Neurobrucellosis - A clinical masquerade in an Indian scenario; Review of 12 cases by correlative diagnostic approach

Abstract

Neurobrucellosis is a most serious complication of brucellosis which has neither a typical clinical picture nor specific cerebrospinal fluid (CSF) findings and mimics other neurological disorders leading to clinical diagnostic dilemmas. Accurate diagnosis is a great challenge for physicians, neurologists and researchers. A retrospective study was conducted to highlight the importance of the integrated diagnostics and clinical approaches to describe and categorize different clinical pictures of patients with neurobrucellosis in Indian scenario. We reviewed the medical records of twelve patients who were diagnosed as cases of neurobrucellosis from January 2010 to September 2013. Clinical details, associated risk factors, image findings were recorded. The serum and CSF Brucellosis work up by Rose Bengal Plate Test (RBPT) Indirect Enzyme Linked Immunosorbent Assay (iELISA), polymerase chain reaction (PCR), was performed and results analysed. Chronic meningitis (33.3%) was the most common form of presentation, followed by infective cerebro venous thrombosis (CVT) (25%), demyelination (16.6%), myelitis (16.6%) and myeloradiculopathy (8.33%). Epidemiological risk factor was present in 59% of the cases. All the twelve cases were positive for serum IgG antibrucella antibodies by ELISA. Two cases had brucella antibodies in the CSF as well. Brucella genus specific PCR was positive in four cases. Neurobrucellosis may be considered as one of the differential diagnoses in unusual cases of neurologic disorders and in cases of neurological dysfunction in absence of any other suitable alternative diagnosis. Multimodal differential diagnostic approaches are essential for accurate diagnosis, effective treatment and to prevent morbidity and mortality associated with neurobrucellosis.