trimethoprim--sulfamethoxazole-drug-combination and Guillain-Barre-Syndrome

Brucellosis is a zoonotic disease caused by Gram-negative bacteria. It has variable manifestations (gastrointestinal, hepatobiliary, skeletal). Neurobrucellosis may develop at any stage of the disease (acute, subacute, and chronic phases) and affects the central and peripheral nervous systems. Acute peripheral neuropathy mimicking Guillain-Barré syndrome caused by brucellosis is rarely reported: only four cases in children were found in the literature review.. We report a case of a 4-year-old Syrian boy who presented with fever, weakness of lower limbs, backache, and fatigue. The patient lived in a brucellosis endemic area. A physical examination including a neurological examination showed mild paresthesia and muscle weakness. He had a stiff neck with Kernig's sign with an absence of deep tendon reflexes in the lower extremities. Proprioception in the lower extremities was impaired, but he did not have any sensory problems. Abdominal cutaneous reflexes were absent. Brucellosis and Guillain-Barré syndrome were found in laboratory investigations and on electroneurogram (ENG). The patient was treated with sulfamethoxazole + trimethoprim, rifampicin, gentamicin, and dexamethasone, with an improvement.. This case demonstrates a rare case of brucellosis neurologic manifestation. Brucellosis should be kept in mind in all patients with acute paralysis, especially in those who live in endemic areas.

Topics: Brucellosis; Child; Child, Preschool; Guillain-Barre Syndrome; Humans; Male; Muscle Weakness; Paralysis; Trimethoprim, Sulfamethoxazole Drug Combination

Melioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare.. A 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew "coliforms" resistant to gentamicin and sensitive to ceftazidime. On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR]. After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit. Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse.. Guillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.

Topics: Abdominal Pain; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Drug Resistance, Bacterial; Female; Gentamicins; Guillain-Barre Syndrome; Humans; Injections, Intravenous; Liver Abscess; Melioidosis; Meropenem; Peripheral Nervous System Diseases; Polymerase Chain Reaction; Splenic Diseases; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a 14-year-old girl with Guillain-Barré syndrome associated with brucellosis due to Brucella melitensis. The diagnosis was established by the isolation of B. melitensis from her blood and by the determination of high levels of Brucella aglutinins in her sera and cerebrospinal fluid. A combination of rifampin, co-trimoxazole and physical therapy resulted in complete healing within 30 days. Antibrucellar treatment continued for 12 weeks. This case report suggests that brucellosis should be kept in mind in the aetiology of Guillain-Barré syndrome in the endemic areas for brucellosis, and bacteriological and serological tests for brucellosis should be performed.

Topics: Adolescent; Anti-Infective Agents; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Drug Combinations; Female; Guillain-Barre Syndrome; Humans; Physical Therapy Modalities; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination