Brucella Abscess and Granuloma of the Brain

Fig. 7.1

Abscess in the remaining hemisphere of a hemispherectomized patient

Table 7.1

A review of Brucella abscess or “brucelloma” of the brain in the available world literature

Reference and date of publication	Age in years	Sex	Symptoms	Signs	Number of lesions	Location	Pathology	Treatment	Result
Ayala-Gaytan et al. 1989 [6]	19	M	Headache, vomiting, fever, and joint pain	Left cerebellar syndrome and bilateral papilledema	1	Left cerebellar hemisphere	Multiloculated abscess	Surgical removal and medical	Cured
Guvenc et al. 1989 [19]	4	M	Headache, weakness, fever, nausea, and vomiting	Hepatosplenomegaly, mild papilledema	6	Both hemispheres and all lobes	Abscesses 2 × 2 to 4 × 4 cm	Aspiration and medical	Cured
Kalelioglu et al. 1990 [24]	12	M	NM	NM	1	NM	Abscess	Aspiration and medical	Cured
Al-Eissa 1993 [1]	3	M	Fever, vomiting, irritability, and unsteady gait	Bilateral Babinski, nystagmus	1	Right cerebellum	Abscess	Aspiration and medical	Cured
Santini et al. 1994 [33]	41	F	Chills, fever, night sweats	Splenomegaly, stiff neck, aphasia, right hemiparesis, and coma	2	L temporal and L parietal	Abscess	Medical	Cured
Galanakis et al. 1996 [13]	5	M	Fever, vomiting, and headache	Aphasia, right hemiparesis followed by coma	1	NA	Abscess	Medical	Cured
Stranjalis et al. 2000 [36]	60	F	Gradual visual loss and headache	NA	1	Chiasmatico-frontal	Multiloculated abscess	Aspiration and medical	Improved
Trifiletti et al. 2000 [39]	60	M	Polydipsia, headache, fever, and asthenia	Nystagmus, hyperreflexia, limb dysmetria, diabetes insipidus	Multiple	Bilateral frontobasilar	Masses	Medical	Cured
Martinez-Chamoro et al. 2002 [31]	14	M	Seizures, no fever, no vomiting, no headache	Mild hypoesthesia of left arm	1	Right parietal surrounded with edema	Nodular lesion	Surgical removal and medical	Cured
Sohn et al. 2003 [34]	26	M	Periorbital pain, headache, and seizures	Neurological examination was “non-focal”	1	Left frontal	5 × 5 mass	Biopsy and medical	Cured
Idem [34]	15	M	Headache, nausea, vomiting	Decreased vision	Several	Left occipitoparietal	Granuloma	Biopsy and medical	Improved
Al-Sous et al. 2004 [4]	30	F	Headache, deafness	Papilledema, sensory ataxia, areflexia	1	Suprasellar	Granuloma	Medical	Cured
Kizilkilic et al. 2005 [27]	30	M	Headache, fever, nausea, vomiting, gait disturbance, and vertigo	Right dysdiadochokinesia, dysmetria, and ataxia	1	Right inferior cerebellar peduncle	Abscess	Medical	Cured
Haddad et al. 2006 [20]	31	M	Seizures, headache, chills, fever, vomiting	Unconscious, localizing to pain, neck rigidity	1	Left frontal parasagittal	Multiloculated abscess	Surgical and medical	Died
Koc^a 2006 [28]	70	M	Headache, confusion, and visual disturbance	NA	3	Right occipital	Multiloculated abscess	Craniotomy and medical	Cured
Miguel et al. 2006 [32]	13	F	Nonfebrile seizures	Fever (38°), no meningeal signs	1	Left parietal	Ring lesion	Medical	Cured
Carrasco- Moro et al. 2006 [9]	54	M	Refractory epilepsy			Right temporal	Abscess	Surgical and medical	Cured
Keihani-Douste et al. 2006 [25]	12	M	Back pain, headache, nausea, of 6 months duration	Quadriplegia and incontinence	Multiple	Brain and spinal intramedullary	Abscesses	Medical	Improved
Haji-Abdolbagi et al. 2008 [22]	NA	NA	NA	NA	1	NA	Abscess	NA-	NA
Gul et al.^b 2009 [15]	12	F	NA	NA	4	3 cerebral and 1 cerebellar	Hyperintense lesions	Medical	Improved
Tonekaboni et al. 2009 [38]	13	M	Visual impairment, unilateral hearing loss		1	Suprasellar and optic chiasm	Mass	Medical	Improved
Solmaz et al. 2010 [35]	10	M	Fever, malaise, anemia, weakness, dysarthria, and anorexia	Fever and cervical lymphadenopathy	1	Left frontal	Abscess	Medical	Cured
Ceran et al. 2011 [10]	NA	NA	NA	NA	1	NA	Granuloma	NA	NA
Demiroğlu et al. 2011 [12]	NA	NA	NA	MA	1	Cerebellum	Abscess	NA	NA
Budnik et al. 2012 [8]	3	F	Fever, arthralgia, and seizure	Negative neurological examination, fever 38 °C, blood culture + for Brucella	1	Left parietal	Ring lesion surrounded by edema	Surgical resection and medical	Cured
Guven et al. 2013 [18]	NM	NM	NM	NM	NM	NM	Abscesses	NM	NM
Idem [18]	NM	NM	NM	NM	NM	NM	Abscesses	NM	NM

NM not mentioned in the text

^aThe case of Gundes (2004) and that of Koc (2006) appear to be the same case

^bGul has no personal cases. He reviewed all the Turkish literature up until 2009 and found three cerebral and one cerebellar cases. Some of these may have been reported by other Turkish authors, cited in this table, preceding his report

7.2 Incidence

Central nervous system (CNS) complications associated with Brucella infection are rare but varied. The commonest are encephalitis, meningitis, radiculitis, and myelitis. On the other hand, brain abscess is one of the rarest. We were able to collect only 24 publications in which Brucella abscess or brucelloma of the brain was reported. Some of the studies dealing with neurobrucellosis do not report the presence of brain brucelloma nor abscess probably because neither computed tomography (CT) scan nor magnetic resonance imaging (MRI) of the brain was obtained in their patients [21, 22]. Had these tests been available or had they been performed, most probably more brucellomata would have been described. Furthermore a great number of brucelloma and Brucella abscess have never been reported. This is why the published incidence is inferior to the real one.

This incidence is variably recorded. Of 400 cases of brucellosis, 13 presented with neurobrucellosis and none had an abscess nor a brucelloma [3]; Benjamin and Annobil [7] found only two cases of neurobrucellosis in 157 Brucella infections, none of whom had a brain brucelloma or abscess; Lubani et al. [30] report on nine children suffering from neurobrucellosis, none of whom had a brain brucelloma; Tanir et al. [37] reported on 90 cases of childhood brucellosis with only two cases of neurobrucellosis not having a brain brucelloma nor Brucella abscess. Kochar et al. [29] reported on 175 serologically confirmed cases of brucellosis and found 33 (18.86 %) involving the nervous system. Al-Eissa [1] reported on 112 cases suffering from brucellosis, only one of whom had a cerebellar Brucella abscess; out of 430 cases of brucellosis, Demiroğlu et al. [12] recorded one case of cerebellar abscess; Gul et al. [14], reviewing the entire Turkish literature over a 10-year period, reported four cases of brain abscesses out of 187 cases of neurobrucellosis; Galanakis et al. [13] reported one brain abscess out of 52 childhood brucellosis in Greece.

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