Neurobrucellosis: the great mimicker

A comparison of clinical features between neurobrucellosis and tuberculous meningitis

BACKGROUD

This study aims to compare the clinical manifestations, imaging findings, routine tests, biochemistry indicators and cerebrospinal fluid cytology between neurobrucellosis and tuberculous meningitis. The objective is to evaluate the similarities and differences of these two diseases and improve early diagnosis.

METHODS

A comprehensive evaluation was conducted by comparing clinical data, imaging results, routine tests findings, biochemistry indicators and cerebrospinal fluid cytology of patients admitted to the Department of Neurology, the Second Hospital of Hebei Medical University from 2019 to 2021. Statistical analysis was applied to identify significant differences and similarities between the two diseases.

RESULTS

Preliminary analysis demonstrated both diseases commonly present with symptoms such as fever, headache. However, there were no statistical differences between neurobrucellosis and tuberculous meningitis in early clinical data, imaging results, routine tests findings, biochemistry indicators. Further analysis indicates there is a statistically significantly difference in the lymphocyte ratio and neutrophil ratio in the cerebrospinal fluid between the two groups.

CONCLUSIONS

Neurobrucellosis and tuberculous meningitis share similarities in early clinical manifestations, imaging findings and initial cerebrospinal fluid parametes, making early-stage differentiation challenging. The ratio of lymphocytes and neutrophil in the cerebrospinal fluid and a detailed medical history investigation can provide clues for early clinical diagnosis. So the examination of CSF cytology might be a potential to distinguish these two diseases and become a powerful tool in the future.

Neurobrucellosis complicated by primary pyogenic ventriculitis: a case report

Neurobrucellosis is a serious focal brucella infection. Ventriculitis is a special form of central nervous infection where pyogenic infection of the ependymal linings hinders antibiotics' accessibility to the cerebrospinal fluids and leads to protracted infection. We present a case of a 37-year-old Shepherd who had low-grade fever for 5 months followed by a brief history of vomiting, abdominal pain, and gait imbalance. Investigations showed neutrophilic leukocytosis, high titers of serum anti-brucella antibodies, and lymphocytic pleocytosis. Mycobacterial tuberculosis workup was negative. Magnetic resonance imaging of the brain revealed cervical and spinal meningeal enhancement in addition to mild hydrocephalus. The patient was presumptively diagnosed with neurobrucellosis. He received treatment with ceftriaxone-based combination antibiotics therapy for 6 months with complete resolution of his symptoms. Central nervous infection by brucella is a challenging diagnosis. The possibility of primary ventriculitis due to Brucella infection mandates early recognition and prolonged antimicrobial therapy to achieve full recovery.

Pituitary Abscess Causing Panhypopituitarism in a Patient With Neurobrucellosis: Case Report

Background/Objective

Pituitary abscess is an uncommon life-threatening disease that could lead to panhypopituitarism. It is important to suspect its prevalence in regions with endemic infectious diseases.

Case Report

A 55-year-old man, a farmer, with a background of consumption of unpasteurized dairy products, presented with headache, impaired consciousness, and fever that started in February 2023. Initial test results were consistent with neuroinfection. Brain MRI showed ventriculitis; the pituitary gland was heterogeneous with the presence of an 8 × 8 mm abscess. The pituitary hormone axis was evaluated, and it showed results compatible with the results of panhypopituitarism with central hypothyroidism, central hypocortisolism, central hypogonadism, and growth hormone deficiency. Hormone replacement treatment with hydrocortisone and levothyroxine was started. The Rose Bengal test for Brucella spp. and 2-mercaptoethanol Brucella agglutination test showed positive results. After neurobrucellosis (NB) was diagnosed, antibiotic treatment was commenced. The patient was discharged 6 weeks later and treatment with prednisone, levothyroxine, recombinant somatropin, testosterone, as well as doxycycline, and rifampin was continued for another 4 months.

Discussion

NB and pituitary abscess are rare manifestations of brucellosis and are challenging to diagnose due to their nonspecific clinical presentation and cerebrospinal fluid (CSF) findings. NB diagnosis relies on neurologic symptoms and serological evidence of Brucella infection. Magnetic resonance imaging is the preferred diagnostic tool for pituitary abscesses. Medical management may be sufficient, while transsphenoidal drainage is not always necessary. Hormonal deficits typically remain permanent.

