Neurobrucellosis

GIAMBARTOLOMEI, GUILLERMO; WALLACH, JORGE; PABLO CESAR BALDI

Encephalitis. Diagnosis and Treatment

Informa Healthcare

Lugar: New York, Estados Unidos; Año: 2008; p. 255 - 272

Human brucellosis is a zoonotic infection caused by four Brucella species pathogenic for man: B. melitensis, B. suis, B. abortus, and B. canis. Recently, two human cases caused by a new Brucella species usually isolated from marine mammals have also been reported. Humans become infected by contact with infected animals (cattle, goats, pigs, dogs, etc.) or their tissues, or by consumption of raw milk or meat. The most frequent clinical and pathological findings are undulant fever with sweats, asthenia, myoarthalgias, weight loss, hepatitis, splenomegaly, adenitis, and leukopenia. Other less frequent findings are osteo-articular, visceral, and neurological complications. Neurobrucellosis has been considered a rare complication, though its frequency has recently been estimated to be up to 10%. Neurobrucellosis can constitute the initial manifestation or can occur at any stage of the disease. Neurological involvement usually occurs by hematogenous dissemination, and lesions are produced by the presence of the bacterium, the action of inflammatory cytokines, or the damaging effect of an immunopathological response. Neurological manifestations may or may not be accompanied by systemic symptoms. While meningoencephalitis is the most frequent clinical manifestation, other pathological conditions such as myelitis, radiculitis, polyradiculitis, Guillain–Barre´ syndrome, cerebrovascular involvement, astrogliosis, brain abscess, and peripheral neuropathy have been described.Isolation of the bacterium from cerebrospinal fluid (CSF) to confirm the diagnosis is difficult, with a success rate of 20%. Thus, different techniques to detect specific antibodies in CSF must be used. These tests, together with imaging [(computed tomography (CT) and magnetic resonance imaging (MRI)], are indispensable tools for the diagnosis and treatment of neurobrucellosis. Up to three antimicrobial drugs can be used in combination to treat this complication. Doxycycline combined with rifampin and gentamicin is the treatment of choice. Doxycycline combined with rifampin and trimethoprim/sulfamethoxazole is an alternative treatment. The use of corticosteroids in the early stages of meningoencephalitis is usually of benefit.