Neurobrucellosis: the evalution of a rare presentation of brucellosis from a tertiary care centre at Central Anatolia
Abstract number: P1865
Aslan H., Metan G., Alp E., Yildiz O., Aygen B., Sumerkan B., Doganay M.
Objectives: Brucellosis is a zoonotic and multisystem disease which is highly endemic in Turkey similiar to other Mediterranean countries. Any organ or system of the body including nervous system can be involved.
The aim of this study is to describe our experience in the diagnosis, treatment, and final outcome of the patients with neurobrucellosis who were diagnosed and treated in our clinic.
Patients and Methods: This study was conducted at Erciyes University Gevher Nesibe Hospital, a 1300-bed tertiary referral centre in central Anatolia. We retrospectively reviewed the records of the Department of Infectious Diseases to identifiy the patients aged 16 years with neurobrucellosis from January 1997 to December 2006. Neurobrucellosis was diagnosed by the following criteria: symptoms or clinical findings concordant with neurobrucellosis, isolation of Brucella from the cerebrospinal fluid (CSF) or/and demonstration of antibodies to Brucella in CSF (at any titer), the presence of any abnormality in CSF (pleocytosis, increased protein levels and decreased glucose levels) with positive serology for brucellosis.
Results: Nine hundred and seventeen patients with brucellosis were admitted to our department during 10-years. Thirty-six patients were diagnosed as neurobrucellosis. (Table 1). Headache and fever were the most common symptoms. Neck stiffness was present in 25 of the patients and the 69.4% of the patients were diagnosed as acute meningitis. Nervus abducens involvement was detected in two patients. Motor deficit was determined at the lower extremities at five and upper extremities in two patients. Hemiparesis was assigned in two patients. Urinary and gaita incontinence was observed in two patients.
Brucella spp. was isolated from the blood of nine of patients and from the CSF of 11. The median serum standart tube agglutination (STA) value of the patients was 1:320 and positive in 30 patients. The median CSF STA titer was 1:20 and positive in 21 patients.
Table 1. Features of the patients with neurobrucellosis
Doxycycline (po) plus rifampin (po) with ceftriaxone (iv) was the most common choice for the treatment. The duration of treatment was three months in 33 patients and four months in three patients. Overall mortality was 8% in this study and none of the patients died due to neurobrucellosis. Relaps occurred in one patient.
Conclusion: Neurobrucellosis presents with hetoregenous clinical signs and attrending physicians should remind the colourfull picture of neurobrucellosis in endemic areas.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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