Brucellosis in a child complicated with multiple brain abscesses

Ocular Lesions in Brucella Infection: A Review of the Literature

Ocular lesions due to Brucella infection are uncommon and easily overlooked in clinical management, but must be differentiated from non-infectious eye diseases and treated promptly to protect the patient's vision. We reviewed the relevant literature and identified 47 patients with ocular complications of Brucella infection. Among them, 28 showed ocular neuropathy, 15 presented with uveitis, and four patients displayed other ocular symptoms. Ocular symptoms accompanying Brucella infection require prompt diagnosis and treatment. The main methods of diagnosis are intraocular fluid tests and blood tests. Early diagnosis and treatment with suitable antibiotics are central to protecting the patient's vision. Notably, in terms of mechanism of injury, Brucella infection is chronic and cannot be eliminated by phagocytes, and can cause damage to the eye by inducing autoimmune reactions, antigen-antibody complex production, release of endogenous and exogenous toxins, and bacterial production of septic thrombi in the tissues. In this review, we summarize the ocular symptoms, diagnosis, treatment and prognosis of Brucella infection, and discuss the mechanisms of Brucella in ocular lesions, providing a reference for the diagnosis and treatment of Brucella ocular lesions.

Neurobrucellosis mimicking cerebral tumor: case report and literature review

We are reporting a case of neurobrucellosis that was clinically and radiologically indistinguishable from a cerebral tumor. The histological diagnosis was granulomatous encephalitis. The diagnosis was established by enzyme-linked immunosorbent assay (ELISA), detecting high levels of Ig G and Ig M Brucella antibodies in the serum and the cerebrospinal fluid. We suggest that patients with granulomatous encephalitis, without a clear etiological agent, should be studied for Brucella.

Solitary extra-axial posterior fossa abscess due to neurobrucellosis

Neurobrucellosis is a rare manifestation of systemic brucellosis. The incidence of nervous system involvement in chronic Brucellosis is approximately 5%. In this case report a solitary, extra-axial posterior fossa abscess due to neurobrucellosis is presented. The clinical manifestations, diagnosis, and treatment of this unusual condition are discussed.

Focal cerebral involvement by neurobrucellosis: pathological and MRI findings

Central nervous system involvement by brucellosis is infrequent and usually presents as acute meningoencephalitis. Neurobrucellosis presenting as a focal brain mass has rarely been demonstrated on imaging studies. We describe the imaging and pathologic findings in a child affected by neurobrucellosis with focal cortico-subcortical involvement.

Central nervous system brucellosis: presentation, diagnosis and treatment

Although neurological symptoms in brucellosis are frequent, central nervous system (CNS) involvement is uncommon. Five patients with neurobrucellosis are presented. Three patients presented with meningoencephalitis, one with polyradiculoneuritis and one with myelitis and an eighth nerve palsy. All patients had lymphocytic pleocytosis, low glucose and elevated levels of protein in the cerebrospinal fluid (CSF). Gamma-globulin and IgG values in the CSF were also increased. Results of agglutination tests for Brucella in serum and CSF were positive for all patients, although titres were less in the CSF. Brucella melitensis was cultured from two patients. Treatment included concurrent administration of three of the following drugs: doxycycline, rifampicin, streptomycin, co-trimoxazole, ceftriaxone or ciprofloxacin. The three patients with meningoencephalitis fully recovered; the other two patients were left with minor disability.

Childhood brucellosis in north-western Greece: a retrospective analysis

Fifty-two cases of childhood brucellosis which occurred in north-western Greece during the 15-year period 1979-1993, are reviewed. It is believed that they represent very closely the total incidence of the disease in the region which has a population of 100,000 children aged 0-14 years old. Brucellosis-affected children were almost exclusively from goat- or shepherd families and of both sexes and all age groups. A broad spectrum of clinical manifestations ranging from malaise only to brain abscess was observed. Fever and arthralgia were the most common manifestations followed by malaise, myalgia, sweating, rash, cough, and gastro-intestinal, cardiac and CNS involvement. Splenomegaly was found more often than hepatomegaly and lymphadenopathy. Laboratory findings included anaemia, leukopenia, neutropenia, lymphocytopenia, monocytosis, eosinophilia, thrombocytopenia and pancytopenia. Leukocytosis and lymphocytosis were extremely rare and ESR and serum C-reactive protein levels were mildly elevated. All patients had positive Rose Bengal slide agglutination tests and standard tube agglutination titres of 1:160 or more. When performed, blood culture was often diagnostic. The children were treated with streptomycin for 2 weeks plus either tetracyclines or trimethoprim-sulphamethoxazole for 3 weeks. Treatment was well tolerated. Relapse was observed in one case.

CONCLUSION

Brucellosis nowadays affects children in an occupational pattern. As symptoms, signs and first-line laboratory findings are not characteristic, agglutination tests and blood culture should be performed in any child with prolonged fever. Treatment is effective, but prevention of the disease by animal testing and education of high risk families is indicated.

Unusual suppurative complications of brucellosis in children

Three cases with suppurative complications of Brucella melitensis infection are presented, demonstrating localized involvement of the brain, bones and lungs, respectively, and the lesions were well defined on radiographic examination. The diagnosis was made on the basis of significant Brucella titres and positive blood culture. Awareness of such complications and performance of the appropriate serological and bacteriological studies will establish the diagnosis and will also differentiate this disease from other infections, especially tuberculosis.

Childhood brucellosis: a deceptive infectious disease

Human brucellosis is a multisystem disease that may notoriously mimic many other illnesses leading to misdiagnosis and increased morbidity. Six pediatric cases of brucellosis who had no epidemiologic evidence of the infection escaped early or correct recognition. The diagnosis of brucellosis was later made on the basis of significant brucella serology and positive blood or bone marrow culture. In endemic areas, a high index of suspicion should prevail in the evaluation of patients with vague or unexplained symptoms.