Brucella Polyradiculoneuritis



Fig. 17.1
A 35-year-old woman with numbness of lower extremity. (a) Sagittal T2-weighted MRI scan shows loss of low signal intensity of the cortical end plates and high signal in disk space and herniated disk. (b) T1-weighted MRI depicts loss of low signal intensity of the cortical end plates, destruction of the intervertebral disk space and end plates and decreased signal intensity in L1–L2 vertebral bodies. (c) Axial T1-weighted MRI shows end plates with decreased signal intensity and high signal intensity in paravertebral soft tissues



A334675_1_En_17_Fig2_HTML.gif


Fig. 17.2
A 41-year-old woman with pain and weakness of lower extremity. (a) Sagittal T2-weighted MRI shows intervertebral disk with decreased signal intensity. (b) T1-weighted MRI reveals destruction of the intervertebral disk space and end plates and decreased signal intensity in L2–L3 vertebral bodies. (c) Axial T1-weighted MRI depicts end plates with decreased signal intensity




17.4 Treatment


As polyradiculoneuritis is one manifestation of neurobrucellosis, the treatment is the same as neurobrucellosis. Polyradiculoneuritis should be diagnosed and managed promptly. It may cause permanent and irreversible sequelae with diagnosis or treatment delay [29]. Treatment of polyradiculoneuritis may be a combination of doxycycline, rifampicin, trimethoprim/sulfamethoxazole, ciprofloxacin, ceftriaxone, and streptomycin. Duration of therapy varies in different studies, most of them recommend at least 3 months treatment [5, 23]. Duration of treatment ranging from several weeks to several months depends on patient’s condition; it may be shortened to 12 weeks if rapid improvement occurs. According to Gül et al.’s study [18], duration of therapy is 6 months with combination antibiotic therapy, in spite of the fact that the therapy should be individualized. In contrast in Asadipouya et al.’s study from Iran [6], duration of treatment was as short as 8 weeks in about half of the patients. Corticosteroids are not proven to be useful on localized brucellosis [13]. Moreover, rehabilitation should also be a part of the treatment in brucellosis polyradiculopathy [15].


Conclusion

Diagnosis of Brucella polyradiculoneuritis needs a high index of suspicion [9]. In patients with polyradiculoneuritis, brucellosis should be considered in the differential diagnosis especially in endemic areas. That may lead to early diagnosis and treatment [13], and in this situation the prognosis will be excellent. Some items will correlate closely with prognosis that includes duration of illness, Brucella spp. virulence, timing between diagnosis and starting antibiotic, and duration of antibiotic therapy [6].


References



1.

Adeva-Bartolomé MT, Montes-Martínez I, Castellanos-Pinedo F, Zurdo-Hernández JM, de Castro-García FJ (2005) Neurobrucellosis: four case reports. Rev Neurol 41:664–666PubMed


2.

Ahmed R, Patil BS (2009) Neurobrucellosis: a rare cause for spastic paraparesis. Braz J Infect Dis 13:245PubMedCrossRef


3.

Alshareef AA (2009) Case report of polyradiclopathy, hearing loss, and ataxia as presentation of neurobrucellosis. JKAU Med Sci 16:85–92


4.

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


5.

Al-Sous MW, Bohlega SA, Al-Kawi MZ, McLean DR, Ghaus SN (2003) Polyradiculopathy. A rare complication of neurobrucellosis. Neurosciences (Riyadh) 8:46–49


6.

Asadipooya K, Dehghanian A, Omrani GH, Abbasi F (2011) Short-course treatment in neurobrucellosis: a study in Iran. Neurol India 59:101–103PubMedCrossRef

Dec 11, 2016 | Posted by in NEUROLOGY | Comments Off on Brucella Polyradiculoneuritis

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