Clinical analysis of 27 neurobrucellosis patients / 中华传染病杂志

Objective To analyze the clinical characteristics and prognosis of neurobrucellosis(NB).Methods Twenty-seven cases of NB patients who received treatment in Disease Prevention and Control Center of Inner Mongolia Autonomous Region and Inner Mongolia Medical University Hospital from January to December in 2016 were collected.The clinical data of these patients were recorded and systematically analyzed.Results Twenty-four cases(88.89%)had a history of exposure to cattle and sheep.Twenty-four cases(88.89%)were admitted with fever,18(66.67%)cases with sweat,16 cases(59.26%)with headache,14 cases(51.85%)with neurological symptoms of meningitis and meningoencephalitis,4 cases(14.81%)with auditory nerve damage and 3 cases(11.11%)with spinal cord damage.Elevated white blood cells were found in 2 cases(7.41%),elevated serum C-reactive protein in 3 cases(11.11%),elevated procalcitonin in 2 cases(7.41%)and elevated erythrocyte sedimentation rate in 15 cases(55.56%).All the 27 patients underwent lumbar puncture and the cerebrospinal fluid test results were abnormal,of which increased protein levels in 17 cases(62.96%),increased mononuclear cell ratio 14 cases(51.85%),increased pressure in 14 cases(51.85%),and reduced chloride levels in 14 cases(51.85%),and reduced glucose levels in 6 cases(22.22%).Positive cerebrospinal fluid culture(CSF)was found in 1 case(3.70%).There were 8 cases(29.63%)with white matter damage,5 cases(18.52%)with meningeal enhancement,3 cases(11.11%)with spinal cord lesions,2 cases(7.41%)with cerebral edema and 2 cases(7.41%)with brain abscess.There were 10 cases(37.04%)with sensory nerve damage in the extremities,4 cases(14.81%)with auditory nerve damage and 2 cases(7.41%)with motor nerve damage.All patients were treated with regular anti-Berg's disease for 6 weeks and were followed up for 1 year(every 3 months)after the treatment.Nineteen patients(70.37%)were cured,7 patients(25.93%)developed sequelae and 1(3.70%)patient died.Conclusions The analysis suggests that NB have a variety of clinical characteristics.CSF examination,imaging examination and neuro electrophysiology detection have contribution to the diagnosis of the NB.

Neurobrucelosis evaluada por reibergrama. Presentación de un caso / Neurobrucellosis evaluated by reibergram. A case report

Introducción: La brucelosis es una enfermedad zoonótica y endémica en muchas partes del mundo. La causa principal de la infección se produce por la ingestión de leche no pasteurizada o por el contacto con animales infectados. La neurobrucelosis incluye afecciones en el sistema nervioso central y periférico. Las principales manifestaciones clínicas son la meningitis, la encefalitis, la neuritis óptica y la periférica. Objetivo: Evaluar, mediante reibergrama, la dinámica intratecal de las clases mayores de inmunoglobulinas y el estado de la barrera sangre/LCR de un paciente con neurobrucelosis. Presentación del caso: Los niveles de IgA, IgM. IgG y albúmina en suero y líquido cefalorraquídeo fueron cuantificados por inmunodifusión. Los resultados fueron colocados en el reibergrama correspondiente. El paciente mostró síntesis intratecal de las tres clases mayores de inmunoglobulinas, sin disfunción de la barrera sangre/LCR. Conclusión: El estudio neuroinmunológico del líquido cefalorraquídeo puede indicar el curso activo de la respuesta inmune intratecal contra el patógeno, donde la síntesis intratecal de inmunoglobulinas y el funcionamiento de la barrera sangre/líquido cefalorraquídeo constituyeron los principales marcadores en el diagnóstico de la neuroinflamación(AU)

Introduction: Brucellosis is a zoonotic and an endemic disease in many areas around the world. The main cause of infection is the intake of unpasteurized milk or the contact with infected animals. Neurobrucellosis includes pathologic conditions in the central and peripheral nervous systems. The main clinical manifestations are meningitis, encephalitis, optical neuritis, and peripheral neuritis. Objective: To evaluate, through reibergram, the intrathecal dynamics of the major immunoglobulin classes and the blood-CSF barrier function in one patient with neurobrucellosis. Case report: IgA, IgM, IgG and albumin levels in serum and cerebrospinal fluid were quantified by using a radial immunodiffusion technique. Results were placed in the corresponding reibergram. The patient showed evidences of intrathecal synthesis of the three major immunoglobulins without blood-CSF barrier dysfunction. Conclusion: The neuroimmunological study of cerebrospinal fluid can indicate the active course of the intrathecal immune response against this pathogen, where the intrathecal synthesis of immunoglobulins and blood-cerebrospinal fluid barrier function constitute the main markers in the diagnosis of neuroinflammation(AU)

Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

The clinical and electrophysiological research on peripheral nerve injuries in neurobrucellosis / 中国神经精神疾病杂志

