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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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Farzinvash Z, Raji MM, Manaviat M. An uncommon case of brucellosis with ocular presentation. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220028] [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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3
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An Unusual Case of Neurobrucellosis Presenting as Acute Flaccid Paralysis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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An Interesting Case of Neurobrucellosis Mimicking Neuropsychiatric Lupus. Case Rep Rheumatol 2018; 2018:9793535. [PMID: 30073110 PMCID: PMC6057280 DOI: 10.1155/2018/9793535] [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: 05/15/2018] [Accepted: 06/23/2018] [Indexed: 11/18/2022] Open
Abstract
This case describes a patient presenting with acute onset papilledema, subacute strokes resulting in upper extremity weakness and numbness, arthritis, maculopapular rash, depressed C4 and CH50, and a high titer anti-double-stranded DNA antibody. The patient was given the diagnosis of probable systemic lupus erythematosus, which was supported by the Systemic Lupus International Collaborating Clinics (SLICC) criteria. He was aggressively treated for neuropsychiatric lupus (NPSLE) with pulse dose steroids and a dose of intravenous cyclophosphamide. Blood cultures drawn on admission later grew out 2/4 bottles of Gram-variable bacteria, speciated as Brucella melitensis by PCR. Serum Brucella serologies were also positive. On further evaluation, the patient noted a history of eating unpasteurized cheese in Mexico. Given these additional findings, the patient's presentation was most consistent with a diagnosis of neurobrucellosis. Steroids were tapered off, no further doses of cyclophosphamide were given, and a prolonged course of intravenous and oral antibiotic therapy was administered, resulting in complete resolution of the patient's presenting symptoms.
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Turkoglu SA, Halicioglu S, Sirmatel F, Yildiz M, Yildiz N, Yildiz S. Vasculitis and neurobrucellosis: Evaluation of nine cases using radiologic findings. Brain Behav 2018; 8:e00947. [PMID: 29670827 PMCID: PMC5893346 DOI: 10.1002/brb3.947] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/14/2018] [Accepted: 01/26/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Brucellosis is an important multisystemic disease with many different clinical symptoms, and its early diagnosis and treatment are possible. Neurobrucellosis (NB) is a rare but serious finding of brucellosis. Brucella can be seen as meningitis and encephalopathy, and it can cause cranial nerve pathologies, vascular syndromes, myopathy, spinal diseases, and psychiatric disorders. In NB, vascular syndromes secondary to inflammation are rarely seen. Here, we present nine young patients with vascular and nonspecific neuropsychiatric findings who had NB as the etiology of stroke. METHODS Nine patients who were admitted to our Neurology Clinic between 2012 and 2017 for various reasons in whom brucellosis was found in the etiology were retrospectively studied. The patients' symptoms, physical examination, laboratory and radiographic findings, treatments, and treatment responses are discussed. RESULTS Of the nine patients who presented to our clinic in the 4-year period, five were female. The average age was 49 years. Five patients had small vessel vasculitis, three had great vessel vasculitis, and one had meningoencephalitis and pons abscess. Two patients had granuloma, and one had an aneurysm. CONCLUSIONS We aimed to present our cases due to the fact that this disease should be kept in mind in the differential diagnosis of patients with stroke and similar neuropsychiatric findings.
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Affiliation(s)
- Sule Aydin Turkoglu
- Department of Neurology Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Siddika Halicioglu
- Department of Radiology Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Fatma Sirmatel
- Department of Infectious Diseases Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Murside Yildiz
- Department of Intensive Care Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Nebil Yildiz
- Department of Neurology Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Serpil Yildiz
- Department of Neurology Abant Izzet Baysal University Medical Faculty Bolu Turkey
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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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8
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Alqwaifly M, Al-Ajlan FS, Al-Hindi H, Al Semari A. Central Nervous System Brucellosis Granuloma and White Matter Disease in Immunocompromised Patient. Emerg Infect Dis 2018; 23:978-981. [PMID: 28518039 PMCID: PMC5443428 DOI: 10.3201/eid2306.161173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Brucellosis is a multisystem zoonotic disease. We report an unusual case of neurobrucellosis with seizures in an immunocompromised patient in Saudi Arabia who underwent renal transplantation. Magnetic resonance imaging of the brain showed diffuse white matter lesions. Serum and cerebrospinal fluid were positive for Brucella sp. Granuloma was detected in a brain biopsy specimen.
