Abstract
Background
Neurobrucellosis (NB) is a rare and serious complication of brucellosis. Its clinical manifestations vary, with no obvious specificity. At present, there is no clear clinical diagnosis or treatment for reference. In this study, we retrospectively analyzed the clinical data for 21 patients with NB to provide reference data for its further study.
Methods
We analyzed the epidemiological and clinical manifestations, laboratory tests, imaging examinations, cerebrospinal fluid, and treatment plans of 21 patients diagnosed with NB in the Department of Neurology, Xuanwu Hospital, Capital Medical University Bei**g, China.
Results
The ages of the patients ranged from 15 to 60 years old (mean age 40.1 ± 13.33 years), the male: female ratio was 4.25:1. Thirteen patients had a history of animal (sheep, cattle) contact, three had no history of animal contact, and the contact status of four was unknown. Brucella can invade various systems of the body and show multi-system symptoms, the main general manifestations were fever (66.67%), fatigue (57.14%) and functional urination or defecation disturbance (42.86%). The main nervous system manifestations were limb weakness (52.38%) and hearing loss (47.62%).The main positive signs of the nervous system included positive pathological signs (71.43%), sensory abnormalities (52.38%), limb paralysis (42.86%). Nervous system lesions mainly included spinal cord damage (66.67%), cranial nerve involvement (61.90%), central demyelination (28.57%) and meningitis (28.57%). In patients with cranial nerve involvement, 69.23% of auditory nerve, 15.38% of optic nerve and 15.38% of oculomotor nerve were involved. The blood of eight patients was cultured for Brucella, and three (37.5%) cultures were positive and five (63.5%) negative. The cerebrospinal fluid (CSF) of eight patients was cultured for Brucella, and two (25.00%) cultures were positive and six (75.00%) negative. Nineteen of the patients underwent a serum agglutination test (SAT), 18 (94.74%) of whom were positive and one (5.26%) of whom were negative. A biochemical analysis of the CSF was performed in 21 patients, and the results were all abnormal. Nineteen patients underwent magnetic resonance imaging (MRI). Twenty-one patients were treated with doxycycline and/or rifampicin, combined with ceftriaxone, quinolone, aminoglycoside, or minocycline. After hospitalization, 15 patients improved (71.43%), two patients did not recover, and the status of four patients was unknown.
Conclusions
The clinical manifestations, CSF parameters, and neurological imaging data for patients with NB show no significant specificity or correlations. When patients with unexplained neurological symptoms accompanied by fever, fatigue, and other systemic manifestations in a brucellosis epidemic area or with a history of contact with cattle, sheep, animals, or raw food are encountered in clinical practice, the possibility of NB should be considered. Treatment is based on the principles of an early, combined, and long course of treatment, and the general prognosis is good.
Similar content being viewed by others
Introduction
Brucella is a genus of Gram-negative bacteria that settle in cells and are commonly classified into sheep-type and bovine-type bacteria. The zoonosis caused by Brucella is called ‘brucellosis’, which is also known as ‘wavy fever’, ‘Mediterranean fever’, or ‘Malta fever’. It is an animal-specific infectious disease involving multiple systems, and is one of the commonest zoonoses in the world, with more than 500,000 new cases annually. It is prevalent in the Mediterranean Basin and countries in the Middle East, including Syria, Iraq, Iran, etc [1]... In China, it is mainly prevalent in pastoral areas, such as Inner Mongolia, Jilin, Heilongjiang, a ** countries, and NB is one of its serious complications. Although the incidence rate is usually < 10%, its early diagnosis and treatment are very important. In this study, we recorded and analyzed the clinical manifestations, laboratory and imaging results, and therapeutic outcomes of 21 patients with NB, to provide reference data for the diagnosis and treatment of this disease. Because NB is rare in the clinical context, there is no effective diagnostic “gold standard”, and the clinical manifestations, CSF parameters, and imaging changes lack specificity, which make its diagnosis very difficult. Therefore, when patients present with nervous system dysfunction accompanied by fever and fatigue, or have a contact history with animals and animal products, the possibility of NB should be considered, and empirical treatment for NB should be given if necessary. It is challenging to develop a highly specific and highly sensitive diagnostic regimen for NB, and the development of such a test will be the focus of research into the diagnosis and treatment of NB. At present, there is no consistent treatment plan for NB. Although the reports of NB have increased in recent years, most results obtained by researchers are observational, and the number of cases is still small. Therefore, multicenter clinical trials of NB are required.
