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| Year : 1999 | Volume
: 47
| Issue : 2 | Page : 160 |
Neurobrucellosis presenting as acute meningoencephalitis.
Banerjee TK, Pal AK, Das S
How to cite this article:
Banerjee T K, Pal A K, Das S. Neurobrucellosis presenting as acute meningoencephalitis. Neurol India 1999;47:160 |
We report a case of neurobrucellosis presenting as acute meningoencephalitis. Neurobrucellosis has been reported from other parts of India[1] but to our knowledge this is the first case report from eastern India.
A 28 year old Hindu man from rural Bengal presented to us with the history of continuous high fever for 4 days associated with intermittent chills, headache and vomiting. There was no history of cough and cold, dysuria, abdominal pain, illicit drug or alcohol abuse. There was no recent contact with persons having febrile illness. However, there was history of frequent consumption of raw milk from cows. Examination revealed a drowsy and febrile (104o F) patient with toxic look and features of meningeal irritation. General and systemic examination was otherwise unremarkable. Full blood count revealed neutrophilic leucocytosis (total WBC count 14,500/cumm with 92% neutrophils). The blood biochemistry, routine urine, chest skiagram, ECG and CT were non-contributory. CSF analysis revealed lymphocytic pleocytosis (cell count 170/cumm with 70% lymphocytes), elevated proteins and normal glucose. Culture was sterile. Antibodies against herpes simplex type-1, Japanese B, dengue and chickengunya were absent in blood and CSF. Brucella agglutinin titres from blood and CSF were found to be 1/640 and 1/200 respectively.
The fever continued unabated and the patient's condition deteriorated. A repeat lumbar puncture performed 72 hours after the first one showed rising CSF brucella agglutinin titre of 1/400. He was started on streptomycin and tetracycline parenterally along with rifampicin orally. There was remission of fever within 72 hours and the patient's condition rapidly improved. The parenteral therapy was continued for 10 days and rifampicin and tetracycline orally for 2 months. The patient made a complete recovery.
Acute neurobrucellosis of the meningoencephalitic variety has been described in the literature.[2] The index case fulfills the diagnostic criteria of neurobrucellosis.[3] Of late, we encountered two more cases who died of acute meningoencephalitis. Although neither of them had brucella antibody estimated in CSF, they both showed highly positive brucella agglutinin titres in their blood samples. These events led us to believe that acute meningoencephalitis due to brucella infection does occur in eastern India. This illness is potentially life threatening and conventional antibiotics like penicillin, chloramphenicol, ceftriaxone or the antiviral agents like acyclovir are ineffective. Awareness of the existence of this disease is essential since appropriate diagnostic tests and therapeutic interventions, if carried out timely, may save lives.
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