Investigators at Ankara Numune Training and Research Hospital, a tertiary care community hospital in Turkey, performed a prospective observational study between February 2002 and March 2005 of patients >16 years of age with laboratory confirmed brucellosis. The diagnosis of brucellosis was based on clinical findings and a serum agglutinin titer of >1:160 in serum tube agglutination or a positive blood culture. Lumbar puncture was performed on patients with neurological symptoms or signs, including headache, neck stiffness, confusion, or changes in personality. Neurobrucellosis among laboratory-confirmed brucellosis patients was diagnosed by any one of the following criteria: 1) neurologic symptoms or signs; 2) brucella organism isolated from the CSF and/or anti-Brucella antibodies in CSF; 3) lymphocytosis, increased protein, and decreased glucose in CSF; or 4) MRI or CT abnormalities.

Of 128 patients with LP, 48 (37.5%) were diagnosed with neurobrucellosis, 45 had a CSF agglutination titer of >1.8, and 7 (15%) had Brucella bacteria isolated from CSF. Of 48 patients with neurobrucellosis, 16 (33%) were female, ages ranged from 13-77 years (median age 42 years), and 32 (65%) raised livestock. Consumption of cheese produced from unpasteurized milk was the source of infection in 41 (85%) patients. In addition to fever, myalgia, sweating, and weight loss, neurobrucellosis patients presented with headache, blurred vision, loss of hearing, and confusion. Neurological symptoms also included behavioral changes, agitation, muscle weakness, disorientation, neck rigidity, paresthesias, and rarely, diplopia, facial paralysis, and ataxia. Following treatment with ceftriaxone, rifampicin, and doxycycline for 6 months, one patient died of cardiac failure while the remainder showed no relapse after 3, 6, and 9 months follow-up. Three patients with cranial nerve involvement (facial paralysis in 1, and sensorineural hearing loss in 2) recovered with sequelae. [1]

COMMENT. Brucellosis in children is usually a mild self-limited disease compared with the more chronic disease in adults. Physical findings include lymphadenopathy, hepatosplenomegaly, and arthritis. Serious complications include meningitis, endocarditis, and osteomyelitis. Most cases occur in travelers returning from endemic areas such as the Mediterranean or Middle East. [2]

Manifestations of neurobrucellosis include encephalitis, meningoencephalitis, radiculitis, myelitis, and neuropathies. In the present study, the diagnosis is based on neurological symptoms and signs, and laboratory findings. In endemic regions, the diagnosis should be considered in a patient with severe and persistent headache.

More than 20 references to studies of neurobrucellosis in children are listed in a PubMed search for the last decade 2002-12, the majority from Turkey or Saudi Arabia. Children <12 years of age constituted 21% (115/545) of the total brucellosis admissions to a major Riyadh hospital in the period 1984-1995. Consumption of unpasteurized camel milk was the main source of infection. Arthritis was the dominant symptom in 70%. [3]