Ocular Lesions in Brucella Infection: A Review of the Literature

Figures & data

Table 1 Summary of 47 Patients with Brucella Infection Causes Eye Disease

Number	Reference	Sex	Age (Years)	Ophthalmic Diagnosis	Contact History	Systemic Symptoms	BCVA (Pre-Treatment)	BCVA (Post-Treatment)	Laboratory Examination			Therapeutic Method	Medication Time	Treatment Effect
									Brucella SAT Titre	Blood Cultures	Other Examination
1	Sarmiento et al^Citation10	F	18	Papilledema, Cranial nerve VI palsy (OU)	Consuming unpasteurized cheese	Fever, tachypnea and tachycardia	-	-	-	Brucella species	-	Ceftriaxone, rifampin and doxycycline	5.5 months	Asymptomatic
2	Havali et al^Citation11	M	11	Papilledema (OU)	Consuming unpasteurized cheese	Fever, arthralgia and weakness	0.02/HM	0.06/0.15	-	-	CSF PCR was positive for Brucella	Doxycycline, rifampicin and ceftriaxone	2 months	Asymptomatic Optic atrophy
3	Turel et al^Citation12	F	6	Cranial nerve VI palsy (OU)	Consumption of ice cream made from unpasteurized milk	Fever, headache, and pain on the right leg	-	-	1:360	Brucella species	-	Trimethoprim, ceftriaxone, sulfamethoxazole and rifampicin	2 months	Asymptomatic
4	Geng et al^Citation13	-	5	Papilledema, Keratitis (OU)	Consuming unpasteurized goat milk	Fever, drowsiness and irritability	-	-	1:25	Brucella species	CSF mNGS was positive for Brucella	Rifampicin, sulfamethoxazole and ceftriaxone	2 months	Asymptomatic
5	Mergen et al^Citation14	F	25	Papilledema (OU), Cranial nerve VI palsy (OD)	Living in a brucellosis endemic area	Weakness and numbness in lower limbs	-	-	1:360	-	CSF cultures was positive for Brucella	Doxycycline, rifampin, cotrimoxazole, and dexamethasone	6 months	Without
6	Bains et al^Citation15	M	50	Papilledema (OU)	Consuming unpasteurized cheese	Fevers, headache and body aches	-	-	1:320	Brucella species	-	Ceftriaxone, doxycycline and rifampin	3 months	Asymptomatic Optic atrophy
7	Sharma et al^Citation16	M	10	Papilledema (OU)	Living in a brucellosis endemic area	Fevers, body ache and joint pains	-	-	1:1280	Brucella species	-	Doxycycline, rifampicin, and trimethoprim sulfamethoxazole	6 months	Asymptomatic
8	Dar et al^Citation17	F	20	Papilledema (OS)	Domesticated animal contact history	Fever, headache, and weakness of lower limbs	-	-	-	Negative	CSF cultures was positive for Brucella	Doxycycline, rifampicin, and ceftriaxone	1 month	Symptom relief
9	Ibrahimagic et al^Citation18	F	49	Papilledema, Cranial nerve VI palsy	History of frequent exposure to sheep	Headache, weakness and vomiting	-	-	-	-	Serum ELISA test was positive for Brucella	Doxycycline, rifampicin, and trimethoprim sulfamethoxazole	2 months	Asymptomatic
10	Tajdini et al^Citation19	F	25	Papilledema (OS)	History of travel in rural areas	Chronic headache	-	-	1:2650	-	Brucella (capt test) was positive	Cefteriaxone, doxycycline and rifampin	1 month	Asymptomatic
11	Akhondian et al^Citation20	F	11	Papilledema (OS)	Consuming unpasteurized cheese	Fever, headache	-	-	-	Negative	CSF serologic was positive for Brucella	Gentamicin, Rifampin, trimoxazole and doxycycline	3 months	Asymptomatic
12	Tugcu et al^Citation21	F	27	Papilledema, Cranial nerve VI palsy (OU)	Living in a brucellosis endemic area	Headache	CF10cm/CF30cm	CF2m/CF2m	-	Negative	Wright agglutination test was positive for Brucella	Rifampin, doxycycline and cotrimoxazole	3 months	Asymptomatic Optic atrophy
13	Sinopidis et al^Citation22	M	4	Papilledema (OS)	Living in a brucellosis endemic area	Vomiting and headaches	-	-	-	-	Wright agglutination test was positive for Brucella	Gentamicin, doxycycline, cotrimoxazole and rifampicin	4 months	Asymptomatic
14	Marques et al^Citation23	F	11	Papilledema (OD)	Consumption of unpasteurized dairy products	Headache	0.6/-	Vision recovery	1:640	-	CSF PCR was negative for Brucella	Doxycycline and rifampicin	6 months	Asymptomatic
15	Sahin et al^Citation24	F	28	Papilledema (OU), Cranial nerve VI palsy (OD)	Living in a brucellosis endemic area	Headache, fever, sweating and neck stiffness	0.05/0.4	1.0/1.0	1:320	Negative	CSF agglutination titer was positive for brucella	Rifampicin and doxycycline	6 months	Asymptomatic
