Neurobrucellosis: Antimicrobial Treatment of Six Complicated Cases of Brucellosis


Brucellosis is a classical zoonosis; it is a common disease in the Middle East countries. Involvement of the Central Nervous System by Brucella microorganisms might be not uncommon and is parallel to the prevalence rate of the disease among population. The work reported here is for six cases with brucella meningoencephalitis diagnosed by isolation of Brucella microorganisms from their blood and spinal fluid together, with high anti-brucella antibodies in their blood and Cerebro Spinal Fluid (CSF). Cases of PUO admitted to Fever Hospital and Neurological unit in the Medical City Teaching Hospital were evaluated clinically and neurologically. Six cases (three males and three females) suspected of neurological involvement by the disease all had fever, sweating +/- joint pains, all had meningeal irritation signs, abnormal CSF findings and all had history of raw milk &/or cheese consumption. They all were treated by different courses of many antibiotics for different times with skeptical responses. The general complaint was varying between fever, vomiting, weight loss, severe depression, headache and sweating, one case had change of sensorium, and hearing loss, one had cranial nerve palsy and three had peripheral weakness. All the cases had pleocytic CSF changes and Br. melitensis types 2 and 3 and Br. abortus type 4 isolated from their blood and all but one had same Brucellae isolated from their CSF. All cases had high titers of anti-brucella antibodies raised both in the serum and CSF though the Rose Bengal and ELISA tests. The treatment given was different of two or three combinations of Rifampin, Tetracycline, Cefotaxim, and Streptomycin for eight weeks up to four months for those with lumber osteomyelitis and epidural abscess cases. The outcome of cases was satisfying; four cases were cured without sequale, one case with cerebral abscesses was died and one case developed hearing loss and peripheral nerve weakness. It can be concluded neurobrucellosis is a treatable disease with a favorable outcomeexcept when there is a myelopathy or deafness and careful awareness of the disease as it is not an uncommon complication of common and treatable disease in our community is required.