"Neurological involvement complicates approximately 3–15% of cases of systemic brucellosis. Neurobrucellosis accounts for approximately 0.5% of all community-acquired central nervous system infections worldwide 12."
"Spinal cord and root involvement is reported in 5–17% of cases 12."
"T1: arachnoiditis"
"T2/FLAIR: arachnoiditis; diffuse, hyperintense lesions affecting the white matter, with an appearance of focal demyelination"
"T1/T2 C+ (Gd): brain abscess or granuloma with ring enhancement; leptomeningeal, basal meningeal, perivascular and/or spinal root enhancement"
"Complications "
"Neurobrucellosis refers to central nervous system involvement by brucellosis and occurs secondary to ingestion or contact with gram-negative, facultative intracellular coccobacilli of the Brucella species. Up to 10% of infections are complicated by neurological involvement 1."
"Brucella is found worldwide. High-risk areas include countries surrounding the Mediterranean Sea, Eastern Europe, Mexico, South and Central America, Africa, Asia, the Caribbean and the Middle East 2."
"Brucella may be isolated from blood cultures and/or cerebrospinous fluid (CSF). Additional CSF abnormalities include the presence of anti-Brucella antibodies, pleocytosis, high protein and low glucose levels 4."
"Transmission occurs secondary to direct contact with infected animals or the consumption of unpasteurised dairy products. In addition to the four main species causing brucellosis, B. ceti and B. pinnipediae have also been isolated in the context of neurobrucellosis 2."
"Japanese encephalitis"
"West Nile virus"
"Murray Valley encephalitis"
Expected headings
"Complications "
"Brucella is found worldwide. High-risk areas include countries surrounding the Mediterranean Sea, Eastern Europe, Mexico, South and Central America, Africa, Asia, the Caribbean and the Middle East 2."
"Brucella is found worldwide. High-risk areas include countries surrounding the Mediterranean Sea, Eastern Europe, Mexico, South and Central America, Africa, Asia, the Caribbean and the Middle East 2."
"Onset is insidious; undulant, low-grade fever, headache, fatigue and malaise may precede any neurological findings by a number of months. A study of 128 patients with brucellosis found that central nervous system involvement is more likely if the following signs and symptoms are present 3:"
"Paediatric neurobrucellosis is uncommon (0.8% of children with systemic brucellosis). The disease in children tends to follow a less chronic course, with fever, nausea/vomiting, fatigue and abdominal pain occurring more frequently, alongside a higher frequency of convulsions, sensorineural hearing loss and papilloedema 12."
"In just under half of brucellosis cases with neurological findings, imaging of the CNS is unremarkable 5,6. Abnormal neuroimaging may involve the meninges, cranial nerves, white and grey matter, vasculature, and spinal nerve roots 5,6."
"Diffuse white matter changes, meningeal enhancement, lacunae and haemorrhages within the basal ganglia, hydrocephalus and cerebral oedema may be demonstrated. Mycotic aneurisms can also be present 12."
"Diffuse white matter changes, meningeal enhancement, lacunae and haemorrhages within the basal ganglia, hydrocephalus and cerebral oedema may be demonstrated. Mycotic aneurisms can also be present 12."
"Treatment is based on combination antimicrobial therapy, typically with ceftriaxone, doxycycline and rifampicin until clinical improvement and CSF normalisation (typical for at least 3-6 months) 8,9,12."
"multiple sclerosis - note the possibility of blurred vision, weakness, ataxia, malaise, fatigue and persistent low-grade fever with evidence of demyelination on MRI as an easy misdiagnosis"
"Onset is insidious; undulant, low-grade fever, headache, fatigue and malaise may precede any neurological findings by a number of months. A study of 128 patients with brucellosis found that central nervous system involvement is more likely if the following signs and symptoms are present 3:"
"T2/FLAIR: arachnoiditis; diffuse, hyperintense lesions affecting the white matter, with an appearance of focal demyelination"
"T1/T2 C+ (Gd): brain abscess or granuloma with ring enhancement; leptomeningeal, basal meningeal, perivascular and/or spinal root enhancement"