Brucella meningitis and papilledema in a child.
OBJECTIVE
To report a rare case of Brucella meningitis with papilledema in a child and to discuss the findings of neurobrucellosis in children.


METHODS
A 6-year-old girl was admitted with headache, fever, and vomiting for 1 week. Her family reported intake of raw unpasteurized goat's milk in the past. Meningeal signs were strongly positive. Bilateral moderate optic disc edema with flame-shaped hemorrhages was observed.


RESULTS
The diagnosis of Brucella infection was established by positive blood culture for Brucella species, serum agglutination titer of antibodies to Brucella >1:160, and positive CSF culture. After treatment consisting of trimethoprim-sulfamethoxazole, rifampin, and doxycycline, the patient's condition gradually improved. One month later, the papilledema disappeared. One year after presentation, the patient remains free of symptoms.


CONCLUSIONS
Brucella meningitis must be ruled out in symptomatic patients reporting ingestion of raw unpasteurized goat's milk. Papilledema is a frequent clinical feature, but irreversible visual impairment is extremely rare.
Levy
J
J
Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. ljaime@bgu.ac.il
Shneck
M
M
Marcus
M
M
Lifshitz
T
T
D000372:Agglutination Tests; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D002002:Brucella / Q000302:isolation & purification*; D002006:Brucellosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D002648:Child; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D010211:Papilledema / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012293:Rifampin / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline; D012293:Rifampin