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Medical Therapy of Neurobrucellosis

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Neurobrucellosis

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Abstract

Antibiotics are the mainstay of brucellosis treatment; several dual or triple antibiotic combinations for spinal brucellosis have been compared in different studies. In uncomplicated brucellosis, the rifampicin plus doxycycline regimen is the most accepted treatment, but the scientific community is also in favor of streptomycin plus doxycycline, possibly because of its lower price and ease of administration. However there is still no consensus on the best treatment regimens and its duration. The treatment with the combination of ceftriaxone or trimethoprim/sulfamethoxazole, doxycycline, and rifampicin is effective in neurobrucellosis cases that affect the central nervous system and should be prolonged for no less than 3 months. Surgery usually is unnecessary for brucellosis spondylodiscitis. The surgical intervention is reserved for biopsy, severe neurological impairment, or spinal stabilization.

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Abbreviations

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

TMP/SMZ:

Trimethoprim/sulfamethoxazole

WHO:

World Health Organization

References

  1. Agalar C, Usubutun S, Turkyilmaz R (1999) Ciprofloxacin and rifampicin versus doxycycline and rifampicin in the treatment of brucellosis. Eur J Clin Microbiol Infect Dis 18:535–538

    Article  CAS  PubMed  Google Scholar 

  2. Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME, Memish ZA, Roushan MR, Rubinstein E, Sipsas NV, Solera J, Young EJ, Pappas G (2007) Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med 4, e317

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ariza J, Gudiol F, Valverde J, Pallarés R, Fernández-Viladrich P, Rufí G, Espadaler L, Fernández-Nogues F (1985) Comparative trial of rifampin-doxycycline versus tetracycline-streptomycin in the therapy of human brucellosis. Antimicrob Agents Chemother 28:548–551

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bordur H, Erbay A, Akinci E, Colpan A, Cevik MA, Balaban N (2003) Neurobrucellosis in an endemic area of brucellosis. Scand J Infect Dis 5:94–97

    Article  Google Scholar 

  5. Bossi P, Tegnell A, Baka A, Van Loock F, Hendriks J, Werner A, Maidhof H, Gouvras G, Task Force on Biological and Chemical Agent Threats, Public Health Directorate, European Commission, Luxembourg (2004) Bichat guidelines for the clinical management of brucellosis and bioterrorism-related brucellosis. Euro Surveill 9:1–5

    Google Scholar 

  6. Bouza E, García de la Torre M, Parras F, Guerrero A, Rodríguez-Créixems M, Gobernado J (1987) Brucellar menengitis. Rev Infect Dis 4:810–822

    Article  Google Scholar 

  7. Cascio A, Scarlata F, Giordano S, Antinori S, Colomba C, Titone L (2003) Treatment of human brucellosis with rifampin plus minocycline. J Chemother 15:248–252

    Article  CAS  PubMed  Google Scholar 

  8. Ceran N, Turkoglu R, Erdem I, Inan A, Engin D, Tireli H, Goktas P (2011) Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region. Braz J Infect Dis 15:52–59

    Article  CAS  PubMed  Google Scholar 

  9. Colmenero JD, Reguera JM, Fernández-Nebro A, Cabrera-Franquelo F (1991) Osteoarticular complications of brucellosis. Ann Rheum Dis 50:23–26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Colmenero JD, Ruiz-Mesa JD, Plata A, Bermúdez P, Martín-Rico P, Queipo-Ortuño MI, Reguero JM (2008) Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin Infect Dis 46:426–433

    Article  PubMed  Google Scholar 

  11. Corbel MJ (2006) Brucellosis in humans and animals [WHO/CDS/ EPR/2006.7]. World Health Organization, Geneva, pp 36–41

    Google Scholar 

  12. Doğanay M, Aygen B (1992) Use of ciprofloxacin in the treatment of brucellosis. Eur J Clin Microbiol Infect Dis 11:74–75

    Article  PubMed  Google Scholar 

  13. Erdem H, Kilic S, Coskun O, Ersoy Y, Cagatay A, Onguru P, Alp S (2010) Community-acquired acute bacterial meningitis in the elderly in Turkey. Clin Microbiol Infect 16:1223–1229

