Toxic-febrile neurobrucellosis, clinical findings and outcome of treatment of four cases based on our experience.
Central nervous system (CNS) involvement is uncommon in brucellosis. Neurological complications of brucellosis may be divided into 2 major groups: 1) those related to the acute-febrile state that occurs in acute disease (toxic-febrile neurobrucellosis), and 2) those related to actual invasion and localization of the pathogen in the CNS (classical neurobrucellosis). In this paper, we present 4 cases of toxic-febrile neurobrucellosis and discuss clinical findings and outcome of treatment in these cases. All patients had fever, headache, stupor or coma with neuropsychiatric symptoms such as hallucination, delirium, convulsion, dysarthria, psychosis, and night raving. Peripheral and cranial vasculitis was present in case 3 and bilateral sensorioneural hearing loss in case 4. Neither pleocytosis nor hyperproteinorrachia was present in any patient in lumbar puncture. Brucella melitensis was isolated in case 3 from bone marrow, and in case 4 both from blood and bone marrow. All patients received combined treatment consisting of ceftriaxone, rifampicin, and doxycycline. They were discharged from the hospital with full recovery. No recurrence or any complaint was observed during the follow-up. In conclusion, despite the rapid course and serious complications, outcome from febrile-toxic neurobrucellosis is excellent especially when effective antimicrobial therapy is started early in the course of illness.
Karsen
Hasan
H
Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Yüzüncü Yil University, Van, Turkey. hasankarsen@hotmail.com
Akdeniz
Hayrettin
H
Karahocagil
Mustafa Kasim
MK
Irmak
Hasan
H
Sünnetçioğlu
Mahmut
M
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use; D002006:Brucellosis / Q000175:diagnosis* / Q000188:drug therapy*; D002494:Central Nervous System Infections / Q000175:diagnosis* / Q000188:drug therapy*; D003975:Diazepam / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010672:Phenytoin / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D010672:Phenytoin; D003975:Diazepam