Clinical and therapeutic features of childhood neurobrucellosis.
Brucellosis is a multisystem disease with diverse clinical presentations, and involvement of the nervous system is considered to be rare in childhood. Five children with meningitis (n=2), meningoencephalitis (n=1), meningomyelitis (n=1), or cerebellar ataxia (n=1) are described, all of whom had a history of exposure to a possible source of brucellosis. Examination of cerebrospinal fluid (CSF) revealed lymphocytic pleocytosis in 4 patients, high protein concentration in 5 and low glucose concentration in 3. Reciprocal brucella agglutination titers were significantly elevated in serum (> or = 160) and in CSF (> or = 80) of all patients. Brucella melitensis was isolated from blood and CSF in one patient, from blood only in 2, and from bone marrow only in another one. All patients were treated successfully by a three-drug combination of streptomycin (4 patients) or doxycycline (one patient) with trimethoprim-sulfamethoxazole and rifampin, and in one patient dexamethasone was also added. In endemic areas, neurobrucellosis should be suspected in the evaluation of patients with unexplained neurologic symptoms.
al-Eissa
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Department of Pediatrics, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
D000900:Anti-Bacterial Agents; D002002:Brucella / Q000302:isolation & purification; D002006:Brucellosis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002524:Cerebellar Ataxia / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008590:Meningoencephalitis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
D000900:Anti-Bacterial Agents