    Article  CAS  PubMed  Google Scholar 

  14. Erdem H, Ulu-Kilic A, Kilic S, Karahocagil M, Shehata G, Eren-Tulek N, Yetkin F, Kemal M, Ceran N, Cem Gul H, Mert G, Tekin-Koruk S, Dizbay M, Seza Inal A, Nayman-Alpat S, Bosilkovski M, Inan D, Saltoglu N, Abdel-Baky L, Adeva-Bartolomé MT, Ceylan B, Sacar S, Turhan V, Yilmaz E, Elaldi N, Kocak-Tufan Z, Ugurlu K, Dokuzoguz B, Yilmaz H, Gundes S, Guner R, Ozgunes N, Ulcay A, Unal S, Dayan S, Gorenek L, Karakas A, Tasova Y, Usluer G, Bayindir Y, Kurtaran B, Resat O, Leblebicioglu H (2012) Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study. Antimicrob Agents Chemother 56:1523–1528

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Falagas ME, Bliziotis IA (2006) Quinolones for treatment of human brucellosis: critical review of the evidence from microbiological and clinical studies. Antimicrob Agents Chemother 50:22–33

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Franco MP, Mulder M, Gilman RH, Smits HL (2007) Human brucellosis. Lancet Infect Dis 7:775–786

    Article  CAS  PubMed  Google Scholar 

  17. Hall WH (1990) Modern chemotherapy for brucellosis in humans. Rev Infect Dis 12:1060–1099

    Article  CAS  PubMed  Google Scholar 

  18. Hasanjani Roushan MR, Mohraz M, Hajiahmadi M, Ramzani A, Valayati AA (2006) Efficacy of gentamicin plus doxycycline versus streptomycin plus doxycycline in the treatment of brucellosis in humans. Clin Infect Dis 42:1075–1080

    Article  PubMed  Google Scholar 

  19. Hatala R, Dinh T, Cook DJ (1996) Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis. Ann Intern Med 124:717–725

    Article  CAS  PubMed  Google Scholar 

  20. Imbuluzqueta E, Gamazo C, Lana H, Campanero MÁ, Salas D, Gil AG, Elizondo E, Ventosa N, Veciana J, Blanco-Prieto MJ (2013) Hydrophobic gentamicin-loaded nanoparticles are effective against Brucella melitensis infection in mice. Antimicrob Agents Chemother 57:3326–3333

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Ioannou S, Karadima D, Pneumaticos S, Athanasiou H, Pontikis J, Zormpala A, Sipsas NV (2011) Efficacy of prolonged antimicrobial chemotherapy for brucellas spondylodiscitis. Clin Microbiol Infect 17:756–762

    Article  CAS  PubMed  Google Scholar 

  22. Izadi S (2001) Neurobrucellosis. SEMJ 2:1–7

    Google Scholar 

  23. Joint FAO/WHO Expert Committee on Brucellosis (1971) Joint FAO/WHO Expert Committee on Brucellosis [meeting held in Geneva, 29 June – 6 July 1970]: fifth report. WHO Technical Report Series No. 464/FAO Agricultural Series No. 85. World Health Organization, Geneva, pp 41–43

    Google Scholar 

  24. Joint FAO/WHO expert committee on brucellosis (1986) World Health Organ Tech Rep Ser. 740:1–132

    Google Scholar 

  25. Karsen H, Koruk ST, Duygu F, Yapici K, Kati M (2012) Review of 17 cases of neurobrucellosis: clinical manifestations, diagnosis and management. Arch Iran Med 15:491–494

    PubMed  Google Scholar 

  26. Kinsara A, Al-Mowallad A, Osoba AO (1999) Increasing resistance of Brucellae to co-trimoxazole. Antimicrob Agents Chemother 43:1531

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Lang R, Dagan R, Potasman I, Einhorn M, Raz R (1992) Failure of ceftriaxone in the treatment of acute brucellosis. Clin Infect Dis 14:506–509

    Article  CAS  PubMed  Google Scholar 

  28. Lecaroz C, Blanco-Prieto MJ, Burrell MA, Gamazo CJ (2006) Intracellular killing of Brucella melitensis in human macrophages with microsphere-encapsulated gentamicin. J Antimicrob Chemother 58:549–556

    Article  CAS  PubMed  Google Scholar 

  29. Lecaroz C, Gamazo C, Blanco-Prieto MJ (2006) Nanocarriers with gentamicin to treat intracellular pathogens. J Nanosci Nanotechnol 6:3296–3302

    Article  CAS  PubMed  Google Scholar 

  30. Lecaroz MC, Blanco-Prieto MJ, Campanero MA, Salman H, Gamazo C (2007) Poly (D, L-lactide-coglycolide) particles containing gentamicin: pharmacokinetics and pharmacodynamics in Brucella melitensis-infected mice. Antimicrob Agents Chemother 51:1185–1190

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Lulu AR, Araj GF, Khateeb MI, Mustafa MY, Yusuf AR, Fenech FF (1988) Human brucellosis in Kuwait: a prospective study of 400 cases. Q J Med 66:39–54

    CAS  PubMed  Google Scholar 

  32. Montejo JM, Alberola I, Glez-Zarate P, Alvarez A, Alonso J, Canovas A, Aguirre C (1993) Open, randomized therapeutic trial of six antimicrobial regimens in the treatment of human brucellosis. Clin Infect Dis 16:671–676

    Article  CAS  PubMed  Google Scholar 

  33. Mundargi RC, Babu VR, Rangaswamy V, Patel P, Aminabhavi TM (2008) Nano/micro technologies for delivering macromolecular therapeutics using poly (D, L-lactide-co-glycolide) and its derivatives. J Control Release 125:193–209

    Article  CAS  PubMed  Google Scholar 

  34. Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005) Brucellosis. N Engl J Med 352:2325–2336

    Article  CAS  PubMed  Google Scholar 

  35. Pappas G, Akritidis N, Christou L (2007) Treatment of neurobrucellosis: what is known and what remains to be answered. Expert Rev Anti Infect Ther 5:983–990

    Article  CAS  PubMed  Google Scholar 

  36. Pappas G, Christou L, Akritidis N, Tsianos EV (2006) Quinolones for brucellosis: treating old diseases with new drugs. Clin Microbiol Infect 12:823–825

    Article  CAS  PubMed  Google Scholar 

  37. Pappas G, Seitaridis S, Akritidis N, Tsianos E (2004) Treatment of brucella spondylitis: lessons from an impossible meta-analysis and initial report of efficacy of a fluoroquinolone-containing regimen. Int J Antimicrob Agents 24:502–507

    Article  CAS  PubMed  Google Scholar 

  38. Pappas G, Siozopoulou V, Akritidis N, Falagas ME (2007) Doxycycline-rifampicin: physicians’ inferior choice in brucellosis or how convenience reigns over science. J Infect 54:459–462

    Article  CAS  PubMed  Google Scholar 

  39. Pappas G, Siozopoulou V, Saplaoura K, Vasiliou A, Christou L, Akritidis N, Tsianos EV (2007) Health literacy in the field of infectious diseases: the paradigm of brucellosis. J Infect 54:40–45

    Article  PubMed  Google Scholar 

  40. Pappas G, Solera J, Akritidis N, Tsianos E (2005) New approaches to the antibiotic treatment of brucellosis. Int J Antimicrob Agents 26:101–105

    Article  CAS  PubMed  Google Scholar 

  41. Prior S, Gander B, Blarer N, Merkle HP, Subirá ML, Irache JM, Gamazo C (2002) In vitro phagocytosis and monocyte-macrophage activation with poly(lactide) and poly(lactide-co-glycolide) microspheres. Eur J Pharm Sci 15:197–207

    Article  CAS  PubMed  Google Scholar 

  42. Prior S, Gander B, Lecároz C, Irache JM, Gamazo C (2004) Gentamicin-loaded microspheres for reducing the intracellular Brucella abortus load in infected monocytes. J Antimicrob Chemother 53:981–988

