Neural involvement in brucellosis: clinical classification, treatment and outcomes

Abstract number: R2525

Demiroglu Y., Turunc T., Karaca S., Arlier Z., Aliskan H., Colakoglu S., Arslan H.

Aim: The aim of this study was to describe and to categorize different clinical pictures of patients with neurobrucellosis in our clinic, and to present demographical and laboratory data about the patients.

Material and Methods: Hospital records, between 2003 and 2009, of about 430 patients with brucellosis were followed and retrospectively reviewed in our clinic.

Results: Out of 430 patients, 19 (4.4%) had neurobrucellosis. These patients were classified into four groups: Meningitis group (n = 14; 13 cases of subacute-chronic meningitis and one case of acute meningitis), Encephalomyelitis group (n = 3; one case of meningoencephalomyelitis, one case of cerebellar abscess, and one case of transverse myelitis), Polyradicular group (n = 1; one case of Miller Fisher Syndrome), and others (n = 1; one case of intradural abscess).

Ten patients (52.6%) were female, and nine patients (47.4%) were male and the mean age of the patients was 48.8 years. About 47.4% of the patients had fever, 26% of the patients had neck stiffness, and 5% of the patients were in an unconscious state. Out of 19 patients, 18 underwent lumbar puncture (LP). According to cerebrospinal fluid (CSF) analyses, the mean leukocyte count was 113/mm3, the mean glucose level was 45 mg/dl, and the mean protein level was 123 mg/dl. Standard tube agglutination test showed brucellosis in all patients who underwent LP. Microorganisms were detected in four patient's blood culture and one patient's CSF culture. There were cranial nerve involvements in five cases. The most frequent was the sixth cranial nerve involvement. Out of 19 patients, 3 recovered with sequels (paraparesis, hearing loss, dementia, and sphincter dysfunction) and 16 patients recovered completely.

Conclusion: Although neurobrucellosis is most frequently accompanied by subacute-chronic meningitis, it may have many different clinical pictures. The classical triad of meningitis (fever, neck stiffness, and unconscious state) is rarely seen in brucellosis-related meningitis. Brucellosis should be kept in mind in patients with unexplained neurological findings in regions where brucellosis is endemic. In addition, a classification of brucellosis, which reflects locations of nervous system involvement, clinical picture, and pathogenesis, is needed.

Session Details

Date: 07/05/2011
Time: 00:00-00:00
Session name: Abstracts of 21st ECCMID / 27th ICC
Location: Milan, Italy, 7 - 10 May 2011
Presentation type:
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