Appendix
Data availability
The datasets are not publicly available due to privacy or ethical restrictions but are available from the corresponding author on reasonable request.
Abbreviations
- NB:
-
Neurobrucellosis
- SAT:
-
serum agglutination test
- CSF:
-
cerebrospinal fluid
- WBC:
-
white blood cell
- MRI:
-
magnetic resonance imaging
References
Al-Qarhi R, Al-Dabbagh M. Brucella shunt infection complicated by peritonitis: case report and review of the literature. Infect Dis Rep. 2021;13(2):367–76. https://doi.org/10.3390/idr13020035.
Tao Z, Chen Q, Chen Y, Li Y, Mu D, Yang H, et al. Epidemiological characteristics of human brucellosis - China, 2016–2019. China CDC Wkly. 2021;3(6):114–9. https://doi.org/10.46234/ccdcw2021.030.
**g Q, Zhao SG. Clinical manifestations, mechanism and imaging features of neurobrucellosis. World Lat Med Inf. 2018;18(51):82–4. https://doi.org/10.19613/j.cnki.1671-3141.2018.51.037.
Jiao LD, Wang XL, Yong Q, Wu LH, Li CJ, Wang XB. Clinical analysis of 6 cases with neurobrucellosis. Bei**g Med Sci. 2015;37(5):412–4. https://doi.org/10.15932/j.0253-9713.2015.5.003.
Buzgan T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, et al. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis. 2010;14(6):e469–78. https://doi.org/10.1016/j.ijid.2009.06.031.
Maji S, Manjunath N, Bahubali VH, Shome R, Palaniappan M, Lahiri S, et al. Neurobrucellosis: a neglected entity? An update from tertiary care neurocentre of South East Asia. J Neurol Sci. 2020;411:116683. https://doi.org/10.1016/j.jns.2020.116683.
Yang Y, Gao JC. Clinical characteristics and treatment of neurobrucellosis. Lab Med Clin. 2017;14(21):3254–6. https://doi.org/10.3969/j.issn.1672-9455.2017.21.051.
Hai LH, Zhao SG. The clinical presentions and features of diagnostic examinations of neurobrucellosis. World Lat Med Inf. 2016;16(14):67–9. https://doi.org/10.3969/j.issn.1671-3141.2016.14.026.
Zheng N, Wang W, Zhang JT, Cao Y, Shao L, Jiang JJ, et al. Neurobrucellosis Int J Neurosci. 2018;128(1):55–62. https://doi.org/10.1080/00207454.2017.1363747.
Zhang WH, Zhang YX. Expert consensus on the brucellosis. Chin J Infect Dis. 2017;35(12):705–10. https://doi.org/10.3760/cma.j.issn.1000-6680.2017.12.001.
Akdeniz H, Irmak H, Anlar O, Demiröz AP. Central nervous system brucellosis: presentation, diagnosis and treatment. J Infect. 1998;36(3):297–301. https://doi.org/10.1016/s0163-4453(98)94279-7.
Kizilkilic O, Calli C, Neurobrucellosis. 927– 37, ix. Neuroimaging Clin N Am. 2011;21(4). https://doi.org/10.1016/j.nic.2011.07.008.
Rodríguez AM, Delpino MV, Miraglia MC, Giambartolomei GH. Immune mediators of pathology in neurobrucellosis: from blood to central nervous system. Neuroscience. 2019;410:264–73. https://doi.org/10.1016/j.neuroscience.2019.05.018.
Karsen H, Tekin Koruk S, Duygu F, Yapici K, Kati M. Review of 17 cases of neurobrucellosis: clinical manifestations, diagnosis, and management. Arch Iran Med. 2012;15(8):491–4. 012158/AIM.0010.
Ceran N, Turkoglu R, Erdem I, Inan A, Engin D, Tireli H, et al. Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region. Braz J Infect Dis. 2011;15(1):52–9.
