Evaluation of the clinical presentations in neurobrucellosis.
BACKGROUND
Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is one of the complications.


METHODS
In this study, we describe our experience in the diagnosis, treatment, and the final outcomes of 20 patients with neurobrucellosis out of 305 patients with brucellosis, within a five-year period between January 1999 and June 2004.


RESULTS
The rate of neurobrucellosis was 6.6%. Twelve males and eight females with a mean age of 37.4 years were investigated. Fever, headache, confusion, and gait disorders were the main complaints. The duration of their complaints varied between one week and six months. On physical examination, 13 patients had fever, six had neck stiffness and confusion, three had motor deficit on either their upper or lower extremities, and four of them had diplopia. The Rose-Bengal test and standard tube agglutination tests were positive in all of the patients. Brucella melitensis was isolated from the blood of six of the 20 (30%) patients. Cerebrospinal fluid (CSF) was analyzed in 18 patients. Pleocytosis with a mean value of 244x10(6)cells/L, and high protein levels were detected in all. A low glucose level in the CSF was detected in ten patients. Patients were treated medically and a complete resolution was achieved in all.


CONCLUSIONS
Patients with a Brucella infection occasionally manifest central nervous system involvement. Clinicians, especially serving in endemic areas or serving patients coming from endemic areas should consider the likelihood of neurobrucellosis in the patients with unexplained neurological and psychiatric symptoms, and should perform the necessary tests on blood and CSF.
Yetkin
Meltem Arzu
MA
Department of Infectious Diseases and Clinical Microbiology, Health Ministry Ankara Training and Research Hospital, Cebeci 06340, Ankara, Turkey. arzumyetkin@yahoo.com
Bulut
Cemal
C
Erdinc
Fatma Sebnem
FS
Oral
Behic
B
Tulek
Necla
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017347:Brucella melitensis / Q000302:isolation & purification; D002006:Brucellosis / Q000150:complications* / Q000453:epidemiology; D002097:C-Reactive Protein / Q000134:cerebrospinal fluid; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D003221:Confusion / Q000473:pathology; D004172:Diplopia / Q000473:pathology; D005260:Female; D006261:Headache / Q000473:pathology; D006786:Hospitals, Urban; D006801:Humans; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000473:pathology; D011446:Prospective Studies; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein