Neurobrucellosis – A Rare Complication of Renal Transplantation

Abstract

Brucellosis is an intracellular bacterial infection contracted by consuming raw milk or by contact with infected cattle. Neurobrucellosis is a rather rare manifestation of brucellosis and has protean clinical presentations characterized by meningoencephalitis, myelitis, myelopathies, subarachnoid hemorrhage and psychiatric manifestations. A depressed immune status is believed to be a risk factor for developing neurobrucellosis. We report a case of neurobrucellosis in a patient 13 years after a cadaveric renal transplantation. Even though a Brucella organism was not isolated from body fluids she satisfied other criteria for establishing the diagnosis. Treatment with doxycycline and rifampin led to a clinical cure as well as to marked improvement in the Brucella titer.

Brucellosis in renal transplant recipients: a comparative review of 5 cases

“…Interleukin (IL)-2, IL-12, interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha are the major constituents 13 14. Long-term glucocorticoids administered in renal transplant patients have been speculated to increase the risk of brucellosis by immunosuppression and cytokine modulation, especially TNF-alpha and IFN-gamma 5. Additionally, renal function deterioration is a stand-alone factor decreasing the level of immunity on multiple levels that may also predispose such patients to brucellosis 15…”

Brucellosis in Immunocompromised Hosts

“…However, it is more frequent in renal transplant recipients than in recipients of liver transplantation. Brucellosis can develop as early as 2 months and as late as 17 years post SOT [105,117,118,[120][121][122][123]. The sources of Brucella infections in recipients of SOT include: (1) donor-derived infection, (2) blood transfusion-related infection, (30 reactivation of old infection due to the immunosuppressive therapy administered to prevent graft rejection, and (4) new infection in these patients who are vulnerable to various infectious complications due to their immunocompromised status [105,118,[122][123][124][125].…”

“…The following complications have been reported in SOT recipients: Brucella arthritis, neurobrucellosis, paraspinal abscess, Brucella endocarditis, Brucella bacteremia in addition to hematological and hepatobiliary complications [105,118,[120][121][122][123]. Brucellosis in recipients of SOT responds well to various combinations of the following antimicrobials: doxycycline, rifampicin, ciprofloxacin and TMP/SMZ.…”

“…Brucellosis in recipients of SOT responds well to various combinations of the following antimicrobials: doxycycline, rifampicin, ciprofloxacin and TMP/SMZ. However, complicated infections may require not only prolonged courses of antimicrobials for 6 to 12 weeks but also surgical intervention, particularly in the presence of BE or abscess formation [117,120,121,123]. Tigecycline is a potential therapeutic option in the treatment of brucellosis in SOT recipients [123].…”

Zoonoses in Solid-Organ and Hematopoietic Stem Cell Transplant Recipients

“…Brucella species infection has been reported after kidney transplantation [21,22] and as a donor-derived infection during HSCT [23], mostly in areas of endemicity. Live, attenuated Brucella animal vaccine has been linked to human disease and has the potential to cause disease in immunocompromised hosts [134].…”