Neurobrucellosis was treated primarily by different combinations of ceftriaxone (2 g intravenously twice daily) and rifampicin (600 mg/day orally) and doxycycline (100 mg orally twice daily) for at least 4 months. In some cases, ciprofloxacin, trimethoprim-sulfamethoxazole, and streptomycin were also given as a secondary line of treatment.
Full Answer
What is the best treatment for neurobrucellosis?
However there is still no consensus on the best treatment regimens and its duration. The treatment with the combination of ceftriaxone or trimethoprim/sulfamethoxazole, doxycycline, and rifampicin is effective in neurobrucellosis cases that affect the central nervous system and should be prolonged for no less than 3 months.
What is the typical duration of treatment for neurobrucellosis?
... However, therapeutic failure is common unless ceftriaxone is used as part of combination therapy. 12, 16 Duration of therapy for neurobrucellosis is usually at least 6 months. 6,7,12,13 We empirically chose 12 months as the treatment duration based on available literature. ...
Is there a role for the nervous system in neurobrucellosis?
Nervous system involvement is a rare manifestation of brucellosis. We describe our experience of the diagnosis, treatment and final outcome of patients with neurobrucellosis at the Erciyes University Gevher Nesibe Hospital, a tertiary referral centre in Central Anatolia, Turkey.
What are the diagnostic criteria for neurobrucellosis?
In the literature, diagnostic criteria of neurobrucellosis is problematic. According to some authors, the diagnosis of neurobrucellosis might be based on clinical neurological symptoms, whereas according to some other authors the diagnosis is based on microbiological and/or biochemical evidence from cerebrospinal fluid [ 6–10 ].
What is the best treatment for brucellosis?
Antibiotics are the mainstay of brucellosis treatment; several dual or triple antibiotic combinations for spinal brucellosis have been compared in different studies. In uncomplicated brucellosis, the rifampicin plus doxycycline regimen is the most accepted treatment, but the scientific community is also in favor of streptomycin plus doxycycline, possibly because of its lower price and ease of administration. However there is still no consensus on the best treatment regimens and its duration. The treatment with the combination of ceftriaxone or trimethoprim/sulfamethoxazole, doxycycline, and rifampicin is effective in neurobrucellosis cases that affect the central nervous system and should be prolonged for no less than 3 months. Surgery usually is unnecessary for brucellosis spondylodiscitis. The surgical intervention is reserved for biopsy, severe neurological impairment, or spinal stabilization.
What is brucellosis caused by?
Brucellosis is a zoonotic infection caused by Brucella species. With a declining incidence of brucellosis in the United States, physicians are becoming less familiar with this infection including its previously described neurological manifestations. In the past, most cases of infection with Brucella suis were associated with occupational exposures, but recreational and sporting exposures have recently been implicated in the acquisition of this infection.1 We report the case of a patient who developed meningitis due to B. suis after hunting and butchering feral swine. His infection was complicated by development of a basilar artery mycotic aneurysm with subsequent subarachnoid hemorrhage, cerebral infarctions, and hydrocephalus.
How common is brucellosis?
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.
Where is brucellosis most common?
Brucellosis is one of the most common zoonotic infections in many parts of the world including the Mediterranean countries and Middle East, Central Asia, India, Central and South America (Gul HC, Erdem H. Brucellosis (Brucella species). In: Bennett JE, Dolin R, Blaser MJ (eds) Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Elsevier Saunders, Philadelphi, pp 2584–2589, 2015; Pappas et al. N Engl J Med 352:2325–2336, 2005). Brucellosis is caused by the bacterial genus Brucella. Brucella is a small gram- negative, non motile and facultative intracellular bacterium. Among the Brucella species (spp.), B. melitensis, B. abortus, B. suis, and B. canis are the most common causative agents of brucellosis in humans (Franco et al. Lancet Infect Dis 7:775–786, 2007). In neurobrucellosis (NB), the most commonly B. melitensis and B. abortus and less commonly B. suis are the causative species (Wallach et al. Eur J Clin Microbiol Infect Dis 21:760–762, 2002; Kutlu et al. J Infect Public Health 9:675–678, 2016). B. ceti and B. pinnipedialis which were isolated from marine mammals, were reported as the responsible agents of intracranial granuloma formation (Sohn et al. Emerg Infect Dis 9:485–488, 2003). B. neotomae was reported to be isolated from cerebrospinal fluid samples from two patients with NB (Suárez-Esquivel et al. Emerg Infect Dis 23:997–1000, 2017). Although there are few studies about the effect of different species in the pathogenesis of the human brucellosis (Dokuzoğuz et al. J Infect 50:41–5, 2005; Troy et al. Medicine (Baltimore) 84:174–187, 2005) virulence and neurotropisim of B. melitensis are considered to be higher than the other species.
