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Brucellar meningitis
E Bouza1, M García de la Torre, F Parras
1Infectious Diseases Unit (Microbiology Service), Hospital Ramón y Cajal, Madrid, Spain.
Abstract:
Neurobrucellosis develops in less than 5% of cases of systemic brucellosis; however, most patients with neurobrucellosis have meningeal involvement. Seven new cases of brucellar meningitis and 17 cases from the Spanish- and English-language medical literature are analyzed in terms of epidemiologic data, clinical manifestations, laboratory results for cerebrospinal fluid and serum, treatment, and course of the disease. Brucellar meningitis mimics other neurologic and non-neurologic conditions, and its diagnosis is only suggested in the presence of adequate epidemiologic information. Isolation of Brucella from the cerebrospinal fluid is uncommon. Treatment is accomplished with the combination of tetracycline or doxycycline and streptomycin, rifampin, or both. Mean length of therapy in the seven new cases was 8.5 months. Brucellar meningitis has a better prognosis than other forms of chronic meningitis, and mortality is low for reasons that are not clear; however, the incidence of minor sequelae is high.
Insights
Brucellar meningitis, a rare complication of brucellosis, often mimics other conditions. Early diagnosis and combination antibiotic therapy are crucial for managing this neurological infection.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Brucellosis is a systemic infection with potential neurological complications.
- Neurobrucellosis, particularly brucellar meningitis, is uncommon, affecting less than 5% of systemic cases.
- Meningeal involvement is the most frequent presentation of neurobrucellosis.
Observation:
- This study analyzed seven new cases of brucellar meningitis and 17 from existing literature.
- Epidemiologic data, clinical symptoms, and laboratory findings (CSF and serum) were evaluated.
- Brucellar meningitis presents a diagnostic challenge due to its mimicry of other neurological and non-neurological conditions.
Findings:
- Isolation of Brucella from cerebrospinal fluid is rare.
- Effective treatment involves a combination of tetracycline or doxycycline with streptomycin or rifampin.
- The average treatment duration in the analyzed cases was 8.5 months.
Implications:
- Prompt diagnosis of brucellar meningitis relies heavily on adequate epidemiological information.
- Brucellar meningitis generally has a better prognosis than other chronic meningitis forms, despite a high incidence of minor sequelae.
- Further research is needed to understand the reasons for low mortality in brucellar meningitis.