Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
May 2016
Next Case of the Month coming June 7 …
Neurobrucellosis
- Additional Clinical History: Had a pet cow; often drank unpasteurized milk
- Background:
- Neurobrucellosis is an endemic zoonotic infection caused by bacterial genus Brucella.
- It is transmitted to humans by infected animals (sheep, cattle, goats, pigs, and dogs) urine, milk, and other fluids.
- The endemic areas of brucellosis include the Mediterranean region, Latin America, western Asia, and parts of Africa, according to the CDC.
- 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.
- Place of residence or dietary, travel, or occupational history suggests a risk for the infection.
- Key Diagnostic Features:
- Sign and symptoms of neurobrucellosis
- Positive blood culture
- Isolation of Brucella species from cerebrospinal fluid and/or presence of anti-Brucella antibodies in CSF
- Presence of lymphocytosis, increased protein, and decreased glucose levels in the CSF
- Findings on MRI or CT: MRI, hyperintense periventricular and white matter lesions on T2WI and FLAIR
- Differential Diagnosis:
- : Demyelinating disorders
- Viral encephalomyelitis
- Granulomatous encephalomyelitis (ie,tuberculosis, fungal infection, and sarcoidosis)
- Conclusion:
- Neurobrucellosis is a treatable disease with a favorable outcome if diagnosed early.
- It is extremely difficult to diagnose or suspect neurobrucellosis on the basis of radiologic appearance of encephalomyelitis, which is a rare presentation.
- History of exposure should always be sought, as the disease may present with protean symptoms and radiologic manifestations.
- Treatment Options:
- Antimicrobial drugs like Rifampicin, doxycycline, ceftriaxone, or co-trimoxazole for a duration of 3–6 months or until normalization of CSF.
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