Treatment of neurobrucellosis: what is known and what remains to be answered

Abstract

Neurological involvement is one of the most perplexing and diverse presentation complications of brucellosis, a worldwide prevalent zoonosis. This review presents the current knowledge available from medical literature and discusses the shortcomings of the existing data. A proposed regimen should include doxycycline and rifampicin and, with the benefit of doubt, ceftriaxone, since its high concentration in the cerebrospinal fluid may offer significant efficacy against the pathogen. Corticosteroids have been used in specialized situations. The use of streptomycin is discouraged owing to its questionable ability to penetrate into the cerebrospinal fluid and its potential neurotoxicity that may perplex the clinical presentation. Treatment duration should be individualized in the absence of an adequate cut-off index.

Keywords::

• brucellosis
• ceftriaxone
• CNS
• corticosteroid
• meningitis
• neurobrucellosis
• streptomycin
• treatment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

^*Cranial nerve involvement variably accompanies these clinical presentations.