The Re-emergence of a Forgotten Disease: Neurobrucellosis

Abstract

Brucellosis may present with a broad spectrum of clinical manifestations. Neurobrucellosis (NB), an uncommon but a serious complication, may occur at any stage of the disease. We aimed to evaluate the clinical, diagnostic, therapeutic, and evolutionary features of NB. We conducted a retrospective study including all patients hospitalized for neurobrucellosis in the infectious diseases department between 1994 and 2018. The diagnosis was based on the association of neurological symptoms with bacteriological and/or serological confirmation of brucellosis in blood or Cerebrospinal Fluid (CSF). There were 16 patients (10 male) with NB. The median (range) age was 35 (24–48) years. The revealing symptoms were fever (n = 15), headache (n = 12), and vomiting (n = 9). CSF analysis showed lymphocytic pleocytosis (n = 9) and a high level of protein (n = 10). Brucella was isolated from the blood and CSF in two and five cases, respectively. All patients had a positive Brucella serological test. Eleven patients received rifampicin, doxycycline, and trimethoprim/sulfamethoxazole. The median (range) duration of treatment was 4.5 (3–5.3) months. The disease evolution was favorable in 13 cases. Sequelae were noted in one case. Two patients died. In cases of unusual neurological disorders, NB should be considered, especially in endemic areas. Prompt diagnosis and treatment are crucial in order to avoid serious complications and sequelae.

Keywords

• Brucella
• neurobrucellosis
• meningitis
• magnetic resonance imaging