Is neurobrucellosis a complication?
Neurobrucellosis is a rare but important complication of brucellosis with a rate of about 3–5 %. Intracranial epidural and subdural empyemas are less common and present with nonspecific signs and symptoms including several days of fever, headache, altered mental status and confusion, seizures, and focal neurological deficits. Neuroimaging is very crucial in the diagnosis. Surgical and medical treatments are the cornerstone of therapy. The purposes of this chapter are to emphasize the brucellar epidural and subdural empyemas to keep these neurobrucellosis forms in mind and to review the diagnostic and treatment modalities.
Is neurobrucellosis a systemic disease?
Neurobrucellosis is a rare form of localized brucellosis usually with no systemic manifestations. We report a rare case of brucellosis presenting as meningoencephalitis associated with hydrocephalus. This patient had a lymphocytic predominant CSF and was initially treated with empirical anti tubercular therapy and steroids. A week later, when his CSF culture grew Brucella species, the treatment was changed to a combination of streptomycin, doxycycline and rifampicin and the patient improved with this therapy. This case illustrates the need to consider neurobrucellosis as a close differential diagnosis of neurotuberculosis in endemic areas when the patient presents with meningo encephalitis with lymphocytic CSF
Is brucellosis a zoonosis?
Brucellosis is a major worldwide zoonosis. The disease is endemic in developing countries, particularly in the Mediterranean basin. Brucellosis is frequently seen in Eastern and South-Eastern Anatolia regions in Turkey. Around 18 000 new cases are reported annually in Turkey. Any organ or system of the body can be involved. Brucellosis is an infection due to Brucella species and is characterized by acute febrile illness, sweating, weakness, and headache. Involvement of the central nervous system is rare in brucellosis. Brucella is continuing to be an important health problem especially who live in the countryside. The clinicians usually rule out neurobrucellosis in the differential diagnosis of brucellosis. The three neurobrucellosis cases presented in this paper referred with various non-specific symptoms. Only the first patient was found to have hydrocephalus on CT imaging, while the CT images of the other patients were normal. The second case had a history of consumption of fresh herby cheese, however the other cases had no such history. These three patients were found to have recovered without sequela during their long term follow up. The aim of this presentation is to draw attention to the importance of neurobrucellosis especially in endemic regions including our country.
How is brucellosis transmitted?
Brucellosis is transmitted to humans by direct contact with infected animals, through cuts and abrasions or inhalation of aerosols, or by ingestion of unpasteurized milk or milk products [ 1, 3 ].
Is neurobrucellosis a complication of brucellosis?
Neurobrucellosis is an important complication of systemic brucellosis infection [ 1, 5 ]. It is a historically significant disease that might have been the cause of the chronic and severe headaches of Florence Nightingale [ 11 ]. We present a large series of patients with neurobrucellosis focused on a detailed description of observed neurological features and laboratory findings. In our study period between 2002 and 2005, a total of 65 245 brucellosis patients with a morbidity rate of 20 per 100 000 and a mortality rate of 1 per 1 000 000 were reported by the Ministry of Health of Turkey [ 12 ]. The hospital where this study was performed provides the healthcare for the entire population, even those with no health insurance, in the high-endemicity region of the country.
How long does tetracycline last?
Therefore, tetracyclines can be replaced by trimethoprim/sulfamethoxazole in children aged <8 years. The World Health Organization (WHO) recommends trimethoprim/sulfamethoxazole for 6 weeks, plus either an aminoglycoside (streptomycin for 3 weeks or gentamicin for 7-10 days) or rifampicin for 6 weeks. [70] . World Health Organization.
How long does rifampicin last?
rifampicin: 600-900 mg/day orally given in 1-2 divided doses. Brucellosis is considered uncomplicated if there are acute non-specific features in the absence of focal infection. The World Health Organization recommends that adults and children aged ≥8 years should be treated with a tetracycline for 6 weeks ...
Is brucellosis uncomplicated?
Brucellosis is considered uncomplicated if there are acute non-specific features in the absence of focal infection. Optimum treatment of pregnant and breastfeeding women is based on anecdotal reports. [54] . Khan MY, Mah WM, Memish ZA. Brucellosis in pregnant women.
Is tetracycline contraindicated for brucellosis?
Brucellosis is considered uncomplicated if there are acute non-specific features in the absence of focal infection. Tetracyclines are generally contraindicated in children aged <8 years due to the risk of tooth discoloration and inhibition of bone growth.