Manifestations, complications, and treatment of neurobrucellosis: a systematic review and meta-analysis

Abstract

Purpose

Central nervous system involvement by Brucella species is the most morbid form of brucellosis disease. Studies on neurobrucellosis are scarce and limited to case reports and series. Brucella is unable to infect or harm neurons without the assistance of monocytes. This raises the question of whether ceftriaxone-based regimens are effective.

Methods

The primary aim of this study was to identify, evaluate, and summarize the findings of all relevant individual studies in the past 30 years to help better understand the disease. To achieve this, a broad systematic search was undertaken to identify all relevant records. Epidemiological and clinical features of the disease were assessed by the pooled analysis of descriptive studies. Through a meta-analysis, the treatment period duration was compared between the ceftriaxone-based and oral regimens using Standardized mean differences to measure effect size.

Results

448 patients were included in the Meta-analyses from 5 studies. A moderate positive effect was found for ceftriaxone-based regimens over oral treatments, and there was a significant difference between these two groups (SMD 0.428, 95% CI −0.63 to −0.22, I 2 = 37.64). Neurobrucellosis has a different clinical picture in pediatric patients. The disease is less chronic in children. Fever, nausea and vomiting, fatigue, and abdominal pain were significantly more prevalent symptoms in children, and Convulsions, ascites, sensorineural hearing loss, and papilledema were significantly more prevalent signs in children than adults.

Conclusion

It is recommended to initiate the treatment of neurobrucellosis with IV ceftriaxone therapy in combination with oral therapy.

Keywords:

• Neurobrucellosis
• meningitis
• ceftriaxone
• treatment
• children

Acknowledgments

This manuscript has been released as a pre-print at https://doi.org/10.21203/rs.3.rs-1424537/v1.

Ethics approval

This study is Evaluated by Research Ethics Committees of Arak University of Medical Sciences and Approved on 2020-08-02. Approval ID: IR.ARAKMU.REC.1399.167.

Disclosure statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author contributions

A.T. and M.S designed the study protocol and did the literature search, study quality assessment and data extraction by A.T. and M.S., and A.T. performed the statistical analysis and drafted the tables and figures. A.T. wrote the first draft of this analysis, N.Z. and A.R. helped to finish the final version. N.Z. and A.R. helped with revision of the manuscript. All authors approved the conclusions of our study.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The study supported by Infectious Diseases Research Center (IDRC), Arak University of medical sciences, Arak, Iran, Islamic Republic Of. ID: 6197.