Jiao LD, Chu CB, Kumar CJ, Cui J, Wang XL, Wu LY, et al. Clinical and laboratory findings of nonacute neurobrucellosis. Chin Med J (Engl). 2015;128(13):1831–3. https://doi.org/10.4103/0366-6999.159362.
Li MX, Tan GJ, Guo L. Review of seven cases of neurobrucellosis: clinical manifestations and imaging characteristics. Chin J Neurol. 2014;47(7):482–6. https://doi.org/10.3760/cma.j.issn.1006-7876.2014.07.010.
Rajan R, Khurana D, Kesav P. Deep gray matter involvement in neurobrucellosis. Neurology. 2013;80(3):e28–9. https://doi.org/10.1212/WNL.0b013e31827deb63.
Jabbour RA, Tabbarah Z. Neurobrucellosis presenting with hearing loss, gait disturbances and diffuse white matter disease on brain magnetic resonance imaging (MRI). J Med Liban. 2011;59(2):105–8.
Guven T, Ugurlu K, Ergonul O, Celikbas AK, Gok SE, Comoglu S, et al. Neurobrucellosis: clinical and diagnostic features. Clin Infect Dis. 2013;56(10):1407–12. https://doi.org/10.1093/cid/cit072.
Cao XY, Zhang ZL, Shi SJ, Chai L. Research progress in the pathogenesis of neurobrucellosis. Chin J Zoonoses. 2022;38(9):843–8. https://doi.org/10.3969/j.issn.1002-2694.2022.00.118.
Yang J, Wang Q, Zhu H, et al. Clinical features of 3 cases of neurobrucellosis and literature review. Neural InjuryAnd Funct Reconstruction. 2021;16(7):378–81. https://doi.org/10.16780/j.cnki.sjssgncj.20201211.
Sudipta P, Vandana KE, Aparna RP, et al. Evaluation of clinical, diagnostic features and therapeutic outcome of neurobrucellosis: a case series and review of literature. Int J Neurosci. 2022;132(11):1080–90. https://doi.org/10.1080/00207454.2020.1860969.
Oueslati I, Berriche A, Ammari L, et al. Epidemiological and clinical characteristics of neurobrucellosis case patients in Tunisia. Med et maladies Infectieuses. 2016;46(3):123–30. https://doi.org/10.1016/j.medmal.2016.01.005.
Hakan E, Seniha S, Kaan M, et al. Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study. Infection. 2016;44(5):623–31. https://doi.org/10.1007/s15010-016-0901-3.
Funding
This work was supported by National Key Research and Development Program of China Research on the Precision Diagnosis, Treatment, and Integrated Prevention, Control for the elderly with common infectious disease (no. 2020YFC2005403), the Key Special Project of the Ministry of Science and Technology Research on Modernization of Traditional Chinese Medicine (no. 2019YFC1712400), the Bei**g Traditional Chinese Medicine Science and Technology Development Fund (no. BJZYYB-2023-47) and the Bei**g Third Batch of Core Talents of Chinese Medicine, and the National Natural Science Foundation of China (no. 82104417).
Author information
Authors and Affiliations
Contributions
WZ and TH wrote the manuscript. WZ, TH, GH, B-LW Y-HY and J-T searched for related studies. J-T and LZ proofread the manuscript. S-YX and X-ZD guided the writing and critically revised the manuscript. All authors have read and approved the final version of the manuscript.
Corresponding authors
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval and consent to participate
The study was carried out by the Declaration of Helsinki criteria and received approval from the Ethics Committee of Xuanwu Hospital, Capital Medical University (IRB, protocol number: 2020[104]; Date of approval: 10/12/2020). All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from all study participants. A 15-year-old patient also obtained consent from himself and his legal guardian.
Consent for publication
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Zhuang, W., He, T., Tuerheng, J. et al. Neurobrucellosis: laboratory features, clinical characteristics, antibiotic treatment, and clinical outcomes of 21 patients. BMC Infect Dis 24, 485 (2024). https://doi.org/10.1186/s12879-024-09308-x
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12879-024-09308-x