Neurobrocellosis

Although uncommon, neurobrucellosis can affect any part of the central or peripheral nervous system clinical syndromes are ultimately diverse, and clinical picture may be confused by the coexistence of two or more clinical syndromes in the same patient. The most common neurologic manifestation is a subacute or chronic meningoencephalitis. Acute toxic manifestations (e.g., headache, neckache, backache, insomnia, depression and muscle weakness) are seen during the acute phase of infection. Incidence of eurobrucellosis cannot be exactly estimated. Most impportant clinical syndromes include:brucella meningitisand encephalitis, vascular syndromes, myelopathy and spinal disease and psychiatric disturbances. All of these syndromes usually occur without any underlying disease. Diagnosis is made by reviewing patient history, physical examination, CSF and serum serological and other laboratory studies. Detection of brucella antibodies in the CSF always indicates local infection, however, febrile agglutination tests are not reliable. Gram stains are usually negative and cultures are positive in only 25% of cases. Since the organism is located intracellularly, treatment is difficult. Doxycycline in addition to rifampin and streptomycin is the best-studied regimen which should be continued untill CSF is clear. In the yaer following treatment, serum agglutinins fall to normal. The efficacy of corticosteroids is not proved. Neurobrucella has a better prognosis than other forms of chronic meningitis and less mortality; however, incidence of minor sequella (not limiting the normal life) is high.