Brucella Shunt Infection Complicated by Peritonitis: Case Report and Review of the Literature

Clinical Insights into Brucella Peritonitis: A Comprehensive Analysis of Four Cases

INTRODUCTION

Brucellosis, a globally distributed zoonotic disease, exhibits diverse clinical manifestations, with Brucella peritonitis being a rare but consequential complication.

METHODS

Analyzing the medical records of four patients with Brucella peritonitis admitted to the First People's Hospital of Kashi Region from January 2022 to November 2023. A retrospective approach was used to analyze the general data, epidemiological history, clinical features, laboratory tests, and efficacy. All four patients with Brucella peritonitis were farmers.

RESULTS

All of them were combined with decompensated stage of liver cirrhosis. The main manifestations were poor appetite, fatigue, bloating. Two patients were accompanied by moderate-high fever. All patients presented with mildly elevated C-reactive protein and procalcitonin < 0.25ng/ml. Brucella was cultured from blood in 2 cases, from pleural fluid in 1 case, and from ascitic fluid in another case. All patients had moderate-to-large amounts of ascites with elevated leukocytes in the ascites, predominantly mononuclear cells. Symptoms of the above patients were reduced or disappeared after effective anti-infection.

CONCLUSION

When patients with decompensated cirrhosis present with exudative ascites dominated by elevated mononuclear cells, the possibility of Brucella peritonitis should also be considered in areas where brucellosis is endemic.

Manifestations, complications, and treatment of neurobrucellosis: a systematic review and meta-analysis

PURPOSE

Central nervous system involvement by Brucella species is the most morbid form of brucellosis disease. Studies on neurobrucellosis are scarce and limited to case reports and series. Brucella is unable to infect or harm neurons without the assistance of monocytes. This raises the question of whether ceftriaxone-based regimens are effective.

METHODS

The primary aim of this study was to identify, evaluate, and summarize the findings of all relevant individual studies in the past 30 years to help better understand the disease. To achieve this, a broad systematic search was undertaken to identify all relevant records. Epidemiological and clinical features of the disease were assessed by the pooled analysis of descriptive studies. Through a meta-analysis, the treatment period duration was compared between the ceftriaxone-based and oral regimens using Standardized mean differences to measure effect size.

RESULTS

448 patients were included in the Meta-analyses from 5 studies. A moderate positive effect was found for ceftriaxone-based regimens over oral treatments, and there was a significant difference between these two groups (SMD 0.428, 95% CI -0.63 to -0.22, I 2 = 37.64). Neurobrucellosis has a different clinical picture in pediatric patients. The disease is less chronic in children. Fever, nausea and vomiting, fatigue, and abdominal pain were significantly more prevalent symptoms in children, and Convulsions, ascites, sensorineural hearing loss, and papilledema were significantly more prevalent signs in children than adults.

CONCLUSION

It is recommended to initiate the treatment of neurobrucellosis with IV ceftriaxone therapy in combination with oral therapy.

Neurobrucellosis: laboratory features, clinical characteristics, antibiotic treatment, and clinical outcomes of 21 patients

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 Beijing, 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.

Brucella Peritonitis in a Patient on Peritoneal Dialysis: A Case Report and Review of Literature

Peritoneal dialysis (PD)-associated peritonitis is the most common cause of morbidity, mortality, and treatment failure in patients on PD. Brucellosis is a worldwide zoonotic infectious disease caused by gram-negative bacteria of the genus Brucella. It is a major public issue in some regions. According to the World Health Organization report in 2011, the Kingdom of Saudi Arabia is considered endemic for brucellosis. Brucella peritonitis is one of the rarest presentations of Brucella. We report a case of a 14-year-old girl known to have end-stage renal disease, secondary to the autosomal recessive polycystic kidney. She had congenital hepatic fibrosis and pancytopenia. She had been undergoing automated PD for the past seven years and presented with abdominal pain, seizure, and poor feeding. There was no history of ingestion of unpasteurized milk or contact with raw infected animal products. The color of PD fluid was turbid with leukocytosis, predominantly neutrophils. The peritoneal fluid culture was positive for methicillin-resistant Staphylococcus aureus. The patient was started on intraperitoneal vancomycin, which showed slow improvement. The second culture of the peritoneal fluid showed Brucella species after a few days. Blood culture and serum serology titer for Brucella showed negative results. An anti-Brucella regimen, including rifampin and doxycycline, was initiated. She was treated with this regimen for six weeks. After the initiation of the anti-Brucella regimen, she showed marked improvement. To the best of our knowledge, only a small number of cases of Brucella peritonitis in PD patients have been reported. Despite the rarity of Brucella as a peritonitis-causing organism, it should be considered as a relevant pathogen in peritonitis cases, especially in endemic regions. PD-associated Brucella peritonitis is rare, and PD catheter saving may be considered if there is a response to anti-Brucella treatment.