Demyelinating steroid-responsive neurobrucellosis

Ata, Fateen; Yousaf, Zohaib; Sharif, Mohammad Khalid; Abdallah, Ahmed

doi:10.1136/bcr-2019-233798

Cited by 5 publications

(6 citation statements)

References 19 publications

(20 reference statements)

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“…Usually, ceftriaxone 4 g/day (due to its excellent CNS penetration) for the first 4-6 weeks, in addition to rifampin and doxycycline for at least 12 weeks, is considered the first-line therapy. A combination of doxycycline, rifampin, and trimethoprim/sulfamethoxazole (TMP-SMX) is another practical regimen that can be used for at least 12 weeks 36 . Patients must be followed-up every three months due to the possibility of relapse.…”

Section: Treatmentmentioning

confidence: 99%

Neurobrucellosis: the great mimicker

Soares

Angelim

Brandão³

et al. 2022

Rev. Soc. Bras. Med. Trop.

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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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Section: Treatmentmentioning

confidence: 99%

Neurobrucellosis: the great mimicker

Soares

Angelim

Brandão³

et al. 2022

Rev. Soc. Bras. Med. Trop.

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“…Although the patient’s intracranial demyelination lesions improved with anti-infection therapy, her psychotic symptoms did not improve significantly. Therefore, the use of glucocorticoids should be considered because they have some established efficacy in treating neurological brucellosis ( 16 ). However, further robust evidence is required to support this claim.…”

Section: Discussionmentioning

confidence: 99%

The challenge of managing ischemic stroke in brucellosis: a case report

Chen,

Lin,

Cai

et al. 2024

Front. Immunol.

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A 64-year-old woman was admitted to the hospital for sudden weakness in one of her left limbs. The patient was diagnosed with acute ischemic stroke (IS) of undetermined cause and received intravenous thrombolysis. Following thrombolysis, the patient’s left limb weakness improved, but she subsequently developed recurrent high fever and delirium. Further diagnostic tests revealed that she had been infected with Brucella melitensis. The patient showed significant improvement during anti-infection treatment for Brucellosis and secondary prevention treatment for IS. However, her condition unexpectedly worsened on the 44th day after admission due to a hemorrhagic stroke (HS), which required an urgent craniotomy. Immunohistochemical analysis of the hematoma sample collected during the operation showed the presence of CD4+ and CD8+ T lymphocytes surrounding the blood vessels. This case highlights the unique challenge of managing IS in brucellosis and sheds light on the potential role of T lymphocytes in the immune response related to stroke.

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“…The nature of these lesions is not completely understood, but possible explanations are direct bacterial invasion or an autoimmune reaction [26]. Improvement is usually observed after proper antibiotic treatment and steroids [15,27,28].…”

Section: Neurological Complications Prevalencementioning

confidence: 99%

“…High protein and reduced glucose levels are also observed, but severe hypoglycorrhachia is unusual [19 ▪ ]. CSF oligoclonal bands may be present in some patients [27,38].…”

Section: Diagnosismentioning

confidence: 99%

“…The effectiveness of corticosteroids in neurobrucellosis was not validated, until nowadays. However, they have been used in severe presentations such as arachnoiditis, cranial nerve involvement, myelopathy, demyelinating lesions, high intracranial pressure, and optic neuritis/ papilledema [27]. As it seems to reduce the incidence of long-term complication, we tend to support its use [36 ▪ ].…”

Section: Treatmentmentioning

confidence: 99%

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Neurobrucellosis

Soares

Silva

Lima

2023

Current Opinion in Infectious Diseases

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Purpose of reviewBrucellosis is one of the most common zoonosis worldwide, affecting 500 000 people, annually. Neurobrucellosis incidence is approximately 4%, and it is almost always heterogeneous. As there are no typical clinical features, its diagnosis is frequently misdiagnosing by other infections.Recent findingsNeurobrucellosis picture includes meningitis, meningoencephalitis, encephalitis, cranial neuropathies, intracranial hypertension, sinus thrombosis, hemorrhages radiculitis, peripheral neuropathy, myelitis, and psychiatric manifestations. The diagnosis should be based on symptoms and signs suggestive of neurobrucellosis, not explained by other neurological disease, cerebrospinal fluid analysis, a positive Brucella serology or culture, and a response to specific antibiotics, with a significant improvement of cerebrospinal fluid parameters.SummaryNeurobrucellosis can be insidious, and despite its global distribution, it is still unrecognized and frequently goes unreported. The understanding of the current epidemiology is necessary for eradication of the disease in humans, as well as the disease control in animals and prevention based on occupational hygiene and food hygiene.

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Demyelinating steroid-responsive neurobrucellosis

Cited by 5 publications

References 19 publications

Neurobrucellosis: the great mimicker

Neurobrucellosis: the great mimicker

The challenge of managing ischemic stroke in brucellosis: a case report

Neurobrucellosis

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