Complication Of Brucellosis Research Articles

A Case of Neurobrucellosis Presenting With Isolated Intracranial Hypertension

Despite being a treatable and preventable zoonosis, brucellosis is still endemic in certain areas of the world. Nervous system involvement is a rare but an important complication of brucellosis in childhood. Neurobrucellosis should be taken into consideration in the differential diagnosis of any kind of neurological signs, particularly in endemic areas. The authors present a patient with neurobrucellosis who presented with isolated intracranial hypertension without any other systemic symptoms of brucellosis.

Epidemiological and clinical features of Brucella arthritis in 24 children

BACKGROUND AND OBJECTIVES:Brucellosis is considered the leading zoonotic disease of the Middle East. The disease has a wide spectrum of clinical manifestations and can result in complications with severe morbidity. The aim of this study was to evaluate the frequency, distribution and characteristics of arthritis in Iranian children with brucellosis.DESIGN AND SETTING:A retrospective descriptive study conducted in a referral children center in Tehran from 1997 to 2005.PATIENTS AND METHODS:Arthritis in children with brucellosis who were admitted to a specialized hospital was detected by clinical signs of the involved joint(s) and characteristics of joint fluid aspiration. Socio-demographic information was recorded.RESULTS:Of 96 patients diagnosed with brucellosis, 24 (25%) had Brucella arthritis 14 (58.3%) males and 10 (41.7%) females. Most common manifestations were fever in 21 patients (87.5%) and fatigue in 18 patients (75%). Monoarthritis was recorded in 15 patients (62.5%) of the cases with involvement of the knee in 8 (45%) and hip in 5 (29%), the ankle in 2 (8%) patients while 9 (37.5%) patients suffered from polyarthritis. None of the patients had axial joints involvement. Seventy-five percent of the subjects (18 patients) were from urban areas and 66.7% (16 patients) had consumed un-pasteurized cheese. Recurrence was not seen in any of the 24 patients who received a combination of co-trimoxazole for 6 weeks and gentamicin for 5 days.CONCLUSION:Childhood brucellosis is a challenging disease in Iran that has serious complications like arthritis. Therefore all physicians who work in endemic areas should be familiar with this disease and consider the possibility of brucellosis in all children who present with arthritis and arthralgia.

Assessment of the findings on the existence of complications in brucellosis

Brucellosis is a prevalent disease in Turkey. The object of this study was to assess the findings in brucellosis cases with and without complications. Materials and methods: A total of 324 patients diagnosed with brucellosis between 1999 and 2005 were reviewed retrospectively. The diagnosis of brucellosis was established serologically and/or by positivite blood culture. Epidemiologic features, clinical symptoms, and laboratory findings of the patients were assessed in both complicated and noncomplicated brucellosis cases by univariate and multivariate analysis. Results: The mean age of patients was 44.0 ± 18.3 years (range 15-83 years). In addition, 56% of the patients were male. Animal husbandry (62.7%) and consumption of raw milk and/or fresh cheese (27.7%) were identified as being the main risk factors for brucellosis. Fever, malaise, sweating, and arthralgia were the most frequent clinical symptoms. The most common physical findings were fever, hepatomegaly, and splenomegaly. Complications were detected in 142 of 324 cases (43.8%). Osteoarticular involvement (25.9%) was the most common complication. Dealing with animal husbandry, living in a rural area, being between 31 years and 50 years of age, and an elevated C-reactive protein (CRP) level were significantly associated with the existence of complications by univariate analysis (P < 0.05). Elevated CRP level remained independently associated with complications by multivariate analysis (P < 0.05). Conclusion: Elevated CRP levels, in accordance with clinical manifestations of the patient, may be a sign of complications, and needs further investigation.