Objective To characterize the clinical manifestations and to evaluate the value of the electrophysio-logical examination in patients with peripheral nerves injuries caused by neurobrucellosis. Methods Electrophysiology examination was conducted in 32 patients with peripheral nerve injuries caused by neurobrucellosis and 32 normal controls who had equivalent age and gender. The results were further statistically analyzed. Results There were sig-nificant difference between patients and healthy control group in distal motor latency (DML), compound motor active potentials (CMAP) amplitude, motor nerve conduction velocity (MCV), sensory nerve action potential latency(SL),senso-ry nerve action potential (SNAP) amplitude and sensory nerve conduction velocity (SCV) ( P﹤0.05). Electrophysiology examination revealed peripheral nerve damage of limbs involving, both sensory nerve and motor nerves, of which sen-sory and motor nerve injuries accounted for 55.47% and 16.80%, respectively. Median and sural nerve injuries were most frequently affected in upper (64) and lower limbs (16). Motor and sensory nerve conduction velocity was delayed in 43 nerves (16.80%) of 256 examined motor nerves and in 142 nerves (55.47%) of 256 examined sensory nerves. The damage of the sensory nerves was more severe than those of the motor nerves and damage of nerves in the upper limbs was more severe than those in the lower limbs. Conclusion Electrophysiologoical examination provides objective basis for the diagnosis of peripheral nerve injuries in neurobrucellosis.

Trend of human brucellosis over a decade at tertiary care centre in North Karnataka.

Background: Brucellosis is an important zoonotic disease. India having a major agrarian population is expected to have a higher prevalence. However, due to lack of laboratory facility or awareness among clinicians, the disease is largely underreported. The aim of this study was to know the prevalence and trend of human brucellosis over a decade, in patients attending a teaching hospital in North Karnataka, and to understand their geographical distribution. Materials and Methods: The study was conducted from January 2006 to December 2015 at a tertiary care teaching hospital in North Karnataka. A total of 3610 serum samples were evaluated from suspected cases of brucellosis. All serum samples were initially screened by Rose Bengal plate test, and positive samples were further analysed by Serum agglutination test (SAT) using standard Brucella abortus antigen from Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India. A titre above or equal to 1:80 IU/ml was considered as positive. Demographic data such as age, sex and native place of these patients were also analysed. Results: We observed that human brucellosis is present in North Karnataka. The overall seropositivity of brucellosis in suspected cases was 5.1%. The positive titres ranged from 1:80 to 163,840 IU/ml. The majority of the patients were from Gadag, Koppal and Haveri districts of North Karnataka. Conclusion: Our study confirms the presence of human brucellosis in the northern part of Karnataka. Further studies to understand the prevalence of animal brucellosis in these areas will help in implementing prevention measures.

Relapsed Brucellosis Presenting as Neurobrucellosis with Cerebral Vasculitis in a Patient Previously Diagnosed with Brucellar Spondylitis: A Case Report / 감염과화학요법

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.

Neurobrucellosis: a case report.

Neurologic involvement of brucellosis is common but exact prevalence of it is unknown due to difficulty in diagnosis and inadequate reporting all over the world. Neurologic involvement may manifest as chronic meningitis, lymphocytic meningoencephalitis, a variety of cranial nerve deficits, or ruptured mycotic aneurysms. We report a case of young male who had history of fever and headache on and off for 2 years and later developed signs of meningitis, lateral rectus palsy, altered sensorium and bilateral papilledema. He did not respond to anti-tubercular therapy and antibiotics. CT scan and MRI brain were normal. He had hepato-splenomegaly with small hypoechoic lesions in the spleen. CSF culture grew gram negative bacilli. Brucella IgG antibodies in serum by EIA 7, IgM negative, Brucella antigen titer was positive, 1:160. Patient received inj. streptomycin 0.75 g for 21 days and doxycycline 100 mg twice daily doxycycline for 6 weeks. The complete improvement in patient’s condition after a long lasting illness motivated authors to report this case. Delay or failure in diagnosis of this treatable disease may lead to significant morbidity and mortality so high index of suspicion should be kept in such cases.

Spinal Neurobrucellosis is an Unusual Cause of Nontraumatic Paraplegia in Zaria, Northern Nigeria: A report of 3 Cases and Review of Current Literature.

Introduction: Brucellosis is a zoonotic febrile infection common among farmers or herdsmen who come into contact with animals or animal products. Neurological complications are uncommon, but when they occur can be confused with other neurological diseases, particularly those due to tuberculosis (TB). Aim: This report is intended to remind health workers and people living in Brucella endemic communities that spinal neurobrucellosis can mimic Potts’ disease as the cause of nontraumatic paraparesis or paraplegia. Study Design: longitudinal case series. Methodology: We report the cases of three patients who presented with paraplegia following months of constitutional symptoms of fever, headache, malaise and weight loss. All were exposed to cows, goats and sheep. One patient had received antituberculous therapy for 18 months with minimal recovery. Serology and neuroimaging were used to confirm the diagnosis. Results: All patients recovered within 6 to 12 weeks of rifampicin, doxycycline, trimethoprim-sulfamethoxazole or streptomycin, but with residual paraparesis. Conclusion: spinal neurobrucellosis can be confused with Pott’s disease (TB of the spine) with consequent poor treatment outcome.

Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region

Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83 percent) and fever (44 percent). All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months) was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations.