Neurobrucellosis: Challenges for Therapy

Background: Brucellosis is a common zoonotic infection throughout the world, and is endemic in Saudi Arabia. Neurobrucellosis is a rare, severe form of systemic brucella infection. Treatment of neurobrucellosis continues to be variable, depending on the location of diagnosis. Methods: A retrospective patient chart review was undertaken from 1995 to 2010 at King Abdulaziz Medical City, Riyadh, to identify cases of neurobrucellosis following a proposed case definition. Follow-up visits were evaluated to determine response to treatment. Results: A total of 22 cases of neurobrucellosis were identified from a total of 517 cases of brucellosis. The mean patient age was 42.5 years with a male to female ratio of 1:1. Most antibiotic combinations included doxycycline, rifampin, and cotrimoxazole (36%). Three patients received ciprofloxacin in combination with other antibiotics and showed a satisfactory response. Conclusion: Combination of antibrucella antibiotics is recommended, but there are no clear guidelines regarding antibiotic selection and duration of therapy. The use of ciprofloxacin in cases of neurobrucellosis should be evaluated.