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Milburn J, Shatti D, Manji H, Everitt A. Progressive weakness and intermittent low-grade fever in a Libyan man. Pract Neurol 2016; 16:462-465. [DOI: 10.1136/practneurol-2016-001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/04/2022]
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Survey of Omp19 immunogenicity against Brucella abortus and Brucella melitensis: influence of nanoparticulation versus traditional immunization. Vet Res Commun 2015; 39:217-28. [DOI: 10.1007/s11259-015-9645-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/08/2015] [Indexed: 11/26/2022]
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Ergonul O, Guven T, Ugurlu K, Celikbas AK, Gok SE, Comoglu S, Baykam N, Dokuzoguz B. Reply to Kesav et al. Clin Infect Dis 2013; 57:1057-8. [DOI: 10.1093/cid/cit399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Kesav P, Vishnu VY, Khurana D. Is neurobrucellosis the Pandora's Box of modern medicine? Clin Infect Dis 2013; 57:1056-7. [PMID: 23804193 DOI: 10.1093/cid/cit398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Praveen Kesav
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kesav P, Modi M, Singla V, Khurana D, Prabhakar S. Kaleidoscopic presentation of neurobrucellosis. J Neurol Sci 2013; 331:165-7. [PMID: 23759362 DOI: 10.1016/j.jns.2013.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 05/16/2013] [Accepted: 05/17/2013] [Indexed: 11/26/2022]
Abstract
Brucellosis remains an important public health problem especially in the underdeveloped countries as well as the Middle East. It may be a "master mimic" leading on to grave diagnostic dilemmas. Chronic neurobrucellosis is seldom associated with signs and symptoms of toxaemia due to multi organ dysfunction. We report the case of a 23-year-old man who presented with fever of 8 weeks associated with ascending weakness of lower limbs and sensorineural type of hearing loss of 6 weeks duration with prominent systemic findings in the form of hepatosplenomegaly and significant loss of weight. He responded well to treatment with combination antimicrobials with clinicoradiological resolution after 6 months of therapy. Even though a rare complication of brucellosis, neurobrucellosis causes significant morbidity if not promptly recognised and treated. Favourable outcomes can be achieved in neurobrucellosis with appropriate protracted polymicrobial antibiotic therapy as was illustrated in our patient.
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Affiliation(s)
- Praveen Kesav
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Neurobrucellosis developing unilateral oculomotor nerve paralysis. Am J Emerg Med 2012; 30:2085.e5-7. [PMID: 22244219 DOI: 10.1016/j.ajem.2011.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/02/2011] [Indexed: 11/22/2022] Open
Abstract
Brucellosis is a zoonotic infectious disease that is common around the world. Its clinical course demonstrates great diversity as it can affect all organs and systems. However, the central nervous system is rarely affected in the pediatric population. Neurobrucellosis is most frequently observed with meningitis and has numerous complications, including meningocephalitis, myelitis, cranial nerve paralyses, radiculopathy, and neuropathy. Neurobrucellosis affects the second, third, sixth, seventh, and eighth cranial nerves. Involvement of the oculomotor nerves is a very rare complication in neurobrucellosis although several adult cases have been reported. In this article, we present the case of a 9-year-old girl who developed unilateral nerve paralysis as a secondary complication of neurobrucellosis and recovered without sequel after treatment. This case is notable because it is a very rare, the first within the pediatric population. Our article emphasizes that neurobrucellosis should be considered among the distinguishing diagnoses in every case that is admitted for nerve paralysis in regions where Brucella infection is endemic.
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Abstract
There is currently no licensed vaccine for brucellosis in humans. Available animal vaccines may cause disease and are considered unsuitable for use in humans. However, the causative pathogen, Brucella, is among the most common causes of laboratory-acquired infections and is a Center for Disease Control category B select agent. Thus, human vaccines for brucellosis are required. This review highlights the considerations that are needed in the journey to develop a human vaccine, including animal models, and includes an assessment of the current status of novel vaccine candidates.
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Affiliation(s)
- Stuart D Perkins
- Department of Biomedical Sciences, Defence Science and Technology Laboratory, Porton Down, Salisbury, Wiltshire, UK
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Brucellosis presenting as pyrexia of unknown origin in an international traveller: a case report. CASES JOURNAL 2009; 2:7969. [PMID: 19918443 PMCID: PMC2769393 DOI: 10.4076/1757-1626-2-7969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 08/14/2009] [Indexed: 11/16/2022]
Abstract
Introduction In this era of globalization frequent traveling across the world is common. It has resulted in exchange of knowledge and expertise among medical professionals around the world which has a visible positive impact. However, this predisposes the travelers to the risk of acquiring an ‘alien’ disease endemic to a particular country. This may be a great challenge for the treating physicians to manage such patients due to lack of facility for diagnosis and experience in handling such disease. We present a similar case scenario and problems we faced in managing that patient. Case presentation A 40-year-old man visited to Africa, developed a skin rash over ankle after an insect bite. This was followed by high grade fever. He was investigated in Kenya, however, returned to India pending results. Later he developed sleepiness and coarse tremors. Work up for the cause of fever was inconclusive. He was diagnosed with trypanosomiasis based on reports from Kenya. In absence of alternate diagnosis and clinical setting, we treated him for trypanosomiasis. This therapy resulted no improvement in patient’s condition. Finally, at request of the patient’s attendants he was referred to Belgium where he was diagnosed as brucellosis and treated successfully. Conclusion Our patient was indeed suffering from neurobrucellosis. Brucellosis is a frequently missed cause of pyrexia. Our case highlights that in this era, taking help from our professional colleagues over the globe is easy which can improve patient care greatly.
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Coskun O, Ertem GT, Ergun U, Kutlu G, Tulek N, Inan LE, Ozkan S. EVALUATION OF BRAINSTEM AUDITORY POTENTIAL IN BRUCELLOSIS PATIENTS WITH AND WITHOUT NEUROLOGICAL INVOLVEMENT. Int J Neurosci 2009; 115:717-23. [PMID: 15823936 DOI: 10.1080/00207450590523341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study investigated the changes in brainstem auditory evoked potentials (BAEPs) in acute phase of brucellosis. Twenty-two patients with brucellosis without neurologic involvement and seven patients with neurobrucellosis were included. BAEPs were evaluated before treatment. No patient had a symptom of hearing loss. Patients who had neurologic involvement did not show any abnormalities in their BAEPs recording. This study suggests that patients with brucellosis who are in the acute phase of the disease with or without neurological involvement may have normal BAEPs. BAEPs do not seem to be a sensitive method for central nervous system involvement of brucella patients in the acute phase of the disease.
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Affiliation(s)
- Ozlem Coskun
- Ministry of Health, Ankara Training & Research Hospital, Department of Neurology, Ankara, Turkey.
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Yetkin MA, Bulut C, Erdinc FS, Oral B, Tulek N. Evaluation of the clinical presentations in neurobrucellosis. Int J Infect Dis 2006; 10:446-52. [PMID: 16914346 DOI: 10.1016/j.ijid.2006.05.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 05/03/2006] [Accepted: 05/23/2006] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is one of the complications. METHODS In this study, we describe our experience in the diagnosis, treatment, and the final outcomes of 20 patients with neurobrucellosis out of 305 patients with brucellosis, within a five-year period between January 1999 and June 2004. RESULTS The rate of neurobrucellosis was 6.6%. Twelve males and eight females with a mean age of 37.4 years were investigated. Fever, headache, confusion, and gait disorders were the main complaints. The duration of their complaints varied between one week and six months. On physical examination, 13 patients had fever, six had neck stiffness and confusion, three had motor deficit on either their upper or lower extremities, and four of them had diplopia. The Rose-Bengal test and standard tube agglutination tests were positive in all of the patients. Brucella melitensis was isolated from the blood of six of the 20 (30%) patients. Cerebrospinal fluid (CSF) was analyzed in 18 patients. Pleocytosis with a mean value of 244x10(6)cells/L, and high protein levels were detected in all. A low glucose level in the CSF was detected in ten patients. Patients were treated medically and a complete resolution was achieved in all. CONCLUSION Patients with a Brucella infection occasionally manifest central nervous system involvement. Clinicians, especially serving in endemic areas or serving patients coming from endemic areas should consider the likelihood of neurobrucellosis in the patients with unexplained neurological and psychiatric symptoms, and should perform the necessary tests on blood and CSF.
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Affiliation(s)
- Meltem Arzu Yetkin
- Department of Infectious Diseases and Clinical Microbiology, Health Ministry Ankara Training and Research Hospital, Cebeci 06340, Ankara, Turkey.
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Abstract
We report a series of four cases presented with transient ischemic attacks (TIA) or ischemic stroke as the predominant manifestation of neurobrucellosis (NB). Three of the patients were 20-28 years of age, and one patient was 53 years old. They all used to consume unpasteurized milk or its products. Two patients had systemic brucellosis in the past and received antibiotic treatment. Other causes of TIA including cardiac embolism, hypercoagulability, vascular malformations, systemic vasculitis, and infective endocarditis were excluded. NB was diagnosed with serological tests or cultures for Brucella in the cerebrospinal fluid. None of the patients had any further TIA after the initiation of specific treatment. NB should always be sought in young patients with TIA or ischemic stroke, especially if they have no risk factors for stroke and live in an endemic area for brucellosis, even if they do not have other systemic signs of brucellosis.
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Affiliation(s)
- A Bingöl
- Neurology, Ankara University School of Medicine, Ankara, Turkey
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20
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Abstract
The purpose of this paper is to draw attention to atypical presentations of brucellosis. A prospective study identified 240 consecutive patients with brucellosis admitted to our department between December 1999 and July 2002. From these cases we present 11 patients with unusual clinical presentations. Neurobrucellosis, peritonitis, pericarditis, pancytopenia, and uveitis were diagnosed in 2 patients each and 1 presented with epididymo-orchitis.
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Affiliation(s)
- Cigdem Ataman Hatipoglu
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara 06340, Turkey.
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21
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McGuiness F. Imaging of Brain and Spinal Cord Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Goktepe AS, Alaca R, Mohur H, Coskun U. Neurobrucellosis and a demonstration of its involvement in spinal roots via magnetic resonance imaging. Spinal Cord 2003; 41:574-6. [PMID: 14504617 DOI: 10.1038/sj.sc.3101479] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To present a neurobrucellosis case with spinal root involvement by means of magnetic resonance imaging (MRI). METHODS A case of neurobrucellosis resembling Guillain-Barré syndrome is being reported. This case is unique in a way that spinal root involvement because of brucellosis was for the first time confirmed by MRI. SETTING Spinal cord unit of a rehabilitation and care center in Ankara, Turkey. RESULTS The correct diagnosis was made with cerebrospinal fluid culture. The patient showed a significant improvement with antimicrobial therapy and rehabilitation. CONCLUSION Polyradiculopathy because of neurobrucellosis may mimic neurological syndromes. Rehabilitation should also be a part of its treatment.
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Affiliation(s)
- A S Goktepe
- Rehabilitation and Care Center, Gulhane Military Medical Academy, Ankara, Turkey
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Abstract
BACKGROUND Although there have been reports of Brucella granuloma or abscess in the literature, they were all localized extradurally except one, and most patients underwent surgery. CASE REPORT A 40-year-old female presented with urinary and fecal incontinence and a two-month history of progressive weakness of the right leg and numbness of the left leg. Four months previously, she had been diagnosed with systemic brucellosis with a period of radiculomeningoencephalitis; she was treated successfully with rifampicin, doxycycline, trimethoprim/sulfamethoxazole (TMP/SMZ), and streptomycin, and was discharged symptom-free on rifampicin and doxycycline. Neurological examination revealed spastic paraparesis, globally hyperactive deep tendon reflexes (DTRs) and sensory level at T6. Magnetic resonance imaging (MRI) of the spinal cord revealed a 10 x 30 mm intradural-intramedullary mass lesion at the T5 level with surrounding edema that enhanced with contrast. The cerebrospinal fluid (CSF) was xanthochromic with lymphocytic pleocytosis and elevated levels of albumin, immunoglobulins, and antibody titers for Brucella. The medications were modified to rifampicin 1200 mg, doxycycline 400 mg, and TMP/SMZ 480/2400 mg daily, and methylprednisolone 100 mg in decremental doses (for 6 weeks). After 2 months, the patient was almost symptom-free and her medication doses were decreased. After 5 months, the mass lesion resolved almost completely. The treatment was discontinued after 2 years. CONCLUSIONS The case is presented because of its uniqueness. In cases of Brucella granuloma, the authors recommend a trial of medical treatment with adequate dosages for a reasonable length of time before considering surgical intervention.
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Affiliation(s)
- A Bingöl
- Department of Neurology, Ankara University Medical Faculty, Turkey
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24
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Kress S, Klooker P, Kaufmann V, Sloot N, Riemann JF, Brass H. [Brucellosis with fatal endotoxic shock]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1997; 92:561-6. [PMID: 9411206 DOI: 10.1007/bf03044933] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Brucellosis is a zoonosis with good prognosis in cases of early diagnosis. To make the diagnosis is still a problem today. CASE REPORT A 60-year-old butcher was admitted with undulating fever, sweats, arthralgia and weight loss. Further examination revealed hepatosplenomegaly with laboratory findings of a hepatitis and multiple focal liver lesions shown by abdominal ultrasound and CT. Histologically, these lesions corresponded to caseous granulomas. Diagnosis of brucellosis was confirmed by detection of brucella species in prolonged incubation in blood culture. After the beginning of antibiotic resistance-tested therapy with tetracycline and quinolones, an endotoxic shock occurred during the first 24 hours of treatment and the patient died after multiorgan failure with disseminated intravascular coagulation. CONCLUSION In cases of undulating fever with liver involvement, a brucellosis should be considered. Good teamwork of the internal, pathological and microbiological departments is necessary for early and correct diagnosis. This is the first report of human brucellosis in association with lethal endotoxic shock.
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Affiliation(s)
- S Kress
- Medizinische Klinik C, Klinikum Ludwigshafen
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Abstract
Brucellosis remains a major zoonosis worldwide. Although many countries have eradicated Brucella abortus from cattle, in some areas Brucella melitensis has emerged as a cause of infection in this species as well as in sheep and goats. Despite vaccination campaigns with the Rev 1 strain, B. melitensis remains the principal cause of human brucellosis. Brucella suis is also emerging as an agent of infection in cattle, thus extending its opportunities to infect humans. The recent isolation of distinctive strains of Brucella from marine mammals has extended its ecologic range. Molecular genetic studies have demonstrated phylogenetic affiliation to Agrobacterium, Phyllobacterium, Ochrobactrum, and Rhizobium. Polymerase chain reaction and gene probe development may provide more effective typing methods. Pathogenicity is related to production of lipopolysaccharides containing a poly N-formyl perosamine O chain, CuZn superoxide dismutase, erythrlose phosphate dehydrogenase, stress-induced proteins related to intracellular survival, and adenine and guanine monophosphate inhibitors of phagocyte functions. Protective immunity is conferred by antibody to lipopolysaccharide and T-cell-mediated macrophage activation triggered by protein antigens. Diagnosis still centers on isolation of the organism and serologic test results, especially enzyme immunoassay, which is replacing other methods. Polymerase chain reaction is also under evaluation. Therapy is based on tetracyclines with or without rifampicin, aminoglycosides, or quinolones. No satisfactory vaccines against human brucellosis are available, although attenuated purE mutants appear promising.
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Affiliation(s)
- M J Corbel
- National Institute of Biological Standards and Control, South Mimmas, Potters Bar, Hertfordshire, United Kingdom.
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Cokça F, Meço O, Arasil E, Unlü A. An intramedullary dermoid cyst abscess due to Brucella abortus biotype 3 at T11-L2 spinal levels. Infection 1994; 22:359-60. [PMID: 7843817 DOI: 10.1007/bf01715549] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 17-year-old boy was admitted to hospital with a history of backache, weakness of the lower extremities and fever. While the diagnosis of brucellosis was made his clinical course worsened. Acute medulla spinalis mass effect and signs of meningitis predominated. It was shown that he had a dermoid cyst infected with Brucella abortus biotype 3 which was the same strain growing in his blood cultures.
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Affiliation(s)
- F Cokça
- Dept of Infectious Diseases, University of Ankara, Faculty of Medicine, Ibn-i Sina Hospital, Turkey
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Bucher A, Gaustad P, Pape E. Chronic neurobrucellosis due to Brucella melitensis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1990; 22:223-6. [PMID: 2356445 DOI: 10.3109/00365549009037906] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 20-year-old male Turkish immigrant to Norway suffering from severe chronic neurobrucellosis with spastic paraplegia and deafness is presented. The diagnosis was established by isolation of Brucella melitensis from cerebrospinal fluid (CSF) culture. Brucella antibody agglutination titers were high in serum and CSF. In spite of intensive, prolonged treatment with a combination of trimethoprim-sulfamethoxazole (TPM-SMZ), rifampicin and doxycycline, the course of the illness was characterized by relapses and severe neurological defects.
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Affiliation(s)
- A Bucher
- Medical Department, Ullevål University Hospital, Oslo, Norway
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