title: Review of 17 cases of neurobrucellosis: clinical manifestations, diagnosis, and management.
abstract: BACKGROUND
  Neurobrucellosis (NB) is a rare, but important complication of brucellosis. The clinical features vary greatly and, in general, tend to be chronic. Many laboratory procedures are usually employed in the diagnosis of NB. Even though the culture method is the gold standard, growth rate is low and time consuming. Thus the rate of sequelae and mortality increase in case of a delay in treatment. Therefore it is necessary to perform serological tests in both serum and cerebrospinal fluid (CSF) in suspected patients. In this study we aim to evaluate clinical features, diagnosis, and treatment of patients with NB.
  
  
  METHODS
  We enrolled 17 patients diagnosed with NB. Clinical features, cultures, serological tests, additional laboratory findings, and CSF analyses were recorded for all patients.
  
  
  RESULTS
  There were 14 female and 3 male patients. Ten patients presented with neuropsychiatric symptoms and signs (aphasia, diplopia, hemiparesis, facial paralysis, tremor, ataxia, depression, personality disorder, and hallucinations). Serum standard agglutination test (SAT) was negative in 4 (23.5%) patients and serum Coombs' test was negative in 2 (11.7%). CSF SAT was negative in 4 (23.5%) patients and CSF Coombs was negative in 3 (17.6%) patients. B. melitensis grew in the blood of 6 (35.2%) patients and in the CSF of 3 (17.6%). Treatment protocol for 11 patients consisted of ceftriaxone, rifampicin, and doxycyline for a period of four weeks, followed by rifampicin and doxycyline for an additional four weeks. The remaining patients were given different treatment combinations. One patient died, mild sequelae was present in another patient and the remaining patients recovered without any sequelae.
  
  
  CONCLUSIONS
  NB should be considered in the differential diagnosis of neurological and psychiatric cases that are encountered in endemic areas for brucellosis. In order to prevent overlooking this diagnosis, Coombs' test should be performed in both CSF and serum.
authors: Department of Infectious Diseases and Clinical Microbiology, Harran University of Faculty Medicine, Sanliurfa, Turkey. hasankarsen@hotmail.com
authors: Hasan
authors: H
authors: Karsen
authors: Suda
authors: S
authors: Tekin Koruk
authors: Fazilet
authors: F
authors: Duygu
authors: Kubilay
authors: K
authors: Yapici
authors: Mahmut
authors: M
authors: Kati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002006:Brucellosis / Q000175:diagnosis* / Q000188:drug therapy*; D020806:Central Nervous System Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult