Neurobrucellosis: the great mimicker

Soares, Cristiane; Angelim, Abraão Iuri Medeiros; Brandão, Carlos Otávio; Santos, Roberto Queiroz dos; Mehta, Ritvik P.; Silva, Marcus Tulius T.

doi:10.1590/0037-8682-0567-2021

Cited by 14 publications

(21 citation statements)

References 32 publications

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“…Previous case reports have shown that infectious meningitis, rheumatic immune diseases, and tumors can be misdiagnosed as TBM. For example, the clinical symptoms of fungal meningitis [ 43 ], neurobrucellosis [ 44 ], and leptomeningeal leukemia [ 45 ] can appear as recurrent bouts of fever along with headache. The cellular population in CSF in these diseases is typically composed of lymphocytes, with additional findings of decreased glucose and raised protein, which constitutes a pattern that is difficult to distinguish from TBM.…”

Section: Discussionmentioning

confidence: 99%

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Huang

et al. 2022

JCM

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Tuberculosis remains a serious world public health problem. Tuberculous meningitis (TBM) is the one of most severe forms of extrapulmonary tuberculosis. However, the insensitivity and time-consuming requirement of culturing the pathogen Mycobacterium tuberculosis, the traditional “gold standard” diagnostic test for TBM, often delays timely diagnosis and treatment, resulting in high disability and mortality rates. In our series case study, we present five pathogen-negative TBM cases who received empirical anti-tuberculosis therapy with a good clinical outcome. We describe in detail the clinical symptoms, laboratory test results, and imaging findings of the five patients from symptom onset to dynamic follow-up. We then summarize the similarities of the clinical characteristics of the presented patients, as well as shared features in laboratory and imaging tests, and proceed to analyze the challenges in the timely diagnosis of TBM. Finally, we argue that monitoring of cerebrospinal fluid markers and imaging are critical for the diagnosis and treatment of TBM, and emphasize the importance of differential diagnosis in cases when tuberculous meningitis is highly suspected despite negative findings for that etiology.

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Section: Discussionmentioning

confidence: 99%

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Huang

et al. 2022

JCM

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“…(b) Linear hyperintensity along the surface of the pons indicating leptomeningeal thickening (Axial FLAIR). Source: [36 ▪ ].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…It reveals total and specific immunoglobulin types (IgG, IgA, and IgM) and is particularly useful for chronic cases and in the diagnosis of neurobrucellosis [39,40]. In order to improve diagnostic accuracy, combination of serological tests (STA and Coombs or STA and ELISA) can be used [36 ▪ ].…”

Section: Diagnosismentioning

confidence: 99%

“…Imaging findings are diverse and frequently mimic other neurological conditions [18]. Tuberculosis, mycoses, sarcoidosis, and other granulomatous diseases have similar radiological patterns and are more prevalent in several regions of the world, making the diagnosis of neurobrucellosis challenging [36 ▪ ]. Among 263 patients with neurobrucellosis, imaging abnormalities were detected in 45% [23] and can be divided into four categories: inflammatory, vascular, white matter changes, and hydrocephalus/brain edema [18,23].…”

Section: Diagnosismentioning

confidence: 99%

“…There are no typical clinical picture or CSF profile in neurobrucellosis. Diagnosis is based on the presence of neurological symptoms not explained by any other disease; isolation of Brucella in culture or positive serological tests in blood or CSF; abnormal CSF parameters (cellularity, protein, and glucose) and clinical response after antibiotic treatment[36 …”

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confidence: 99%

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Neurobrucellosis

Soares

Silva

Lima

2023

Current Opinion in Infectious Diseases

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Purpose of reviewBrucellosis is one of the most common zoonosis worldwide, affecting 500 000 people, annually. Neurobrucellosis incidence is approximately 4%, and it is almost always heterogeneous. As there are no typical clinical features, its diagnosis is frequently misdiagnosing by other infections.Recent findingsNeurobrucellosis picture includes meningitis, meningoencephalitis, encephalitis, cranial neuropathies, intracranial hypertension, sinus thrombosis, hemorrhages radiculitis, peripheral neuropathy, myelitis, and psychiatric manifestations. The diagnosis should be based on symptoms and signs suggestive of neurobrucellosis, not explained by other neurological disease, cerebrospinal fluid analysis, a positive Brucella serology or culture, and a response to specific antibiotics, with a significant improvement of cerebrospinal fluid parameters.SummaryNeurobrucellosis can be insidious, and despite its global distribution, it is still unrecognized and frequently goes unreported. The understanding of the current epidemiology is necessary for eradication of the disease in humans, as well as the disease control in animals and prevention based on occupational hygiene and food hygiene.

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