Diagnosis and early

symptoms of
Neurobrucellosis in an
elderly male patient.
 Case Description:

The patient is a 70-year-old male daily wage worker hailing from CHIKMAGLAOUR. He was
admitted to the hospital on 13/12/19 with the complaints of fever and lower back pain both for
a month.
The fever is intermittent with increase in the evening and night. Chills, myalgia and malaise
are associated with it. Apart from that the patient has dry cough without any affect in change in
posture. On further questioning the patient revealed that he had soft stools, loss of appetite as
well as increased frequency of micturition. The patient reported a long history of
consumption of alcohol. His temperature was 101°F but rest of his vital signs were normal.
General examination displayed slight lymphadenopathy at the inguinal lymph nodes and
edema at the lower extremities.
 Chief Complaints:
• Fever [1 month]
• Lower back pain [ 1month]
History of Presenting Illness:
• Fever:
-Type: Intermittent
-High Grade
-Associated with Chills, Malaise
and Myalgia
• Soft Stools [ 2 times/day ]
• Lower Back Pain [1month]
• Loss of appetite [1month]
• Increased frequency of Micturition
[1month]
 NO SIGNIFICANT PAST
HISTORY
Personal History:
• Chronic alcoholic - stopped
1 month back

General Examination:
• Lymphadenopathy
• Edema.
NO SIGNIFICANT FINDING IN
SYSTEMIC EXAMINATION
 Lab Report Findings:
 MRI scan of the brain was normal
 CSF analysis was suggestive of pyogenic meningitis
 Fever workup and serology showed borderline positive titres for brucella
 Blood cultures were found to grow Brucella
 MRI scan of spine revealed that he had lumbar spondylodiscitis

Brucella growing in blood

culture

Spine spondylodiscitis

*IMAGES SHOWN ARE NOT FROM CASE FILE. SHOWN TO BETTER UNDERSTAND THE FINDINGS*
Diagnosis:
It is a classical case of Neurobrucellosis that caused Meningitis and L2-S1
spondylodiscitis.

Medication Prescribed
Drugs Strength Frequency No. of days

Tab DOXYCYCLINE 100mg 1-0-1 2 months

Tab RIFAMPICIN 600mg 1-0-0 2 months

Tab PAN 40mg 1-0-0 2 weeks and SOS

Nanofast Gel For local application SOS 1 tube

Discussion, Conclusion and Importance

Brucellosis is the commonest bacterial zoonosis and causes more than 500 000
human infections per year worldwide. It has a variable clinical manifestation due
to extensive involvement of organ systems during infection. Neurobrucellosis is a
complication of systemic brucellosis infection. Rural population is predominantly
agrarian society linked with animal husbandry and shepherding in the state.
Neurological complications include encephalitis, meningoencephalitis,
radiculitis, myelitis, peripheral and cranial neuropathies. Disease is usually not
considered as a cause of meningitis which leads to missed or delayed diagnosis.
This could be because of the lack of awareness, suspicion, and diagnostic
facilities at the health provider's end. Brucellosis is considered a deceptive
infectious disease in India. Human brucellosis is well reported in India; however,
there are only few reports on neurobrucellosis.
Acknowledgement
I would like to thank my guide Dr. Raviraj Acharaya and his staff for
providing me the details about the case as well as giving me this
chance to present it by taking time off their busy schedule.

Bibliography
https://www.hindawi.com/journals/criid/2016/2019535/#abstract
https://www.ncbi.nlm.nih.gov/pubmed/21412590
https://academic.oup.com/cid/article/56/10/1407/405896
https://n.neurology.org/content/84/14_Supplement/P4.173