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Epidural and Subdural Brucellar Empyema

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Neurobrucellosis

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Abstract

Neurobrucellosis is a rare but important complication of brucellosis with a rate of about 3–5 %. Intracranial epidural and subdural empyemas are less common and present with nonspecific signs and symptoms including several days of fever, headache, altered mental status and confusion, seizures, and focal neurological deficits. Neuroimaging is very crucial in the diagnosis. Surgical and medical treatments are the cornerstone of therapy. The purposes of this chapter are to emphasize the brucellar epidural and subdural empyemas to keep these neurobrucellosis forms in mind and to review the diagnostic and treatment modalities.

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Abbreviations

2-ME:

2-Mercaptoethanol

CSF:

Cerebrospinal fluid

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PCR:

Polymerase chain reaction

References

  1. Al Deeb SM, Yaqub BA, Sharif HS, Phadke JG (1989) Neurobrucellosis: clinical characteristics, diagnosis, and outcome. Neurology 39:498–501

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  3. American Academy of Pediatrics (2009) Brucellosis. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS (eds) Red book: 2009 report of the Committee of Infectious Diseases, 28th edn. American Academy of Pediatrics, Elk Grove Village, pp 237–239

    Google Scholar 

  4. Araj GF (2010) Update on laboratory diagnosis of human brucellosis. Int J Antimicrob Agents 36:12–17

    Article  Google Scholar 

  5. Bruce D (1887) Note on the discovery of a micro-organism in Malta fever. Practitioner 39:161–170

    Google Scholar 

  6. 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 

  7. Corbel MJ, Beeching NJ (2012) Brucellosis. In: Braunwald BE, Fauci AS, Kasper DL, Hauser SL (eds) Harrison’s principles of internal medicine, 18th edn. McGraw Hill, New York, pp 1295–1296

    Google Scholar 

  8. Danner RL, Hartman AJ (1987) Update of spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis 9:265–274

    Article  CAS  PubMed  Google Scholar 

  9. Dean AS, Crump L, Greter H, Hattendorf J, Schelling E, Zinsstag J (2012) Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis 6, e1929

    Article  PubMed  PubMed Central  Google Scholar 

  10. Demiroğlu YZ, Turunç T, Karaca S, Arlıer Z, Alışkan H, Colakoğlu S, Arslan H (2011) Neurological involvement in brucellosis; clinical classification, treatment and results. Mikrobiyol Bul 45:401–410

    PubMed  Google Scholar 

  11. Dill SR, Cobbs CG, McDonald CK (1995) Subdural empyema: analysis of 32 cases and review. Clin Infect Dis 20:372–386

    Article  CAS  PubMed  Google Scholar 

  12. Doganay M, Aygen B (2003) Human brucellosis: an overview. Int J Infect Dis 7:173–182

    Article  Google Scholar 

  13. Erdem H, Ulu-Kilic A, Kilic S, Karahocagil M, Shehata G, Eren-Tulek N, Yetkin F, Celen MK, Ceran N, Gul HC, Mert G, Tekin-Koruk S, Dizbay M, Inal AS, Nayman-Alpat S, Bosilkovski M, Inan D, Saltoglu N, Abdel-Baky L, Adeva-Bartolome 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, Sipahi OR, 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 

  14. Erdem M, Namiduru M, Karaoglan I, Kecik VB, Aydin A, Tanriverdi M (2012) Unusual presentation of neurobrucellosis: a solitary intracranial mass lesion mimicking a cerebral tumor: a case of encephalitis caused by Brucella melitensis. J Infect Chemother 18:767–770

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gul HC, Erdem H, Gorenek L, Ozdag MF, Kalpakci Y, Avci IY, Besirbellioglu BA, Eyigun CP (2008) Management of neurobrucellosis: an assessment of 11 cases. Intern Med 47:995–1001

    Article  PubMed  Google Scholar 

  16. Guvenc H, Kocabay K, Okten A, Bertas S (1989) Brucellosis in a child complicated with multiple brain abscesses. Scand J Infect Dis 21:33–36

    Article  Google Scholar 

  17. Haji-Abdolbagi M, Rasooli-Nejad M, Jafari S, Hasibi M, Soudbakhsh A (2008) Clinical and laboratory findings in neurobrucellosis: review of 31 cases. Arch Iran Med 11:21–25

    PubMed  Google Scholar 

  18. Köse Ş, Senger SS, Çavdar G, Yavaş S (2011) Case report on the development of a brucellosis-related epidural abscess. J Infect Dev Ctries 5:403–405

    Article  PubMed  Google Scholar 

  19. Mantur BG, Amarnath SK, Shinde RS (2007) Review of clinical and laboratory features of human brucellosis. Indian J Med Microbiol 25:188–202

    Article  CAS  PubMed  Google Scholar 

  20. Mantur BG, Biradar MS, Bidri RC, Mulimani MS, Veerappa Kariholu P, Patil SB, Mangalgi SS (2006) Protean clinical manifestations and diagnostic challenges of human brucellosis in adults: 16 years’ experience in an endemic area. J Med Microbiol 55:897–903

    Article  PubMed  Google Scholar 

  21. McIntyre PB, Lavercombe PS, Kemp RJ, McCormack JG (1991) Subdural and epidural empyema: diagnostic and therapeutic problems. Med J Aust 154:653–657

