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Seronegative brucella meningitis diagnosed by CSF PCR: report on seven cases

Elham Jafari1, Mansoureh Togha2, Zhale Salami1,3

  • 1Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

BMC Infectious Diseases
|October 14, 2024
PubMed
Abstract

Insights

Neurobrucellosis (NB) can mimic pseudotumor cerebri, presenting with headaches and signs of increased intracranial pressure. Molecular techniques like PCR are crucial for diagnosing NB, especially when traditional tests are negative.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Microbiology

Background:

  • Neurobrucellosis (NB) can manifest as meningitis, causing headaches and meningeal signs.
  • Pseudotumor presentation of NB is often associated with lymphocytic cerebrospinal fluid (CSF) pleocytosis.
  • Traditional NB diagnosis relies on Brucella isolation or antibody detection in blood/CSF.

Purpose of the Study:

  • To investigate the presentation of neurobrucellosis mimicking pseudotumor cerebri.
  • To highlight the utility of molecular diagnostic techniques in challenging NB cases.

Main Methods:

  • Case series of seven patients with neurobrucellosis.
  • Clinical evaluation including neurological examination and neuroimaging (MRI).
  • Cerebrospinal fluid (CSF) analysis and Brucella PCR testing.

Main Results:

  • Seven NB cases presented with headaches and meningeal involvement.
  • Five patients showed signs of intracranial hypertension (papilledema, sixth nerve palsy).
  • Brucella serology was negative; diagnosis was confirmed by Brucella PCR in all cases.

Conclusions:

  • NB should be considered in pseudotumor cerebri differentials in endemic regions.
  • Molecular techniques (PCR) are essential for diagnosing NB, particularly with negative serology.
  • Sterile CSF samples are critical for accurate molecular-based NB diagnosis.
Keywords:
Brucella PCRNeurobrucellosisPseudotumor CerebriSeronegative

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