.094; tigecycline 0.094 and 0.125; trimethoprim/sulfamethoxazole 0.064 and 0.19; ciprofloxacin 0.19 for both; streptomycin 0.75 and 1; rifampin 1 and 2 and azithromycin 4 and 8. According to the MIC values, doxycycline was found to be the most effective antibiotic, followed by tigecycline, trimethoprim-sulfamethoxazole and ciprofloxacin. CONCLUSION Currently recommended antibiotics for the treatment of brucellosis such as doxycycline, rifampin, streptomycin, trimethoprim-sulfamethoxazole and ciprofloxacin were found to be still effective. While our results showed that tigecycline can be used an alternative agent in the treatment of brucellosis, azithromycin has not been confirmed as an appropriate agent for the treatment.
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Affiliation(s)
- Mehmet Parlak
- 1. Microbiology Laboratory, Van Education and Training Hospital, Van, Turkey
| | - Hüseyin Güdücüoğlu
- 2. Department of Medical Microbiology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Yasemin Bayram
- 2. Department of Medical Microbiology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Aytekin Çıkman
- 3. Microbiology Laboratory, Mengucek Gazi Education and Training Hospital, Erzincan, Turkey
| | - Cenk Aypak
- 4. Department of Family Medicine, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Selçuk Kılıç
- 5. Bacterial Zoonoses Research Reference Laboratory, Turkey Public Health Agency, Ankara, Turkey
| | - Mustafa Berktaş
- 2. Department of Medical Microbiology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
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Yaghoobi MH, Siroos B, Foroumandi M, Gharabaghi MA. Tricky brucellosis. BMJ Case Rep 2013; 2013:bcr-2013-009522. [PMID: 23709547 DOI: 10.1136/bcr-2013-009522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a 23-year-old woman who was admitted due to fever, palpitation, musculoskeletal pain and a transient bout of sudden-onset left-sided hemiparesis. She had also myopericarditis according to echocardiography findings. After comprehensive diagnostic work-up for infectious and immunologic disorders, brucellosis was confirmed by bone marrow aspiration culture. She received doxycycline, rifampin and trimethoprim-sulfamethoxazole for 3 months. The treatment was continued with doxycycline and rifampin for another 6 months. By the end of treatment, she recovered completely with no evidence of persistent neurological or cardiac complications.
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Affiliation(s)
- Mojtaba Hedayat Yaghoobi
- Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Miraglia MC, Scian R, Samartino CG, Barrionuevo P, Rodriguez AM, Ibañez AE, Coria LM, Velásquez LN, Baldi PC, Cassataro J, Delpino MV, Giambartolomei GH. Brucella abortus induces TNF-α-dependent astroglial MMP-9 secretion through mitogen-activated protein kinases. J Neuroinflammation 2013; 10:47. [PMID: 23587438 PMCID: PMC3637408 DOI: 10.1186/1742-2094-10-47] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/21/2013] [Indexed: 01/18/2023] Open
Abstract
Background Central nervous system (CNS) invasion by bacteria of the genus Brucella results in an inflammatory disorder called neurobrucellosis. We have recently demonstrated that B. abortus infects microglia and astrocytes, eliciting the production of a variety of pro-inflammatory cytokines which contribute to CNS damage. Matrix metalloproteinases (MMP) have been implicated in inflammatory tissue destruction in a range of pathological situations in the CNS. Increased MMP secretion is induced by pro-inflammatory cytokines in a variety of CNS diseases characterized by tissue-destructive pathology. Methods In this study, the molecular mechanisms that regulate MMP secretion from Brucella-infected astrocytes in vitro were investigated. MMP-9 was evaluated in culture supernatants by ELISA, zymography and gelatinolytic activity. Involvement of mitogen-activated protein kinases (MAPK) signaling pathways was evaluated by Western blot and using specific inhibitors. The role of TNF-α was evaluated by ELISA and by assays with neutralizing antibodies. Results B. abortus infection induced the secretion of MMP-9 from murine astrocytes in a dose-dependent fashion. The phenomenon was independent of bacterial viability and was recapitulated by L-Omp19, a B. abortus lipoprotein model, but not its LPS. B. abortus and L-Omp19 readily activated p38 and Erk1/2 MAPK, thus enlisting these pathways among the kinase pathways that the bacteria may address as they invade astrocytes. Inhibition of p38 or Erk1/2 significantly diminished MMP-9 secretion, and totally abrogated production of this MMP when both MAPK pathways were inhibited simultaneously. A concomitant abrogation of B. abortus- and L-Omp19-induced TNF-α production was observed when p38 and Erk1/2 pathways were inhibited, indicating that TNF-α could be implicated in MMP-9 secretion. MMP-9 secretion induced by B. abortus or L-Omp19 was completely abrogated when experiments were conducted in the presence of a TNF-α neutralizing antibody. MMP-9 activity was detected in cerebrospinal fluid (CSF) samples from patients suffering from neurobrucellosis. Conclusions Our results indicate that the inflammatory response elicited by B. abortus in astrocytes would lead to the production of MMP-9 and that MAPK may play a role in this phenomenon. MAPK inhibition may thus be considered as a strategy to control inflammation and CNS damage in neurobrucellosis.
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Affiliation(s)
- M Cruz Miraglia
- Laboratorio de Inmunogenética, Instituto de Inmunología, Genética y Metabolismo, Hospital de Clínicas "José de San Martín"-CONICET/UBA, Buenos Aires, Argentina
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A Case of Underdiagnosed Brucella Meningitis Presented With Hearing Loss. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e318261151e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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