Short-course treatment in neurobrucellosis: A study in Iran

Neurobrucellosis is a rare neurological complication of brucellosis. This report describes 19 patients of neurobrucellosis and they accounted for 8% of all cases of brucellosis admitted to Shiraz University Hospitals over a period of eight years. Headache, fever, fatigue, drowsiness and neck stiffness were the common clinical features. Cerebrospinal fluid (CSF) showed pleocytosis in 100%, elevated protein levels in 89% and low glucose level in 47% of the patients. All the patients improved with specific antibiotic treatment. Of the 19 patients, 10 (52.5%) patients received treatment for 8 to 28 weeks. Duration of antibiotic treatment was: 8-14 weeks in 8 (42%) patients; 24-28 weeks in 2 (10.5%) patients; 6 months in 7 (37%) patients; 12 months in 1 (5.3%) patient; and 18 months in 1 (5.3%) patient. Clinicians in endemic areas should consider the likelihood of neurobrucellosis in patients with unexplained neurological and psychiatric symptoms.

Pedro Pons′ sign as a Brucellosis complication

Brucellosis is one of the most important zoonotic diseases. Several complications may be seen during its clinical course. Here, we describe a patient who presented with complaints of fatigue, malaise, and intensive lumbar pain. He had been suffering from these complaints for nearly 1 month. It was learned that he lived in rural area, made and ate his own cheese. The Rose Bengal test was positive and Brucella standard tube agglutination was positive at 1/320 titer. Pedro Pons' sign, an osteoarticular complication of brucellosis, was revealed with the aid of radiologic imaging. Osteoarticular involvement is common in the course of brucellosis. Deformation in vertebrae formerly known as Pedro Pons' sign should be thought in brucellosis patients suffering from lumbar pain.

Die Brucellose als Differentialdiagnose zum Hodentumor

Brucellosis has become a rarity in industrialized countries. The manifestation as a granulomatous inflammation of the testes is described with an incidence of 5-40% in the literature and therefore is a relatively common complication of brucellosis. In cases of pain of the testes combined with B symptoms, a systemic inflammation with a local complication should also be considered besides cancer of the testes.

Epidemiological, clinical, and laboratory features of brucellar meningitis.

One of the rare complications of brucellosis is mononuclear meningitis, which usually imitates systemic disease. Documents of patients with confirmed brucellar meningitis hospitalized in Sina Hospital (Western Iran) between 1988-2005 were collected. The average age was 26.9. 64% were female and 36% were male. There were 25% confirmed cases in the spring, 21% in summer, 33% in autumn and 21% in winter.Patient complaints in order of frequency were: headache (95%), vomiting (77%), fatigue (39%), myalgia (15%), movement disorders (15%), arthralgia (13%), sleepiness (13%), and aphasia (3%). The main clinical findings were: nuchal rigidity (74%), splenomegaly (49%), fever (41%), Kernig's (41%), and Brudzinski's signs (39%). Leukopenia (WBC<4.5×109/L; 18%), leukocytosis (WBC>9.5×109/L; 20%), and anemia (hemoglobin level<13 g/dL in men and 12 g/dL in women) were detected in 16% of patients. The Wright agglutination test, with a titer of 1:80 to 1:1280 was present in the serum of all patients, CSF Wright test or Coombs test was positive in half of the patients. Blood, bone marrow and CSF cultures were positive in 6 out of 10 patients. The epidemiological aspects of brucellar meningitis are similar to systemic brucellosis and, in most studies; there is no significant difference between them. The sex distribution of patients was different from most studies. Seasonal distribution of the disease did not follow seasonal distribution of systemic brucellosis, however, clinical findings or laboratory changes were similar to Turkey and other studies in Iran. A definite response, without complications and next recurrence, in this study, was achieved with co-trimoxasole plus rifampin for 45 days of therapy.

A rare case of seronegative neurobrucellosis

Neurobrucellosis is one of the complications of brucellosis. We report a rare case of a 17-year-old girl with seronegative neurobrucellosis and depression and diplopia. Results of agglutination tests for Brucella both in serum and CSF were negative. Diagnosis was made only by positive culture of Brucella mellitensis with inoculation of the patient’s cerebrospinal fluid in a BACTEC 9050 System. The patient was successfully treated using ceftriaxone, doxycycline and rifampicin therapy for six months.

Unusual case of occult Brucella osteomyelitis in the skull detected by bone scintigraphy.

Brucellosis is a worldwide infectious disease of animals that can be transmitted to humans. Osteoarticular involvement is the most common complication of brucellosis. A 47-year-old man, who was a stockbreeder, complained of myalgia with fever and chills for 2weeks. The serology titers and blood cultures for brucellosis were positive. Bone scintigraphy demonstrated a focally increased uptake in the left supraorbital area. Plain radiographs showed an osteolytic lesion, and an MRI revealed signal abnormalities in the corresponding site. We present an unususal case of occult Brucella osteomyelitis in the frontal bone of the skull detected by bone scintigraphy.

Pediatric neurobrucellosis associated with hydrocephalus

Brucellosis is an infectious disease, frequently encountered in developing countries. It may involve multiple organ systems of the human body. However, neurobrucellosis is a rare complication of brucellosis. The most frequent events of cranial involvement are meningitis and meningoencephalitis. In the present case, a 10-year-old girl was referred to our clinic with fever, headache, nausea, and vomiting. The patient’s blood and cerebrospinal fluid cultures were found positive for brucellosis. Communicating hydrocephalus was also present in the cranial computed tomography as a complication of neurobrucellosis. The patient was successfully treated by external ventricular drainage and triple antibiotic therapy. There was no need to insert a ventriculo-peritoneal shunt.

Brucella endocarditis: a report from Iran

Endocarditis is a rare focal complication of brucellosis but the most common cause of mortality. The diagnosis of the complications of endemic diseases is therefore important. We evaluated Brucella endocarditis cases in a teaching hospital in Iran between April 1998 and March 2006. Nine patients with a median age of 38.11 years were recorded, of whom seven (77.7%) were male. Underlying cardiopathy was present in three patients (33.3%). The median duration of the symptoms prior to diagnosis was 5.33 months. Endocarditis involved the aortic valve in six cases (66.6%), the mitral valve in two cases (22.2%) and the aortic valve plus the mitral valve in one case (11.1%). Serologic tests were positive in eight (88.8%) and blood culture was positive in two (22.2%). Aortic valve replacement surgery was undertaken for five patients (55.5%). One patient died due to arrhythmia. A high degree of suspicion is therefore necessary in order to ameliorate the course of Brucella endocarditis.

A case of Brucella endocarditis in association with superficial femoral artery thrombus

We report here a case of Brucella endocarditis associated with superficial femoral artery thrombus. The patient was treated only with medical treatment. The clinical significance of the case was the presence of two rare complications of brucellosis:endocarditis and arterial thrombus.

Nöropsikiyatrik bulgularla başvuran nörobruselloz olgusu Olgu Sunumu

Nervous system involvement is an uncommon complication of brucellosis In adults clinical manifestation may range from severe meningoencephalitis or peripheral neuropathy radiculopathy to such behavioural disturbances as depression mental inattention hallucination amnesia psychosis agitation nightmares personality disorder euphoria nervousness In contrast neurobrucellosis is usually of acute presentation in children involving the central nervous system and neuropsychiatric manifestation is rarely observed The most clinical form in children are meningitis and meningoencephalitis In this case report we described an eight year old girl with neurobrucellosis primarily displaying neuropsychiatric symptoms In endemic areas neurobrucellosis should be suspected in the evaluation of patients with unexplained neurologic symptoms Turk Arch Ped 2009; 44: 103 5 Key words: Brucellosis childhood neurobrucellosis neuropsychiatric manifestation

Psoas abscess due to brucellosis

Skeletal system involvement is a relatively common complication of human brucellosis. However, muscular involvement and psoas abscess are less frequently seen. Psoas abscess is usually secondary to spondylitis. We report on a 45-year-old man and a 51-year-old woman with brucellosis complicated with spondylitis and psoas abscess. The man was successfully treated with the triple antibiotic regimen with percutaneous drainage of abscess. The woman was treated using an antibiotic combination.

