Brucella meningitis: presentation, diagnosis and treatment--a prospective study of ten cases

Diagnosis of brucella meningitis was made in 10 patients by serological tests on blood and cerebrospinal fluid using Rose Bengal, standard agglutination, indirect immunofluorescent and enzyme-linked immunosorbent assay (ELISA) tests and by blood and CSF culture. All patients had significantly elevated antibody titres. In three Br. melitensis was isolated both from blood and CSF and in a further three from blood only. Eight patients were 30 years old or less and seven were female. Seven patients had a history of contact with livestock and had consumed raw milk. Meningitis occurred in five, meningoencephalitis with hemiplegia in one, paraplegia and cranial nerve palsies in one and psychosis and/or nightmares in three. Transient Parkinsonism was seen in one patient and generalized rigidity and non-Parkinsonian tremors in another. Computerized tomography revealed ventricular dilation in one patient and punctate hyperdense, non-enhancing shadows in the lentiform nuclei in two others. Treatment with a combination of tetracycline, rifampicin and streptomycin was successful.