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Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study

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Abstract

Objective

Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes.

Methods

Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain.

Results

A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1–28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002–1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000–0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.3–2.7, p = 0.0001) were associated with diffuse inflammation.

Conclusions

In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

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References

  1. Gul HC, Erdem H. Brucellosis (brucella species). In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, douglass, and bennett’s principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier Co; 2015. p. 2584–9.

    Google Scholar 

  2. Franco MP, Mulder M, Gilman RH, Smits HL. Human brucellosis. Lancet Infect Dis. 2007;7:775–86.

    Article  CAS  PubMed  Google Scholar 

  3. Buzgan T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, et al. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis. 2010;14:e469–78.

    Article  PubMed  Google Scholar 

  4. Gul HC, Erdem H, Bek S. Overview of neurobrucellosis: a pooled analysis of 187 cases. Int J Infect Dis. 2009;13:e339–43.

    Article  PubMed  Google Scholar 

  5. Gul HC, Erdem H, Gorenek L, Ozdag MF, Kalpakci Y, Avci IY, et al. Management of neurobrucellosis: an assessment of 11 cases. Intern Med. 2008;47:995–1001.

    Article  PubMed  Google Scholar 

  6. Martinez-Chamorro E, Munoz A, Esparza J, Munoz MJ, Giangaspro E. Focal cerebral involvement by neurobrucellosis: pathological and mri findings. Eur J Radiol. 2002;43:28–30.

    Article  PubMed  Google Scholar 

  7. Erdem H, Ulu-Kilic A, Kilic S, Karahocagil M, Shehata G, Eren-Tulek N, et al. Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study. Antimicrob Agents Chemother. 2012;56:1523–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Shakir RA, Al-Din AS, Araj GF, Lulu AR, Mousa AR, Saadah MA. Clinical categories of neurobrucellosis. A report on 19 cases. Brain. 1987;110:213–23.

    Article  PubMed  Google Scholar 

  9. Bashir R, Al-Kawi MZ, Harder EJ, Jinkins J. Nervous system brucellosis: diagnosis and treatment. Neurology. 1985;35:1576–81.

    Article  CAS  PubMed  Google Scholar 

  10. Erdem H, Senbayrak S, Gencer S, Hasbun R, Karahocagil MK, Sengoz G, et al. Tuberculous and brucellosis meningitis differential diagnosis. Travel Med Infect Dis. 2015;13:185–91.

    Article  PubMed  Google Scholar 

  11. Akdeniz H, Irmak H, Anlar O, Demiroz AP. Central nervous system brucellosis: presentation, diagnosis and treatment. J Infect. 1998;36:297–301.

    Article  CAS  PubMed  Google Scholar 

  12. Habeeb YK, Al-Najdi AK, Sadek SA, Al-Onaizi E. Paediatric neurobrucellosis: case report and literature review. J Infect. 1998;37:59–62.

    Article  CAS  PubMed  Google Scholar 

  13. Ozisik HI, Ersoy Y, Refik Tevfik M, Kizkin S, Ozcan C. Isolated intracranial hypertension: a rare presentation of neurobrucellosis. Microbes Infect. 2004;6:861–3.

    Article  PubMed  Google Scholar 

  14. Yetkin MA, Bulut C, Erdinc FS, Oral B, Tulek N. Evaluation of the clinical presentations in neurobrucellosis. Int J Infect Dis. 2006;10:446–52.

    Article  PubMed  Google Scholar 

  15. Al-Sous MW, Bohlega S, Al-Kawi MZ, Alwatban J, McLean DR. Neurobrucellosis: clinical and neuroimaging correlation. AJNR Am J Neuroradiol. 2004;25:395–401.

    PubMed  Google Scholar 

  16. Kizilkilic O, Calli C. Neurobrucellosis. Neuroimaging Clin N Am. 2011;21:927–37.

    Article  PubMed  Google Scholar 

  17. Eisenhut M. Vasospasm in cerebral inflammation. Int J Inflam. 2014;2014:509707.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ozkavukcu E, Tuncay Z, Selcuk F, Erden I. An unusual case of neurobrucellosis presenting with unilateral abducens nerve palsy: clinical and MRI findings. Diagn Interv Radiol. 2009;15:236–8.

    PubMed  Google Scholar 

  19. Vezzani A, Dingledine R, Rossetti AO. Immunity and inflammation in status epilepticus and its sequelae: possibilities for therapeutic application. Expert Rev Neurother. 2015;15:1081–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Colmenero JD, Queipo-Ortuno MI, Reguera JM, Baeza G, Salazar JA, Morata P. Real time polymerase chain reaction: a new powerful tool for the diagnosis of neurobrucellosis. J Neurol Neurosurg Psychiatry. 2005;76:1025–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Erdem H, Kilic S, Sener B, Acikel C, Alp E, Karahocagil M, et al. Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study. Clin Microbiol Infect. 2013;19:E80–6.

