Brucella: A Cause of Peripheral Neuropathy

Abstract

Brucellosis is a common infectious disease in Mediterranean countries. We evaluated the peripheral nerve involvement in patients with brucellosis. Thirty-eight patients with brucellosis were examined. Four of them were excluded because of B₁₂ deficiency and diabetes mellitus. Thirty-four patients were included. The average age was 43.08 ± 15.3 years. Patients were divided into two groups according to the abnormality in their peripheral nervous system (PNS) examination. All patients underwent nerve conduction and needle electromyography EMG studies. Twenty normal healthy subjects were used as a control group. Axonal sensorimotor neuropathy was determined in 12 patients who also had abnormality in PNS examination. After 6 months of treatment, nerve conduction studies were nearly normal in these patients. The EMG findings of the remaining 22 patients were normal, as well as the clinical examination. However, the motor conduction velocities of median (p < 0.001), peroneal (p < 0.001), and ulnar (p < 0.05) nerves were decreased, F wave latencies were prolonged in the posterior tibial and peroneal nerve, and distal latency was also prolonged in the posterior tibial nerve (p < 0.05) when compared to healthy subjects. Sensory conduction velocities of the median (p < 0.001), ulnar and sural (p < 0.05) nerve were also decreased. Brucellosis may be considered as a cause of clinical or subclinical peripheral neuropathy and should be evaluated especially in endemic areas.

Frequency of subclinical peripheral neuropathy in cases of untreated brucellosis

“…Previously Kutlu et al and Benbir et al described similar studies and found that the patients with PN in the brucellosis group had a higher average age than the average of the whole brucellosis group and stated that the age factor may be a reason for identification of PN [8,12]. This fits in with our study where the average age of PN patients was higher, leading to the consideration that age may create a susceptibility for PN.…”

“…Motor transmission speeds slowed in the median and ulnar nerves of the upper extremity and terminal latency and delays in F latencies lengthened for these nerves. While slowing was found only for transmission speeds of motor nerves in patients in our study, Kutlu et al found slowing of transmission speeds for both motor and sensory branches of median and ulnar nerves in the brucellosis group [8].…”

“…The [8,12]. The Kutlu et al study investigated the nerve conductance of brucellosis patients before and after treatment by electrophysiological approaches by examining the motor and sensory transmittance and F response of median, ulnar, tibial, peroneal and sural nerves using standardized methods and found sensorimotor PNs in 35% of the patients [8].…”

“…Studies indicate that systemic treatment of brucellosis has caused regression of peripheral neuropathy linked to Brucella spp. infection [8,12]. This shows that though the mechanism of peripheral neuropathy linked to Brucella spp.…”

“…Peripheral nervous system involvements of polyradiculoneuritis, cranial nerve neuropathies and peripheral neuropathies have been reported. However, only a single study in the literature could be found which evaluated the presence of subclinical neuropathy in patients asymptomatic for peripheral neuropathies [8]. As a result, in Turkey, where brucellosis is endemic, we aimed to evaluate the presence of subclinical peripheral neuropathies using electrophysiology in newly-diagnosed untreated brucellosis patients with no clinical or examination findings to indicate peripheral neuropathy.…”