Neurobrucellosis A23.9

Subacute or chronic course; colourful clinical picture; wavelike fever, leukopenia, lymphadenopathy, hepatosplomegaly, bradycardia (50% of patients have a subclinical course) (see below brucellosis).

Neurological symptoms occur in the form of aseptic meningitis, encephalitis, myelitis, cerebrovascular involvement (vasculitis, vasospasm, mycotic aneurysm, septic embolism in endocarditis) or polyradiculonuritis with cranial nerve involvement occur at all stages of the disease (at the beginning, during convalescence and months after the acute phase of infection).

S.u. brucellosis; CSF: inflammatory liquor syndrome with lymphocytic pleocytosis, increased protein content and reduced glucose.

Detection of pathogens in the blood and cerebrospinal fluid (often negative in chronic cases)

Detection of elevated antibody titers(ELISA, CFT, agglutination reaction according to Widal)

The classic therapy is recommended for acute neurobrucellosis:

Doxycycline: 2 x 100 mg / day p.o. or in combination with cotrimoxazole (320-480 mg / daily dose of trimethoprim) for 4-6 weeks, then doxycycline alone for another 3-4 weeks.

Alternative: Ceftriaxone (Fatani DF et al. 2019): 2x2g/day for 10 days

If there is no clinical improvement within 10 days, rifampicin can be prescribed in addition to doxycycline for 10 mg/kg body weight/day p.o.

There is no generally accepted therapeutic regimen for chronic forms: good results have been obtained with a 3 to 6-month therapy with cotrimoxazole (320-480 mg/day trimethoprim) in combination with rifampicin (10 mg/kg body weight/day p.o.) or doxycycline.

1. Fatani DF et al (2019) Ceftriaxone use in brucellosis: A case series. IDCases 18:e00633.