Overall, these data support the use of standard-dose 400 mg/kg intravenous immunoglobulin therapy, despite the high cost, to raise trough IgG levels to 5-7 g/l, but underlines that some categories of infectious events (non-respiratory, upper respiratory) may need parallel surgical or pharmacological approaches to be optimally prevented or treated.
Correspondence 157 species (table I)'. Serum (rose bengal-positive, Wright 1:160, immunofluorescence 1:160) and CSF (rose bengal-positive, immunofluorescence 1:64) Brucella serology were positive and the patient was treated with daily rifampin, 900 mg, plus doxycycline, 200 mg, for 8 weeks with complete recovery. Brucellosis and tuberculosis are still endemic in our country. When the central nervous system is involved, the clinical picture and CSF analysis (elevation of protein, decreased glucose, and lymphocytic pleocytosis) may appear similar [6]. Fortunately, CSF and blood serology in neurobrucellosis are rarely negative, especially when a complete battery of tests is available, such as rose bengal and Wright agglutination, Coombs' test, and indirect immunofluorescence (as is the case in our hospital) or ELISA [7]. However, in the absence of these examinations, a correct diagnosis may be difficult [8]. Increased (>9 units/l) ADA in CSF has been reported to have a sensitivity of 1 and specificity of O.99 in the diagnosis of tuberculous meningitis [9]. However, patients with neurobrucellosis were not included in the control groups. False-positive results have been reported in cases of purulent meningitis [9, 10], but that condition could hardly be confused with tuberculous meningitis. However,neurobrucellosis can easily be mistaken for tuberculous meningitis. On the basis of our data, we think that physicians in countries where brucellosis and tuberculosis are endemic should take care when interpreting increased ADA in CSF, at least until neurobrucellosis can be definitively excluded.
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