Conclusion

Pituitary abscess could be suspected in patients presenting with symptoms of neuroinfection, panhypopituitarism, and heterogenous image in the magnetic resonance imaging differential diagnosis. Opportune management can lead to reduced mortality and improved recovery of the pituitary hormone function.

VZV Encephalitis with Brucella coinfection-case report

Encephalitis occasionally occurs due to the central nervous system (CNS) infection by Varicella-zoster virus (VZV). The coincidence of herpes Encephalitis-brain infection and brucellosis occurs rarely. In this case, a 56-year-old woman was described with low consciousness, seizures, fever, and mood disorders. The brain CT revealed no pathological lesions, but MR showed non-specific plaques in the periventricular white matter. VZV was detected in molecular tests for the panel of viral Encephalitis in cerebrospinal fluid (CSF). The blood culture and the Wright test revealed the presence of Brucella spp. The antiviral treatment of choice was Acyclovir, Levetiracetam to control seizures, and Ampicillin/Sulbactam as prophylaxis antibiotics. Coinfections common poor prognoses makes it crucial to administer antiviral medications immediately. Many clinical challenges require a multidisciplinary team, including involvement of the CNS, resistance to viral strains, reactivation of diseases, and drug toxicity. The early detection of Encephalitis and treatment can promptly prevent exacerbation and complications.

Neurobrucellosis

PURPOSE OF REVIEW

Brucellosis is one of the most common zoonosis worldwide, affecting 500 000 people, annually. Neurobrucellosis incidence is approximately 4%, and it is almost always heterogeneous. As there are no typical clinical features, its diagnosis is frequently misdiagnosing by other infections.

RECENT FINDINGS

Neurobrucellosis picture includes meningitis, meningoencephalitis, encephalitis, cranial neuropathies, intracranial hypertension, sinus thrombosis, hemorrhages radiculitis, peripheral neuropathy, myelitis, and psychiatric manifestations. The diagnosis should be based on symptoms and signs suggestive of neurobrucellosis, not explained by other neurological disease, cerebrospinal fluid analysis, a positive Brucella serology or culture, and a response to specific antibiotics, with a significant improvement of cerebrospinal fluid parameters.

SUMMARY

Neurobrucellosis can be insidious, and despite its global distribution, it is still unrecognized and frequently goes unreported. The understanding of the current epidemiology is necessary for eradication of the disease in humans, as well as the disease control in animals and prevention based on occupational hygiene and food hygiene.

Case report: A case of abrupt stroke as the first symptom of neurobrucellosis

Acute cerebral infarction caused by small artery inflammatory disease, which is triggered by neurobrucellosis, is a rare condition that can be easily misdiagnosed. Neurobrucellosis is a rare complication of brucellosis that can present clinically as meningitis, meningoencephalitis, myelitis, neuritis, or psychosis. In this study, we report the case of a patient with neurobrucellosis who was hospitalized in the First People's Hospital of Lianyungang in September 2022; the primary symptom was weakness in the left limb for 14 h. The patient was discharged after receiving symptomatic and anti-Brucella medication.

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Tuberculosis remains a serious world public health problem. Tuberculous meningitis (TBM) is the one of most severe forms of extrapulmonary tuberculosis. However, the insensitivity and time-consuming requirement of culturing the pathogen Mycobacterium tuberculosis, the traditional "gold standard" diagnostic test for TBM, often delays timely diagnosis and treatment, resulting in high disability and mortality rates. In our series case study, we present five pathogen-negative TBM cases who received empirical anti-tuberculosis therapy with a good clinical outcome. We describe in detail the clinical symptoms, laboratory test results, and imaging findings of the five patients from symptom onset to dynamic follow-up. We then summarize the similarities of the clinical characteristics of the presented patients, as well as shared features in laboratory and imaging tests, and proceed to analyze the challenges in the timely diagnosis of TBM. Finally, we argue that monitoring of cerebrospinal fluid markers and imaging are critical for the diagnosis and treatment of TBM, and emphasize the importance of differential diagnosis in cases when tuberculous meningitis is highly suspected despite negative findings for that etiology.