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Dhar D, Jaipuriar RS, Mondal MS, Shunmugakani SP, Nagarathna S, Kumari P, Mahale R, Mailankody P, Mathuranath PS, Padmanabha H. Pediatric neurobrucellosis: a systematic review with case report. J Trop Pediatr 2022; 69:7008360. [PMID: 36708042 DOI: 10.1093/tropej/fmad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Pediatric neurobrucellosis represents a common anthropozoonosis in endemic areas but only anecdotal reports are available till date. Using appropriate search terms in the database platforms of MEDLINE, SCOPUS and Web of Sciences, we performed a systematic review of all the cases of pediatric neurobrucellosis published in the medical literature till date, in the light of a case report. The protocol was registered under PROSPERO (CRD42022333907). Our search strategy yielded 187 citations of which 51 citations were included. A total of 119 cases were reviewed. Of these cases, eight of them had insufficient data. The most common presentation was meningitis with or without encephalitis (n = 79, 71.2%). A high prevalence of cranial neuropathies (n = 22, 20.7%) was observed in the pediatric population in which abducens palsy was the most common (n = 9, 8.1%). Diagnosis was based on multimodal investigations including standard agglutination test (n = 44, 39.6%), Rose Bengal test (n = 37, 33.3%), blood culture (n = 23, 20.7%), serology (n = 20, 18.0%) and cerebrospinal fluid (CSF) culture (n = 11, 9.9%). Rifampicin-based triple drug regimen was the most commonly employed (83/102, 81.4%). Pediatric neurobrucellosis was associated with greater frequency of sequalae (5.4%), deafness (2.7%) and mortality (2.7%), when compared to that of general population. Neurobrucellosis mimics neuro-tuberculosis in various aspects. The review highlights several unique aspects of this entity in children. A high index of suspicion can ensure prompt diagnosis, timely initiation of management and favorable outcomes.
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Affiliation(s)
- Debjyoti Dhar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Ravi Shekhar Jaipuriar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Mahammad Samim Mondal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Siva Prakash Shunmugakani
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - S Nagarathna
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Pratima Kumari
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - P S Mathuranath
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
| | - Hansashree Padmanabha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMAHNS), Bangalore, Karnataka 560029, India
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Miyares FR, Deleu D, ElShafie SS, Equia F, Mesraoua B, Al Hail H, Salim K. Irreversible papillitis and ophthalmoparesis as a presenting manifestation of neurobrucellosis. Clin Neurol Neurosurg 2007; 109:439-41. [PMID: 17320277 DOI: 10.1016/j.clineuro.2007.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2006] [Revised: 01/16/2007] [Accepted: 01/18/2007] [Indexed: 11/20/2022]
Abstract
A 35-year-old man presented with a meningeal syndrome and acute onset of visual blurring. Clinical investigations revealed bacterial meningitis with bilateral papillitis and ophthalmoparesis. Serum and cerebrospinal fluid serology confirmed the diagnosis of chronic active neurobrucellosis. Following therapy there was no improvement and he developed optic atrophy. Extensive literature review revealed, one case of bilateral irreversible papillitis resulting from neurobrucellosis. However no cases of neurobrucellosis have been reported with meningitis, irreversible papillitis and ophthalmoparesis. This case demonstrates that in endemic areas, acute meningitis is a potential manifestation of neurobrucellosis and that bilateral irreversible papillitis with ophthalmoparesis can be a potential serious complication.
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Affiliation(s)
- Francisco Ruiz Miyares
- Department of Neurology (Medicine), Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
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González García H, Fernández Alonso J, de Paz García M, Ramos Sánchez C, Aguirre Gervás B. Meningitis como primera y única manifestación de brucelosis. An Pediatr (Barc) 2000. [DOI: 10.1016/s1695-4033(00)77458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Neurobrucellosis accounts for <1% of cases of brucellosis in children. Six new cases of neurobrucellosis are presented and data from 39 previously published cases are analysed. The incidence is equal in males and females, and the source of infection is likely to be unpasteurised milk. Clinical presentation varies from severe meningoencephalitis or peripheral neuropathy/radiculopathy to behavioural disturbance. Diagnostic certainty requires isolation of the organism from the CSF, but as this is rarely possible serological diagnosis can be performed with the Coombs test on the CSF. Treatment requires combination antibiotic therapy and should continue for at least 8 weeks.
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Affiliation(s)
- F Z Omar
- Children's and Maternity Hospital, Riyadh, Saudi Arabia
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Kalelioğlu M, Ceylan S, Köksal I, Kuzeyli K, Aktürk F. Brain abscess caused by Brucella abortus and Staphylococcus aureus in a child. Infection 1990; 18:386-7. [PMID: 2127588 DOI: 10.1007/bf01646416] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of a 12-year-old male with Fallot's tetralogy and brain abscess due to Brucella and Staphylococcus is presented. The abscess was aspirated and Brucella abortus and Staphylococcus aureus were isolated.
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Affiliation(s)
- M Kalelioğlu
- Department of Neurosurgery, KTU, Medical Faculty, Trabzon, Turkey
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