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Neurologic involvement among brucellosis cases

Abstract number: p853

Ugurlu  K., Ergonul  O., Eren  S., Celikbas  A., Baykam  N., Dokuzoguz   B.

Objectives: 

To determine the neurological involvement among the brucellosis cases and describe the risk factors for the development of neurobrucellosis.

Methods: 

In patient brucellosis cases were followed up prospectively between 2002 and 2005 in an endemic region. The patients with serum culture positivity or Standard tube agglutination with Coombs (STA) >160 or fourfold increase of STA were included to the study. Neurologic involvement was defined as (i) isolation of Brucella spp. from CSF, or (ii) demonstration of antibodies to Brucella >1/4 in the CSF and the presence of lymphocytosis, increased protein and decreased glucose levels in the CSF, or (iii) neurological findings not related to any other neurological disease. Risk factors for neurological involvement was analysed by logistic regression. Multivariate analysis was performed to determine the predictors of neurobrucellosis. Age, gender, numerous visits to physicians, brucellosis history, duration of symptoms were included to the model.

Results: 

Two hundred brucellosis patients were included. The mean age was 43, and 43% of the patients was female. The number of neurobrucellosis cases was 68 (34%). Brucella spp. was isolated in CSF of seven patients, STA in CSF was positive among 62 cases, and abnormalities in CSF findings were detected among 48 patients. In 12 cases, magnetic resonance and/or computerized tomography revealed useful findings. Headache was significantly more common among neurobrucellosis cases (p = <0.001). The most common neurological findings were meningeal irritation signs, unconsciousness, disorientation, confusion, paraparesia, incontinence, amenorrhea, diplopia, dysarthria, papilledema, hipo-hyperreflexia, areflexia, loss of hearing, cerebellar ataxia.

The level of the aspartate aminotransferase was higher among neurobrucellosis cases (p = 0.014). Six patients with positive STA Coombs in CSF had isolated serious headache as the neurologic symptom. Multivariate analysis revealed that neurobrucellosis cases visited numerous physicians (OR: 3, CI: 1.17–7.5, p = 0.021), particularly psychiatrists. One out of 68 neurobrucellosis cases was died, three had neurological sequela.

Conclusions: 

(1) Magnetic resonance imaging and computerized tomography support the diagnosis of neurobrucellosis. (2) The patients with serious headache should be considered for neurobrucellosis in endemic regions. (3) STA in CSF could be positive without any neurologic signs in patients with systemic brucellosis.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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