    Article  CAS  PubMed  Google Scholar 

  43. Rubinstein E, Vaughan D (2005) Tigecycline: a novel glycylcycline. Drugs 65:1317–1336

    Article  CAS  PubMed  Google Scholar 

  44. Solera J, Espinosa A, Martinez-Alfaro E, Sanchez L, Geijo P, Navarro E, Escribano J, Fernández JA (1997) Treatment of human brucellosis with doxycycline and gentamicin. Antimicrob Agents Chemother 41:80–84

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Solera J, Lozano E, Martinez-Alfaro E, Espinosa A, Castillejos ML, Abad L (1999) Brucellar spondylitis: review of 35 cases and literature survey. Clin Infect Dis 29:1440–1449

    Article  CAS  PubMed  Google Scholar 

  46. Solera J, Martinez-Alfaro E, Saez L (1994) Meta-analysis of the efficacy of the combination of rifampicin and doxycycline in the treatment of human brucellosis. Med Clin (Barc) 102:731–738

    CAS  Google Scholar 

  47. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39:1267–1284

    Article  PubMed  Google Scholar 

  48. Turgut M, Sendur OF, Gurel M (2003) Brucellar spondylodiscitis in the lumbar region-case report. Neurol Med Chir (Tokyo) 43:210–212

    Article  Google Scholar 

  49. Turgut M, Cullu E, Sendur OF, Gurer G (2004) Brucellar spine infection. Four case reports. Neurol Med Chir (Tokyo) 44:562–567

    Article  Google Scholar 

  50. Ulu-Kilic A, Karakas A, Erdem H, Turker T, Inai AS, Ak O, Turan H, Kazak E, Inan A, Duygu F, Demirasian H, Kader C, Sener A, Dayan S, Deveci O, Tekin R, Saltoglu N, Aydin M, Horasan ES, Gul HC, Ceylan B, Kadanal A, Karabay O, Karagoz G, Kayabas U, Turhan V, Engin D, Gulsun S, Elaldi N, Alabay S (2014) Update on treatment options for spinal brucellosis. Clin Microbiol Infect 20:O75–O82

    Article  CAS  PubMed  Google Scholar 

  51. Ulu-Kilic A, Sayar MS, Tutuncu E, Sezen F, Sencan I (2013) Complicated brucellar spondylodiscitis: experience from an endemic area. Rheumatol Int 33:2909–2912

    Article  CAS  PubMed  Google Scholar 

  52. Yilmaz E, Parlak M, Akalin H, Heper Y, Ozakin C, Mistik R, Oral B, Helvaci S, Töre O (2004) Brucellar spondylitis: review of 25 cases. J Clin Rheumatol 10:300–307

    Article  PubMed  Google Scholar 

  53. Yousefi-Nooraie R, Mortaz-Hejri S, MehraniM, Sadeghipour P (2012) Antibiotics for treating human brucellosis. Cochrane Database Syst Rev (10):CD007179

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery and Traumatology, Hospital Universitario Costa del Sol., University of Malaga, Marbella, (Málaga), Spain

    Ana Cerván MD, Miguel Hirschfeld MD, Miguel Rodriguez MD & Enrique Guerado MD, PhD, MSc

Authors
  1. Ana Cerván MD
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  2. Miguel Hirschfeld MD
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  3. Miguel Rodriguez MD
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  4. Enrique Guerado MD, PhD, MSc
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Corresponding author

Correspondence to Enrique Guerado MD, PhD, MSc .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydin, Turkey

    Mehmet Turgut

  2. Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon

    Fuad Sami Haddad

  3. School of Medicine and Surgery, University of Naples Federico II School of Medicine and Surgery, Naples, Italy

    Oreste de Divitiis

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Cerván, A., Hirschfeld, M., Rodriguez, M., Guerado, E. (2016). Medical Therapy of Neurobrucellosis. In: Turgut, M., Haddad, F., de Divitiis, O. (eds) Neurobrucellosis. Springer, Cham. https://doi.org/10.1007/978-3-319-24639-0_20

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  • DOI: https://doi.org/10.1007/978-3-319-24639-0_20

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