    Article  CAS  PubMed  Google Scholar 

  22. Tunkel AR. Approach to the patient with central nervous system infection. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglass, and Bennett’s principles and practice of infectious diseases. Philadelphia: Elsevier Co; 2015. p. 1091–6.

    Google Scholar 

  23. McLean DR, Russell N, Khan MY. Neurobrucellosis: clinical and therapeutic features. Clin Infect Dis. 1992;15:582–90.

    Article  CAS  PubMed  Google Scholar 

  24. Shakir RA. Brucellosis. In: Shakir RA, Neuman PK, Poser CM, editors. Tropical neurology. Cambridge: WB Saunders; 1996. p. 168–79.

    Google Scholar 

  25. Hernandez MA, Anciones B, Frank A. Barreiro P [neurobrucellosis and cerebral vasculitis]. Neurologia. 1988;3:241–3.

    CAS  PubMed  Google Scholar 

  26. Guerreiro CA, Scaff M, Callegaro D, Facure NO, Dianin VM. [neurobrucellosis: report of 3 cases]. Arq Neuropsiquiatr. 1981;39:203–13.

    Article  CAS  PubMed  Google Scholar 

  27. Rajan R, Khurana D, Kesav P. Deep gray matter involvement in neurobrucellosis. Neurology. 2013;80:e28–9.

    Article  PubMed  Google Scholar 

  28. Mousa AM, Muhtaseb SA, Reddy RR, Senthilselvan A, Al-Mudallal DS, Marafie AA. The high rate of prevalence of ct-detected basal ganglia calcification in neuropsychiatric (cns) brucellosis. Acta Neurol Scand. 1987;76:448–56.

    Article  CAS  PubMed  Google Scholar 

  29. So YT, Olney RK. Acute lumbosacral polyradiculopathy in acquired immunodeficiency syndrome: experience in 23 patients. Ann Neurol. 1994;35:53–8.

    Article  CAS  PubMed  Google Scholar 

  30. Koffman B, Junck L, Elias SB, Feit HW, Levine SR. Polyradiculopathy in sarcoidosis. Muscle Nerve. 1999;22:608–13.

    Article  CAS  PubMed  Google Scholar 

  31. Shrikanth V, Salazar L, Khoury N, Wootton S, Hasbun R. Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance. Int J Infect Dis. 2015;39:39–43.

    Article  PubMed  Google Scholar 

  32. Al-Kawi MZ. Brucellosis. In: Moher JP, Gautier J, editors. Guide to clinical neurology. New York: Churchill Livingstone Co; 1995. p. 677–80.

    Google Scholar 

  33. Koussa S, Chemaly R. Neurobrucellosis presenting with diffuse cerebral white matter lesions. Eur Neurol. 2003;50:121–3.

    Article  PubMed  Google Scholar 

  34. Bektas O, Ozdemir H, Yilmaz A, Fitoz S, Ciftci E, Ince E, et al. An unusual case of neurobrucellosis presenting as demyelination disorder. Turk J Pediatr. 2013;55:210–3.

    PubMed  Google Scholar 

  35. Kang BH, Lim YM, Kim KK. Brucellosis manifesting as chronic inflammatory demyelinating polyneuropathy. Can J Neurol Sci. 2012;39:536–8.

    Article  PubMed  Google Scholar 

  36. Bussone G, La Mantia L, Grazzi L, Lamperti E, Salmaggi A, Strada L. Neurobrucellosis mimicking multiple sclerosis: a case report. Eur Neurol. 1989;29:238–40.

    Article  CAS  PubMed  Google Scholar 

  37. Brinar VV, Habek M. Rare infections mimicking ms. Clin Neurol Neurosurg. 2010;112:625–8.

    Article  PubMed  Google Scholar 

  38. Khorvash F, Keshteli AH, Behjati M, Salehi M, Emami Naeini A. An unusual presentation of brucellosis, involving multiple organ systems, with low agglutinating titers a case report. J Med Case Rep. 2007;1:53.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Greenblatt D, Krupp LB, Belman AL. Parainfectious meningo-encephalo-radiculo-myelitis (cat scratch disease, lyme borreliosis, brucellosis, botulism, legionellosis, pertussis, mycoplasma). Handb Clin Neurol. 2013;112:1195–207.

    Article  PubMed  Google Scholar 

  40. Martin Escudero JC, Gil Gonzalez MI, Aparicio Blanco M. [Intracranial hypertension and subarachnoid hemorrhage: the forms of presentation of neurobrucellosis]. An Med Interna. 1990;7:358–60.

    CAS  PubMed  Google Scholar 

  41. Araj GF. Update on laboratory diagnosis of human brucellosis. Int J Antimicrob Agents. 2010;36(Suppl 1):S12–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey

    Hakan Erdem

  2. Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey

    Seniha Senbayrak, Secil Deniz, Derya Ozturk-Engin & Asuman Inan

  3. Department of Radiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey

    Kaan Meriç

  4. Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey

    Ayşe Batirel

  5. Department of Infectious Diseases and Clinical Microbiology, Yuzuncuyil University School of Medicine, Van, Turkey

    Mustafa Kasım Karahocagil, Ali Irfan Baran & Mahmut Sunnetcioglu

  6. Department of Infectious Diseases, Medical School, The University of Texas Health Science Center at Houston, Houston, USA

    Rodrigo Hasbun

  7. Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey

    Gonul Sengoz & Filiz Pehlivanoglu

  8. Department of Infectious Diseases and Clinical Microbiology, Harran University, School of Medicine, Sanliurfa, Turkey

    Hasan Karsen

  9. Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey

    Selçuk Kaya

  10. Department of Infectious Diseases and Clinical Microbiology, Cukurova University School of Medicine, Adana, Turkey

    Ayşe Seza Inal

  11. Department of Infectious Diseases and Clinical Microbiology, Private Erzurum Sifa Hospital, Erzurum, Turkey

    Abdullah Umut Pekok

  12. Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey

    Mustafa Kemal Celen, Recep Tekin & Celal Ayaz

  13. Department of Infectious Diseases and Clinical Microbiology, Private Umit Hospital, Eskisehir, Turkey

    Mehmet Ulug

  14. Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey

    Tuna Demirdal

  15. Department of Infectious Diseases and Clinical Microbiology, Gaziantep University School of Medicine, Gaziantep, Turkey

    Mustafa Namiduru

  16. Department of Infectious Diseases and Clinical Microbiology, Ankara Atatürk Training & Research Hospital, Ankara, Turkey

    Tumer Guven

  17. Department of Infectious Diseases and Clinical Microbiology, Ataturk University School of Medicine, Erzurum, Turkey

    Emine Parlak

  18. Department of Infectious Diseases and Clinical Microbiology, Bezmi Alem Vakif University School of Medicine, Istanbul, Turkey

    Sibel Bolukcu & Oguz Reşat Sipahi

  19. Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey

    Meltem Avci & Selma Tosun

  20. Department of Infectious Diseases and Clinical Microbiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

    Kadriye Yaşar

  21. Department of Infectious Diseases and Clinical Microbiology, Uludag University School of Medicine, Bursa, Turkey

    Emel Yilmaz

  22. Department of Infectious Diseases and Clinical Microbiology, Sutcu Imam University School of Medicine, Kahramanmaras, Turkey

    Selma Ates-Guler

  23. Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey

    Esmeray Mutlu-Yilmaz

  24. Department of Infectious Diseases and Clinical Microbiology, Izzet Baysal University School of Medicine, Bolu, Turkey

    Fatma Sirmatel

  25. Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey

    Elif Sahin-Horasan

  26. Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey

    Ayhan Akbulut & Affan Denk

  27. Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey

    Nefise Oztoprak

  28. Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training ad Research Hospital, Istanbul, Turkey

    Yasemin Cag

  29. Department of Infectious Diseases and Clinical Microbiology, Umraniye Training and Research Hospital, Istanbul, Turkey

    Ayten Kadanali

  30. Department of Infectious Diseases and Clinical Microbiology, Pamukkale University School of Medicine, Denizli, Turkey

    Huseyin Turgut

  31. Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey

    Hanefi Cem Gul & Asim Ulcay

  32. Department of Infectious Diseases and Clinical Microbiology, Igdir State Hospital, Igdir, Turkey

    Asli Haykir-Solay

  33. Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, Izmir, Turkey

    Sukran Kose

  34. Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey

    Canan Agalar

  35. Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey

    Nazif Elaldi

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  1. Hakan Erdem
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  2. Seniha Senbayrak
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  3. Kaan Meriç
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  9. Selçuk Kaya
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  12. Mustafa Kemal Celen
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  14. Mehmet Ulug
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  18. Tumer Guven
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  19. Emine Parlak
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  34. Yasemin Cag
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  38. Hanefi Cem Gul
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  39. Mahmut Sunnetcioglu
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  40. Asli Haykir-Solay
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  41. Affan Denk
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  42. Asuman Inan
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  43. Celal Ayaz
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  44. Asim Ulcay
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  45. Sukran Kose
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  46. Canan Agalar
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  47. Nazif Elaldi
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Corresponding author

Correspondence to Hakan Erdem.

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On behalf of all authors, the corresponding author (Hakan Erdem) states that there is no conflict of interest.

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Erdem, H., Senbayrak, S., Meriç, K. et al. Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study. Infection 44, 623–631 (2016). https://doi.org/10.1007/s15010-016-0901-3

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