Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center.
and the Departments of Internal Medicine.
Neurologist. 2021 Nov 4;26(6):248-252. doi: 10.1097/NRL.0000000000000348.
Brucella are small, nonmotile, intracellular, and aerobic gram-negative bacteria. Of the 10 species that currently form the genus Brucella, 5 were shown to be pathogenic in humans.
The epidemiology, clinical manifestations, diagnosis and imaging, and treatment of neurobrucellosis will be reviewed.Brucellosis's transmission to humans occurs by direct contact with contaminated animals. Older patients are at increased risk of nervous system involvement in brucellosis. Brucella spp. can lead to central nervous system involvement through direct damage via invasion of neural tissue or indirect damage caused by endotoxins or immune inflammatory reactions elicited by the presence of the bacteria in the body. Patients can have general nonspecific symptoms in addition to neurological and psychiatric symptoms. There are 4 diagnostic criteria for the diagnosis of neurobrucellosis, which include signs and symptoms suggestive of neurobrucellosis, a positive finding of Brucella spp. in the cerebrospinal fluid (CSF), and/or a positive titer of antibodies targeting brucella in the CSF, lymphocytosis with high protein levels and low glucose levels in CSF, and imaging findings (either cranial magnetic resonance imaging or computed tomography) peculiar to neurobrucellosis. For the treatment, a combined therapy is favored over monotherapy for the eradication of Brucella. Moreover, a multirouted therapy has been associated with increased treatment efficacy. The prognosis of neurobrucellosis is dependent on patients' clinical presentation: brucellar meningitis is associated with a good prognosis, whereas diffuse central nervous system involvement is associated with the development of long-term sequelae.
Neurobrucellosis affects patients globally and in endemic areas. Neurologists should familiarize themselves with its clinical presentation, diagnosis, and treatment to provide optimal care for their patients.
布鲁氏菌是一种小的、非运动的、细胞内的、需氧革兰氏阴性细菌。在目前形成布鲁氏菌属的 10 个种中，有 5 种被证明对人类具有致病性。
本文将回顾神经布鲁氏菌病的流行病学、临床表现、诊断和影像学以及治疗。布鲁氏菌病通过直接接触受污染的动物传染给人类。老年患者患布鲁氏菌病神经系统受累的风险增加。布鲁氏菌属可通过直接侵犯神经组织或通过内毒素或免疫炎症反应引起的间接损害导致中枢神经系统受累。除了神经和精神症状外，患者还可有一般非特异性症状。神经布鲁氏菌病的诊断有 4 项标准，包括有提示神经布鲁氏菌病的体征和症状、脑脊液中布鲁氏菌属的阳性发现、脑脊液中针对布鲁氏菌的抗体滴度阳性、脑脊液中淋巴细胞增多伴高蛋白水平和低葡萄糖水平、以及神经布鲁氏菌病特有的影像学表现。对于治疗，联合治疗比单一药物治疗更有利于消除布鲁氏菌。此外，多途径治疗与增加治疗效果有关。神经布鲁氏菌病的预后取决于患者的临床表现：布鲁氏菌性脑膜炎预后良好，而弥漫性中枢神经系统受累与长期后遗症的发展有关。
神经布鲁氏菌病影响全球和流行地区的患者。神经科医生应熟悉其临床表现、诊断和治疗，为患者提供最佳护理。