    CAS  PubMed  Google Scholar 

  22. McLean DR, Russell N, Khan MY (1992) Neurobrucellosis: clinical and therapeutic features. Clin Infect Dis 15:582–590

    Article  CAS  PubMed  Google Scholar 

  23. Papaioannides D, Giotis C, Korantzopoulos P, Akritidis N (2003) Brucellar spinal epidural abscess. Am Fam Physician 67:2071–2072

    PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  25. 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 

  26. Perez-Calvo J, Matamala C, Sanjoaquin I, Rodriguez-Benavente A, Ruiz-Laiglesia F, Bueno-Gomez J (1994) Epidural abscess due to acute Brucella melitensis infection. Arch Intern Med 154:1410–1411

    Article  CAS  PubMed  Google Scholar 

  27. Pradilla G, Ardila GP, Hsu W, Rigamonti D (2009) Epidural abscesses of the CNS. Lancet Neurol 8:292–300

    Article  PubMed  Google Scholar 

  28. Rajan R, Khurana D, Kesav P (2013) Deep gray matter involvement in neurobrucellosis. Neurology 80(3):e28–e29

    Article  PubMed  Google Scholar 

  29. Samdani PG, Patil S (2003) Neurobrucellosis. Indian Pediatr 40:565–568

    CAS  PubMed  Google Scholar 

  30. Santini C, Baiocchi P, Berardelli A, Venditti M, Serra P (1994) A case of brain abscess due to Brucella melitensis. Clin Infect Dis 19:977–978

    Article  CAS  PubMed  Google Scholar 

  31. Shakir RA, Al-Din AS, Araj GF, Lulu AR, Mousa AR, Saadah MA (1987) Clinical categories of neurobrucellosis. A report on 19 cases. Brain 110:213–223

    Article  PubMed  Google Scholar 

  32. Shoshan Y, Maayan S, Gomori MJ, Israel Z (1996) Chronic subdural empyema: a new presentation of neurobrucellosis. Clin Infect Dis 23:400–401

    Article  CAS  PubMed  Google Scholar 

  33. Solera J, Martínez-Alfaro E, Espinosa A (1997) Recognition and optimum treatment of brucellosis. Drugs 53:245–256

    Article  CAS  PubMed  Google Scholar 

  34. 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 

  35. Solera J (2010) Update on brucellosis: therapeutic challenges. Int J Antimicrob Agents 36:S18–S20

    Article  CAS  PubMed  Google Scholar 

  36. Tajdini M, Akbarloo S, Hosseini SM, Parvizi B, Baghani S, Aghamollaii V, Tafakhori A (2014) From a simple chronic headache to neurobrucellosis: a case report. Med J Islam Repub Iran 28:12

    PubMed  PubMed Central  Google Scholar 

  37. Tappe D, Melzer F, Schmoock G, Elschner M, Lâm TT, Abele-Horn M, Stetter C (2012) Isolation of Brucella melitensis biotype 3 from epidural empyema in a Bosnian immigrant in Germany. J Med Microbiol 61:1335–1337

    Article  PubMed  Google Scholar 

  38. Tufan K, Aydemir F, Sarica FB, Kursun E, Kardes Ö, Cekinmez M, Caner H (2014) A extremely rare case of cervical intramedullary granuloma due to Brucella accompanied by Chiari Type-1 malformation. Asian J Neurosurg 9:173–176

    Article  PubMed  PubMed Central  Google Scholar 

  39. Tunkel AR, Scheld WM (2005) Acute meningitis. In: Mandell G, Bennett J, Dolin R (eds) Principles and practice of infectious diseases, 6th edn. Churchill Livingstone, Philadelphia, pp 1084–1126

    Google Scholar 

  40. Turgut M, Cullu E, Sendur OF, Gürer G (2004) Brucellar spine infection-four case reports. Neurol Med Chir (Tokyo) 44:562–567

    Article  Google Scholar 

  41. Turgut M, Sendur OF, Gürel M (2003) Brucellar spondylodiscitis in the lumbar region. Neurol Med Chir (Tokyo) 43:210–212

    Article  Google Scholar 

  42. Young EJ (2010) Brucella species. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 7th edn. Churchill Livingstone, Philadelphia, pp 2921–2925

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Abbas Tafakhori MD

  2. Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey

    Ahmet Tuncay Turgut MD

  3. Department of Pediatric Infectious Disease, Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara, Turkey

    Saliha Kanık-Yüksek MD

  4. Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydın, Turkey

    Mehmet Turgut MD, PhD

Authors
  1. Abbas Tafakhori MD
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  2. Ahmet Tuncay Turgut MD
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  3. Saliha Kanık-Yüksek MD
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  4. Mehmet Turgut MD, PhD
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Corresponding author

Correspondence to Abbas Tafakhori MD .

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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Tafakhori, A., Turgut, A.T., Kanık-Yüksek, S., Turgut, M. (2016). Epidural and Subdural Brucellar Empyema. In: Turgut, M., Haddad, F., de Divitiis, O. (eds) Neurobrucellosis. Springer, Cham. https://doi.org/10.1007/978-3-319-24639-0_4

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  • DOI: https://doi.org/10.1007/978-3-319-24639-0_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-24637-6

  • Online ISBN: 978-3-319-24639-0

  • eBook Packages: MedicineMedicine (R0)

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