16	Sahin et al^Citation25	F	23	Papilledema (OU), Cranial nerve VI palsy (OS)	Living in a brucellosis endemic area	Headache, nausea and vomiting	-	CF1m / CF1.5m	1:160	-	CSF Coombs agglutination test was positive for brucella	Rifampicin, doxycycline and cotrimoxazole	6 months	Asymptomatic Optic atrophy
17	Tonekaboni et al^Citation26	M	13	Normal (Optic chiasma compression)	Consumption of unpasteurized dairy products	Fever, loss of hearing and leg pain	NLP/-	CF0.5m /-	-	-	Wright agglutination test was positive for Brucella	Doxycycline, rifampin, trimethoprim-sulfamethoxazole and ciprofloxacin	12 months	Asymptomatic No improvement of hearing
18	Vinod et al^Citation27	M	45	Normal (Cerebral infarction)	History of contact with infected animals	Dry cough, headache, and fever	NLP/NLP	CF2foot/ CF2foot	1:40	Brucella species	CSF was negative for Brucella	Doxycycline, rifampicin and streptomycin	1.5 months	Asymptomatic
19	Miyares et al^Citation28	M	35	Papilledema (OU), Cranial nerve VI palsy (OS)	Living in a brucellosis endemic area	Headache			1:640	Negative	CSF was positive for Brucella	Doxycycline, streptomycin and rifampicin	1.5 months	Optic atrophy
20	Karakurum et al^Citation29	M	38	Papilledema (OS), Cranial nerve VI palsy (OS)	Living in a brucellosis endemic area	-	0.1/1.0	0.5/1.0	1:1280	-	CSF IgG and IgM was positive for Brucella	Ceftriaxone, rifampicin and doxycycline	1 month	Asymptomatic
21	Levy et al^Citation30	F	6	Papilledema (OU)	Consuming unpasteurized goat milk	Headache, fever and vomiting	-	1.0/1.0	1:160	Brucella species	CSF was positive for Brucella	Trimethoprim-sulfamethoxazole, rifampin and doxycycline	1 month	Asymptomatic
22	Karapinar et al^Citation31	F	15	Normal	Living in a brucellosis endemic area	Fever	NLP/NLP	Normal	1:40	Brucella species	-	Rifampicin, doxycycline and streptomycin	3 months	Asymptomatic
23	Tunc et al^Citation32	M	19	Papilledema, Serous retinal detachment (OU)	Medical history of brucellosis	Fever, fatigue, headache	LP/LP	HM/HM	1:640	Negative	Rose-Bengal test was positive for Brucella, CSF culture was negative	Doxycycline, rifampin	-	Asymptomatic Optic atrophy
24	Þiftçi et al^Citation33	F	25	-	Medical history of brucellosis	Headache, generalized weakness, amenorrhoea and galactorrhoea	-	-	1:320	Negative	CSF was positive for Brucella	Tetracycline and trimethoprim-sulfamethoxazole	2.5 months	Asymptomatic
25	Esteavo et al^Citation34	M	8	Cranial nerve VI palsy (OU)	His parents were shepherds	Headaches and vomiting	-	-	-	Brucella species	CSF was positive for Brucella	Rifampicin and doxycycline	1.5 months	Asymptomatic
26	Elrazak et al^Citation35	F	13	Papilledema (OS)	Consuming unpasteurized goat milk	Fever and headaches	1.0/NLP	1.0/1.0	1:640	-	-	Tetracycline hydrochloride, Prednisone (2weeks)	2 months	Asymptomatic
27	Guvenc et al^Citation36	M	4	Papilledema (OS)	Living in a brucellosis endemic area	Weakness, fever, nausea and vomiting, headache	-	-	1:320	Negative	CSF was negative for Brucella	Tetracycline and streptomycin	3 weeks	Asymptomatic
28	Diaz Espejo et al^Citation37	F	47	Papilledema, Cranial nerve VI palsy (OU)	Consuming unpasteurized goat milk	Headache	-	-	1:400	Negative	-	Doxycyclin and streptomycin	3 months	Asymptomatic
29	Xi et al^Citation38	F	57	Uveitis (OU)	She is the shepherd	Knee and waist pain	LP/ 2/3	HM/ 2/3	1:25	-	mNGS was positive for Brucella	Doxycycline and rifampicin	3 months	Asymptomatic
30	AlMutairi et al^Citation39	F	31	Uveitis (OU)	Consuming unpasteurized goat milk	Bilateral knee pain, fever, and upper respiratory infection	0.2/0.05	0.5/0.125	1:80	Negative	-	Doxycycline and rifampicin	1.5 months	Asymptomatic
31	Adusumilli et al^Citation40	M	71	Serous choroidal detachment (OU)	He is the shepherd	Fever with chills, malaise, and nausea	0.25/0.25	1.0/1.0	-	-	Brucella IgM antibody was positive	Rifampicin and doxycycline	1.5 months	Asymptomatic
32	Oray et al^Citation41	F	26	Uveitis (OS), Exudative retinal detachment (OS)	Consuming unpasteurized goat milk	Weight loss and fatigue	1.0/0.6	1.0/0.1	-	Positive	-	Doxycycline, trimethoprim-sulfamethoxazol and rifampicin	6 months	Asymptomatic
33	Al-Kharashi et al^Citation42	M	18	Endogenous endophthalmitis (OS)	Living in a brucellosis endemic area	Fever and weakness	1.0/CF	1.0/0.13	-	-	Vitreous sample was positive for Brucella	Doxycycline and rifampicin	3 months	Asymptomatic
34	Akyol et al^Citation43	F	28	Uveitis	Consuming unpasteurized goat milk	Backache and hip pain	-	-	1:640			Rifampicin and doxycycline	2 months	Asymptomatic
35	Mohammadi et al^Citation44	F	7	Uveitis (OS)	Consuming unpasteurized cheese	Wrist pain, fever and anorexia	1.0/0.05	1.0/1.0	-	-	2-ME brucella test (1/160), Wright test (1/160) and Combs Wright (1/320)	Rifampin and sulfadiazine trimethoprim	2 months	Asymptomatic
36	Rabinowitz et al^Citation45	M	39	Uveitis (OU), Exudative retinal detachment (OU)	Consuming unpasteurized goat milk	-	0.025/1.0	0.6/0.6	1:160	Negative	-	Streptomycin sulfate and doxycycline	1.5 months	Asymptomatic
37	Hatipoglu et al^Citation46 Case 1	F	56	Uveitis	Living in a brucellosis endemic area	Fever, knee and back pain	-	-	1:640	-	-	Streptomycin, rifampicin and doxycycline	6 months	Asymptomatic
37	Hatipoglu et al^Citation46 Case 2	M	30	Uveitis	Living in a brucellosis endemic area	-	-	-	1:2560	-	-	Streptomycin and tetracycline	3 months	Asymptomatic
38	Akduman et al^Citation47	F	16	Uveitis (OU)	Consuming unpasteurized milk	Fever, sweating, malaise, joint and muscle pain	HM/HM	FC2m/FC 2m	1:20	-	Agglutination titer for aqueous humor was 1:40 and for vitreous was 1:640	Doxycycline and Rifampicin	-	Optic nerve damage
39	Walker et al^Citation48	M	56	Uveitis (OU)	Travel to many rural areas	Fevers, night sweats, and right upper quadrant pain	0.4/0.5	-	1:640	-	-	Tetracycline	2 weeks	Asymptomatic
40	Gasser et al^Citation49	F	52	Uveitis (OD)	Living in a brucellosis endemic area	Suspected tumor sited left breast.	0.3/-	0.7/-	1:320	-	Brucella found in necrotic material culture	Doxycycline and streptomycin	1.5 months	Asymptomatic
41	Tabbara et al^Citation50	F	34	Uveitis (OS)	Consuming unpasteurized milk	Headache, Paravertebral abscess	1.0/0.2	1.0/0.3	1:1644	Negative	Culture of paravertebral abscess showed Brucella	Streptomycin, doxycycline and rifamycin	3 months	Asymptomatic Posterior lenticular subcapsular opacities
42	Rolando et al^Citation51	F	59	Uveitis (OS), Exudative retinal detachment (OS)	Living in a brucellosis endemic area	Pain in lumbar spine, arthralgia, and fever	0.5/FC	-	1:1256	-	-	Rifampin doxycycline and prednisone	2 months	-
43	Lidgett et al^Citation52	M	24	Uveitis (OD)	He is poultry farmer	Fever	0.5/-	1.0/-	1:160	-	-	Tetracycline hydrochloride and streptomycin	-	Asymptomatic
44	Bhasin et al^Citation53	M	33	Cystoid macular edema (OU)	Living in a brucellosis endemic area	Fever with chills, itching all over body	0.08/0.5	0.5/0.3	-	-	Brucella antigen (IgG) was positive	Plasma exchange	-	Asymptomatic
45	Vempuluru et al^Citation54	M	58	Canaliculitis (OD)	He is a farmer	-	-	-	-	-	Brucella was found in lacrimal duct pus and stone culture	Chloramphenicol	1.5 months	Asymptomati
46	Imamura et al^Citation55	M	35	Blepharoptosis (OS)	Travel history to Vietnam	Fever	-	-	-	Negative	IgG serum titer was elevated for Brucella at 0.91 mg/dL	Doxycycline	-	Asymptomatic
47	Bekir et al^Citation56	M	16	Dacryoadenitis (OD)	Medical history of brucellosis	Fever, malaise, generalized arthralgia, sweating and low back pain	1.0/1.0	-	1:640	Negative	Brucella can be seen in lacrimal gland secretion culture	Rifampin and doxycyclin	3 months	Asymptomatic

Figure 1 Route of Brucella infection. Infection first occurs through the mucous membranes; once inside the body it is engulfed by phagocytes, such as macrophages, neutrophils and dendritic cells. The bacteria replicate within these cells before moving to regional lymph nodes and then spreading to different organs such as the eye, lung, spleen, liver and bone marrow.

Figure 2 Ocular pathogenesis of Brucella.

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