18
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Unilateral optic neuritis as a presentation of neurobrucellosis

      case-report

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Neurobrucellosis manifesting as optic neuritis is a rare disease in childhood. We report a case of neurobrucellosis in a 11 year old girl leading to visual impairment and headache. Physical examination revealed mild oedema of right tibiotarsic joint and optic neuritis. Investigations showed CSF pleocytosis and a Brucella serum agglutination titer of 1/640. Complete reversal of the symptoms was observed after appropriate antibiotic treatment. To our knowledge only four cases of neurobrucellosis manifesting with visual impairment in childhood are previously reported in literature.

          Related collections

          Most cited references10

          • Record: found
          • Abstract: found
          • Article: not found

          Neurobrucellosis: clinical and therapeutic features.

          Eighteen patients with neurobrucellosis are described. Eleven patients had meningitis alone or with papilledema, optic neuropathy, or radiculopathy. Four patients had meningovascular complications manifested by stroke or intracerebral hemorrhage from a presumed mycotic aneurysm. Two patients had parenchymatous dysfunction, including a child who had a cerebellar syndrome without evidence of direct infection of the central nervous system. One patient presented with polyradiculopathy. Twelve of 16 patients had pleocytosis; none had cell counts greater than 419 x 10(6)/L. Most patients had hypoglycorrhachia and elevated levels of protein in the cerebrospinal fluid (CSF). Results of an agglutination test for Brucella in serum were positive for all patients. Six of 16 patients had positive blood cultures, and four of 14 had positive CSF cultures. Antimicrobial treatment included concurrent administration of two or more of the following drugs: streptomycin, tetracycline (or doxycycline), rifampin, and trimethoprim-sulfamethoxazole. Eleven patients fully recovered. Five patients were left with residual neurological deficits. Four of these patients suffered permanent hearing loss, one of whom also had significant loss of vision in one eye. One elderly senile patient with meningovascular brucellosis remained in a vegetative state despite receiving antimicrobial therapy for 6 months. One patient died due to rupture of a mycotic aneurysm within 7 days of initiation of therapy. One other patient was treated after sustaining an intracerebral hemorrhage, but this patient's condition was diagnosed only after discharge.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Neurobrucellosis: clinical and neuroimaging correlation.

            Manifestation of nervous system involvement by neurobrucellosis, a treatable infection, is not well documented. We investigated patterns of nervous system involvement and determined if neuroimaging abnormalities correlated with clinical manifestations of neurobrucellosis. We reviewed 23 MR imaging studies (17 of brain, six of spine) and seven CT scans of brain in 23 patients (14 male and nine female patients; age range 17-71 years) with positive Brucella titers in their serum and CSF. Twelve patients had central nervous system (CNS) involvement, four had peripheral nervous system (PNS) involvement, two had combined PNS and CNS involvement, and five had isolated hearing loss. Imaging findings were variable: five of seven brain CT studies were normal, and 10 of 23 MR studies were normal (eight brain, one thoracic, one lumbar). One brain CT study showed subthalamic hemorrhage, mild perivascular enhancement, left caudate lacunae, and diffuse white matter changes. One other brain CT study showed enhancement of the tentorium in addition to white matter changes. Abnormal MR findings were basal meningeal enhancement (n = 3), lumbar nerve root enhancement (n = 3), granuloma of the suprasellar region (n = 1), diffuse white matter changes (n = 7), and spinal cord atrophy (n = 1). All patients improved after treatment with three antimicrobial drugs for 3-12 months. Seven patients had follow-up imaging; the enhancement disappeared but the white matter and ischemic changes persisted despite almost complete clinical recovery. Clinical-radiologic correlation in neurobrucellosis varies from a normal imaging study despite positive clinical findings, to a variety of imaging abnormalities that reflect either an inflammatory process, an immune-mediated process, or a vascular insult.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Optic neuritis in children.

              To describe the clinical characteristics of optic neuritis in children, including final visual acuity and development of multiple sclerosis (MS). Charts were reviewed of all patients or = 20/40 in 58.3% of eyes. Thirty percent of the patients had vision of finger counting or worse. Four (26%) patients developed MS. The mean age of patients with MS was 12 years, compared with 9 years in children who did not develop MS. Patients with unilateral involvement had an excellent visual prognosis (100% > 20/40), but a higher rate of development of MS (75%). Two patients had positive serology for Lyme disease. Optic neuritis presents differently in children than in adults. Children typically have bilateral involvement with papillitis following an antecedent viral illness. Although visual prognosis is poorer in children than adults, the development of MS is less common in children. Children who present with unilateral involvement have a better visual prognosis; however, they also develop MS at a greater frequency than children with bilateral involvement. Patients who developed MS were, on average, older at presentation with optic neuritis than those who did not develop MS.
                Bookmark

                Author and article information

                Journal
                Pediatr Rep
                PR
                PR
                Pediatric Reports
                PAGEPress Publications (Pavia, Italy )
                2036-749X
                2036-7503
                16 June 2011
                16 June 2011
                : 3
                : 2
                : e11
                Affiliations
                [1 ]Pediatric Department, Hospital Garcia da Orta, Almada, Portugal;
                [2 ]Ophthalmologic Department, Hospital Garcia da Orta, Almada, Portugal
                Author notes
                Correspondence: Rita Marques, Serviço de Pediatria, Hospital Garcia da Orta, Av. Professor Torrado da Silva, 2801-951 Almada, Portugal. Tel. +351.21.294 02.94 - Fax. +351.21.295.70.04. E-mail: ritamarq@ 123456gmail.com

                Contributions: RM, patient screening and manuscript writing, CM, IM, manuscript writing; JPM, NC, PC patient screening supervision and manuscript writing.

                Conflict of interest: the authors report no conflicts of interest.

                Article
                pr.2011.e11
                10.4081/pr.2011.e11
                3133493
                21772948
                bbc4ce77-354a-4730-a66e-0337355bb601
                ©Copyright R. Marques et al., 2011

                This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0).

                Licensee PAGEPress, Italy

                History
                : 08 December 2010
                : 07 April 2011
                : 15 April 2011
                Categories
                Case Report

                Pediatrics
                brucellosis.,optic neuritis,neurobrucellosis
                Pediatrics
                brucellosis., optic neuritis, neurobrucellosis

                Comments

                Comment on this article