Clinical characteristics and outcome of Brucella endocarditis

Brucella endocarditis, a rare complication of brucellosis, is the main cause of death attributable to this disease. There are difficulties in the diagnosis and uncertainty regarding many aspects of the treatment of Brucella endocarditis. We retrospectively examined the clinical characteristics and outcome of patients diagnosed with Brucella endocarditis. Of the six patients diagnosed as having Brucella endocarditis, four had valvular disease, one had aortic and mitral mechanic valve prosthesis (AVR+MVR) and one had secundum type atrial septal defect. Transesophageal echocardiography showed vegetations in four patients. Blood culture grew Brucella mellitensis only in two patients. Standard agglutination tests were elevated in all patients (range 1/320-1/10240). Four patients were managed with combined antibiotherapy and surgery. One refused further treatment and one refused an operation and follow-up was lost for that patient. Two patients died during follow-up; one having had a previous AVR+MVR operation refused further treatment and the other suffering renal failure. Due to the fulminant course of the disease, treatment should be initiated when there is a clinical suspicion, even if the culture results are unknown or negative. Agglutination titres aid in the diagnosis. A combination of antibiotherapy and surgery seems to be preferable treatment modality.

Correction: Rapid Differential Diagnosis between Extrapulmonary Tuberculosis and Focal Complications of Brucellosis Using a Multiplex Real-Time PCR Assay

Correction: Rapid Differential Diagnosis between Extrapulmonary Tuberculosis and Focal Complications of Brucellosis Using a Multiplex Real-Time PCR Assay

A Rare Complication of Brucella Infection: Myocarditis and Heart Failure

Cardiac complications from brucellosis are unusual and usually manifest as endocarditis. The other possible complication is myocardial involvement. Brucella myocarditis and development of heart failure is a very rare complication of brucellosis. We present a patient with new onset heart failure due to brucella myocarditis treated with favorable antibiotic therapy.

Complicated brucella endocarditis of the aortic valve

Endocarditis is a rare and the most fatal complication of brucellosis and can cause severe cardiac injuries.Generally aortic valve invasion is seen.We describe a case of Complicated brucella endocarditis of the aortic valve.

Long-standing, neglected sacroiliitis with remarked sacro-iliac degenerative changes as a result of Brucella spp. infection

Background Osteoarticular disease is universally the most common complication of brucellosis. Sacro-iliac joint (SIJ) is the most frequent osteoarticular location of involvement. Sacroiliitis (SI) usually is associated with acute form of the disease, thus frank SIJ destruction caused by brucellosis is rare. Purpose To report the case of a patient suffering from severe, prolonged lumbar pain with sciatica, refractory to medical treatment, in which the correct and misdiagnosed cause of her pain was a long-standing, neglected brucellar SI. Study design Case report. Methods Scintigraphy and imaging methods (computed tomography, magnetic resonance imaging). Results The result of the delayed diagnosis was a pronounced degeneration of the SIJ. Conclusions Sacroiliitis as a result of infection with Brucella might cause severe joint degeneration if left untreated.

First case report of neurobrucellosis associated with hydrocephalus

Brucellosis is a common zoonosis in many parts of the world, including Mediterranean and Middle Eastern countries. The disease is primarily related to occupations at risk, such as veterinarians, farmers, laboratory technicians, abattoir workers, and others working with animals and their products. Neurologic complications of brucellosis are quite rare, ranging from 1.7 to 10% of those infected. To date, no cases of neurobrucellosis with hydrocephalus have been reported. A 38-year-old right-handed farmer complained of headaches, nausea, vomiting, gait disturbance, and sweating for 2 days. He also complained of bilateral hearing loss of 4 months duration. On neurologic examination, dysmmetry, dysdiadochokinesis, ataxia on the left, and bilateral sensorineural hearing loss existed. On cranial MRI, a communicating hydrocephalus was noted. Because the patient consumed fresh sheep cheese and was a farmer, brucellosis was considered in the differential diagnosis. Brucella agglutination was positive with a 1/320 titer in the blood and a 1/80 titer in the cerebrospinal fluid. Ceftriaxone, doxycycline, and rifampicin were administered and by the fourth week of treatment, the ataxia was markedly improved, and the patient was able to walk without support. His cranial MRI demonstrated a total regression of the hydrocephalus. As a result, we suggest that neurobrucellosis should be considered in patients with hydrocephalus, especially if they live in an endemic area for brucellosis, even in the absence of other systemic signs.