The common presentations include fever, meningitis, brisk deep-tendon reflexes, extensor plantars, sensory deficit usually below the twelfth thoracic vertebral level, weakness of lower limbs, ocular signs of papilledema, and retrobulbar neuritis.
Neurologic symptoms of brucellosis can include weakness, dizziness, unsteadiness of gait, and urinary retention. Symptoms associated with cranial nerve dysfunction may affect persons with chronic central nervous system (CNS) involvement.
Neurobrucellosis is a focal complication of brucellosis affecting both central and peripheral nervous system presenting varieties of signs and symptoms. The most reported manifestations are meningitis and meningoencephalitis. It is a rare presentation of brucellosis.
Clinical Presentation:
The symptoms of neurobrucellosis may include symptoms like headache, fever, or muscle or joint pain, along with neurologic symptoms such as confusion, meningoencephalitis, myelitis, peripheral and cranial neuropathies, and psychiatric manifestations.
Brucellosis can be diagnosed in a laboratory by finding bacteria in samples of blood, bone marrow or other bodily fluids. Serological tests can also be done to detect antibodies against the bacteria. Learn more about what can be done to help confirm diagnosis of this disease.
The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement.
In the first stage of the disease, bacteremia occurs and leads to the classic triad of undulant fevers, sweating (often with a characteristic foul, moldy smell sometimes likened to wet hay), and migratory arthralgia and myalgia (joint and muscle pain).
Brucella: a cause of peripheral neuropathy.
Neurobrucellosis occurs in 5%–10% of patients with brucellosis (4). The most frequent clinical manifestation is meningoencephalitis (5). Mass lesions in the brain are uncommon (4).
Inflammation of the inner lining of the heart chambers (endocarditis). This is one of the most serious complications of brucellosis. Untreated endocarditis can damage or destroy the heart valves and is the leading cause of brucellosis-related deaths.
Generally, the antibiotics doxycycline and rifampin are recommended in combination for a minimum of 6-8 weeks.
Chronic brucellosis is treated with triple-antibiotic therapy. The combination of rifampin, doxycycline, and streptomycin often is used.
Brucellosis can also cause long-lasting or chronic symptoms such as recurrent fevers, joint pain, testicular swelling, heart infections, nervous system impairment, depression, and fatigue. Death from brucellosis is rare.
Involvement of bone and joint is the most common complication of brucellosis, with a prevalence of approximately 2-77%. Brucella osteoarthropathy usually presents as spondylitis, sacroiliac arthritis, peripheral arthritis and osteomyelitis, while bursitis and tenosynovitis are rare.
Brucellosis is a multisystem disease with various clinical symptoms. Neurobrucellosis is a rare but serious manifestation of brucellosis. A 60-year-old man with a previous diagnosis of brucellar spondylitis presented with sudden onset of aphasia and numbness of the right upper extremity.
Culture is the gold standard method for Brucella detection, but the sensitivity of blood culture had a wide range, from 10% to 90% [7]. Real-time polymerase chain reaction (PCR) is the most commonly used molecular method currently.
The standard test for diagnosis of brucellosis is the isolation of the organism from blood or tissues (eg, through bone marrow biopsy or liver aspiration).
Hematological inflammatory markers of brucellosis include mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR).
Treatment options include doxycycline 100 mg twice a day for 45 days, plus streptomycin 1 g daily for 15 days. The main alternative therapy is doxycycline at 100 mg, twice a day for 45 days, plus rifampicin at 15mg/kg/day (600-900mg) for 45 days.
An abnormal (positive) result usually means you have come in contact with the bacteria that causes brucellosis. However, this positive result does not mean that you have an active infection. Your provider will have you repeat the test after a few weeks to see if the test result increases.
The test consists of mixing colored Brucella whole-cell antigen with fresh bulk/tank milk. In the presence of anti-Brucella antibodies, antigen-antibody complexes form and migrate to the cream layer, forming a purple ring on the surface. In the absence of antigen-antibody complexes, the cream remains colorless.
Most cases with uncomplicated brucellosis in adults can be readily treated with the combination of doxycycline and rifampicin (in a dose adjusted to body weight) for 45 days.