Human neurobrucellosis with intracerebral granuloma caused by a marine mammal Brucella spp

Abstract

We present the first report of community-acquired human infections with marine mammal-associated Brucella spp. and describe the identification of these strains in two patients with neurobrucellosis and intracerebral granulomas. The identification of these isolates as marine mammal strains was based on omp2a sequence and amplification of the region flanking bp26.

Figure 1

Hematoxylin and eosin–stained sections from patient 1 (panels A, B) and patient 2 (panels C, D). Note the predominantly lymphohistocytic infiltrate forming large granulomas (A, original magnification 100x); well-formed giant cells (B, arrow, original magnification 200x); lymphohistiocytic infiltrates distorting brain parenchyma and forming vague granulomas (C, original magnification 40x); and the dense astrogliosis at the interface between granulomatous inflammation and surrounding brain parenchyma (D, asterisk, original magnification 100x).

Figure 2

Axial MRI (magnetic resonance imaging) from patient 2 obtained when first seen in Peru (April 21, 2001), before surgical biopsy in the United States (September 21, 2001), and 7 months after start of treatment (June 7, 2002). The top images are postgadolinium-enhanced, T1-weighted images, which demonstrate resolution of one of the irregular areas of enhancement over time. The bottom images are T2-weighted images (image from April 21 is from a fluid attenuated inversion recovery [FLAIR] sequence), which demonstrate the extensive brain edema associated with these lesions. The right bottom image shows resolution of the brain edema but persistent brain atrophy.

Figure 3

Amplification of bp26 from marine mammal and terrestrial strains of Brucella. The amplification products were electrophoresed on a 1% agarose gel and stained with ethidium bromide. Lane 1, strain 01A09163; lane 2, strain 85A05748; lane 3, B. abortus ATCC 23448; lane 4, no template control. DNA ladder is shown in Lane M.