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The impact of previous brucellosis treatment on the clinical course of neurobrucellosis: a multicentre retrospective study

Year: 2026

Type: article

Abstract: BACKGROUND: Neurobrucellosis is a rare but clinically significant complication, accounting for approximately 3-5% of all brucellosis cases. This study aimed to investigate the effect of previous brucellosis treatment on the clinical course, laboratory findings, and treatment response in patients with neurobrucellosis. METHODS: This multicentre retrospective study included patients diagnosed with neurobrucellosis between January 2014 and December 2024 in nineteen hospitals across Türkiye. Demographic data, clinical symptoms, cerebrospinal fluid findings, serological results, radiological features, treatment regimens, and outcomes were analysed. Patients were divided into two groups based on history of prior brucellosis treatment: previously treated vs. treatment-naive. RESULTS: A total of 64 patients (35 male, 29 female; mean age 39.8 ± 14.6 years) were included in the study. 24 (37.5%) had a prior history of brucellosis treatment, while 40 (62.5%) had not received treatment previously. The mean treatment duration was 4.94 ± 3.34 months.The mortality rate was 3.1% (n = 2). Cranial nerve involvement was observed in 17.19% of patients (n = 11). Neuropathy was detected in 7.81% (n = 5), and paralysis in 6.25% (n = 4). Patients with a prior history of brucellosis treatment exhibited markedly lower frequencies of fever (25% vs. 65%, p = 0.005) and neck stiffness (4% vs. 27%, p = 0.023), but significantly higher rates of visual disturbances (62.5% vs. 25%, p = 0.007). CSF protein levels were also significantly higher in previously treated patients (211 vs. 122 mg/dL, p = 0.024). CONCLUSIONS: To our knowledge, this is the first study to evaluate the impact of prior brucellosis treatment on the clinical presentation of neurobrucellosis. Prior brucellosis treatment history may be associated with fewer systemic inflammatory findings, such as fever and neck stiffness, and more frequent visual disturbance at presentation. These findings suggest a potentially modified clinical presentation in previously treated patients. However, given the retrospective design, inter-centre heterogeneity, and the multiple comparisons performed, these findings should be interpreted cautiously. Prospective studies are needed to confirm these observations. CLINICAL TRIAL REGISTRATION: Not applicable. This study is a retrospective multicentre observational study and does not involve any interventions requiring trial registration.

Source: BMC Infectious Diseases

DOI: 10.1186/s12879-026-13440-1