Neurobrucellosis

Neurobrucellosis is a form of brucellosis in which Brucella species invade the nervous system, causing meningitis, meningoencephalitis, or other central and peripheral nervous system disorders. It is an uncommon complication of brucellosis, most often reported in regions where brucellosis is endemic and among individuals exposed to unpasteurized dairy products or infected animals.

Pathogenesis and presentation: Brucella reach the CNS via hematogenous spread and cross the blood-brain barrier, triggering inflammatory responses. Clinical features are heterogeneous and may include meningitic symptoms (fever, headache, neck stiffness), altered mental status, seizures, focal neurologic deficits (weakness, ataxia, cranial nerve palsies), radiculopathy, myelopathy, or psychiatric symptoms.

Diagnosis: Suspicion arises in patients with compatible neurologic symptoms and a history of brucellosis or exposure. Laboratory confirmation relies on cultures and serology. Brucella may be cultured from blood, CSF, or other specimens. Serologic tests such as Rose Bengal, standard agglutination (Wright) and Coombs tests are used for blood and CSF. CSF analysis typically shows lymphocytic pleocytosis, elevated protein, and sometimes low glucose. PCR on CSF can aid; MRI often shows meningeal enhancement or inflammatory lesions.

Treatment and prognosis: Management requires prolonged multi-drug therapy with good CNS penetration. Common regimens include doxycycline (100 mg twice daily) plus rifampin (600–900 mg daily) combined with either trimethoprim-sulfamethoxazole or ceftriaxone; an aminoglycoside is sometimes added in the initial period. Duration is usually six to twelve months to reduce relapse risk. With timely, appropriate therapy, prognosis improves, though delays can lead to persistent deficits or relapse.

Prevention: Public health measures include pasteurization of dairy products, animal vaccination, and protective practices for at-risk workers.