Evaluation of children with neurobrucellosis

Abstract

Background: Brucellosis is an endemic disease in many areas throughout the world. Central nervous system involvement is a serious complication of brucellosis with a ratio of 4-11% of all patients. Aim: to describe our experience in diagnosis, treatment, and outcome of 25 pediatric patients with neurobrucellosis. Patients and methods: This study included a review of medical records of patients who were diagnosed with neurobrucellosis between March 2001 and March 2009. Patients who had both clinical fi ndings consistent with neurobrucellosis and positive microbiologic/serologic examinations of CSF with abnormal CSF fi ndings were enrolled in the study. Results: The study included 25 patients between 1 and 15 years of age (mean 8.8 years), while 15 were males and 10 were females. Most of the patients (52 %) were in the age group of 5-9 years with male predominance. The distribution of cases showed density in June and February. The most commonly presented complaints were headache, fever and sweating while the most commonly observed fi ndings were fever and meningeal irritation signs. All patients had positive cerebrospinal fl uid agglutination test for brucellosis. Four different regimens were used based on ceftriaxone, doxycycline, cotrimoxasole, streptomycin, and rifampicin. One patient died, three patients were discharged with sequel, and the remaining patients (84 %) were discharged with full recovery. Conclusion: Clinicians, especially those providing health services in endemic areas like Turkey, should keep in mind that neurobrucellosis can be involved in patients with unexplained symptoms like memory impairment or in patients diagnosed with meningitis (Tab. 5, Fig, 2, Ref. 39).

A Rare Pediatric Case of Neurobrucellosis With Cerebral Salt Wasting

“…After being treated, all were discharged without sequela. 7 Our patient presented with diplopia and restricted outward gaze due to sixth nerve involvement in the acute stage, which was completely recovered with antibrucellosis treatment.…”

Neurobrucellosis in Childhood

“…Akbayram ve ark., 25 çocuk hastada yaptıkları bir çalışmada; nöbet %48, papil ödemi %8 oranında bildirmişlerdir. [9][10][11] P Ps sö öd do ot tü üm mö ör r s se er re eb br ri i: Oldukça nadir bir kliniktir. Hastaların çoğunda klasik brusella kliniğine ek olarak baş ağrısı, papil ödem, yürüme güçlüğü mevcuttur.…”

“…Brusella meningoensefalitinden farklı olarak beyin omurilik sıvısı (BOS) bulguları normaldir. 9,10 N Nö ör ro op pa at ti i: : Periferik sinir paralizisi, radikülopati ve Guillain-Barré gibi durumlar nörobrusellozun neden olduğu nadir durumlardır. Polinöropati tablosu elektromiyografi (EMG)'de aksonal dejenerasyon, demiyelinizasyon şekillerinde görülebilmektedir.…”

“…Polinöropati tablosu elektromiyografi (EMG)'de aksonal dejenerasyon, demiyelinizasyon şekillerinde görülebilmektedir. 4,8,9 TANI Tanıda ayrıntılı anamnez en önemli aşamalardan biridir. Özellikle enfekte süt ve süt ürünlerinin tüketiminin belirtilmesi, aile bireylerinden benzer şikâyeti olanların varlığı veya brusella tanısı alan aile bireylerinin varlığında mutlaka düşünülmelidir.…”

“…Çoğu merkez tarafından önerilen rejimler doksisiklin, rifampin ve seftriakson veya trimetoprimsülfametoksazol [trimethoprin-sulfamethoxazole (TMP-SMX)]'dür. 1,9 Seftriakson temelli rejimler çoğu çalışmada daha başarılı olmuştur. Özellikle sekiz yaşından küçük çocuklarda doksisiklin yerine TMP-SMX tercih edilmektedir.…”