Osman ÖZDEMİR, Ali İrfan BARAN, Vedat ÇİLİNGİR, Mehmet Deniz BULUT, Pınar Güzel ÖZDEMİR, Ekrem YILMAZ

Toksik nörobruselloza bağlı iki ergen hastada görülen psikotik atak

Birçok organı etkileyebilen ve çeşitli klinik tablolarla seyredebilen Bruselloz enfeksiyonu santral sinir sistemini direkt ya da indirekt yollarla etkileyebilir. Sitotoksik T hücre aracılı ve mikroglia aktivasyonu gibi bazı immünopatolojik mekanizmalar nörobrusellozda rol oynayabilir. Toksik nörobruselloz tanısı herhangi bir beyin omirilik sıvısı (BOS) bulgusu olmamasına rağmen kan kültüründe etkenin üretilmesi veya serolojik olarak pozitif bulunması ile doğrulanır. Nörobrusellozun manyetik rezonans görüntülemesinde inflamasyon, beyaz cevher değişiklikleri ve damar tutulumları gibi nörolojik hastalıkları, diğer enfeksiyöz ve enflamatuvar durumları taklit eden değişik bulgular görülebilir. Nörobrusellozda menenjit, meningoensefalit, myelit ve psikiyatrik bozukluklar şeklinde farklı klinik tablolar tanımlanmıştır. Vaka çalışmalarında nörobrusellozun psikotik tablolara yol açabileceği bildirilmiştir. Bu çalışmada toksik nörobruselloza bağlı iki ergen hastada görülen psikotik ataklar sunulmuştur.

Psychotic Attacks Due to Toxic Neurobrucellosis in Two Adolescent Patients

Brucellosis is a multisystem disease which can present with a broad spectrum of clinical manifestations and complications and affect the central nervous system directly or indirectly. Immunopathologic mechanisms like T-cell mediated cytotoxicity and microglia activation are suggested to play a role in neurobrucellosis. The diagnosis of toxic neurobrucellosis is confirmed by isolation of Brucella organism from blood cultures and/or positive Coombs Wright test and the Standard agglutination test (SAT) in serum when there are no cerebrospinal fluid (CSF) findings. The magnetic resonance imaging (MRI) of brain in patients with neurobrusellosis may show different findings mimicking such neurological diseases as inflammation, white matter changes and vascular involvements and other infectious and inflammatory conditions. Different clinical manifestations of neurobrucellosis have been described including meningitis, meningoencephalitis, myelitis, and psychiatric disorders. It has been indicated in case studies that neurobrucellosis may lead to psychotic disorders. In this study, we present two adolescents who presented with psychotic symptoms due to toxic neurobrucellosis.

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