Neurobrucellosis: Clinical and Diagnostic Features.
Clin Infect Dis. 2013 Feb 27;
Authors: Guven T, Ugurlu K, Ergonul O, Celikbas AK, Gök SE, Comoglu S, Baykam N, Dokuzoguz B
Background.?We described the neurological involvement in brucellosis and revisited diagnostic criteria for neurobrucellosis. Methods.?Consequently hospitalized laboratory confirmed brucellosis cases were observed prospectively in a brucellosis endemic region. The neurobrucellosis was diagnosed by any one of following criteria, (i) symptoms and signs consistent with neurobrucellosis, (ii) isolation of Brucella spp. from cerebrospinal fluid (CSF) and/or presence of anti-Brucella antibodies in CSF (iii) the presence of lymphocytosis, increased protein and decreased glucose levels in CSF, or (iv) diagnostic findings in cranial MRI or CT. Results.?Lumbar puncture was performed in 128 laboratory confirmed brucellosis cases, who had neurological symptoms and signs, and 48 (37.5%) were diagnosed as neurobrucellosis. The sensitivity of tube agglutination (TA) in CSF was 0.94, specificity 0.96, positive predictive value 0.94, and negative predictive value 0.96. Brucella bacteria were isolated from CSF in 7 patients out of 48 (15%). The mean age of 48 neurobrucellosis patients was 42 (sd 19), and 16 (33%) were female. The most common neurological findings were agitation (25%), behavioural disorders (25%), muscle weakness (23%), disorientation (21%), and neck rigidity (17%). Cranial nerves were involved in 9 patients out of 48 (19%). One patient was left with a sequela of peripheral facial paralysis and two patients with sensory neural hearing loss. Conclusions.?Patients with severe and persistent headache and other neurologic symptoms and signs should be considered for neurobrucellosis in endemic regions to consider longer therapy than 6 weeks. Brucella TA with Coombs test in CSF is sensitive and specific by using cut-off >1/8.
PMID: 23446629 [PubMed - as supplied by publisher]