Differential Diagnosis
- Single most likely diagnosis
- Brucellosis meningitis: The patient has a history of acute brucellosis, and the current symptoms such as periodic fever, sweating, joint pain, and fatigue are consistent with chronic brucellosis. The development of meningitis symptoms like headache, vomiting, and rigidity of the occipital muscles, along with Kernig's symptom, suggests involvement of the central nervous system, which is a known complication of brucellosis.
- Other Likely diagnoses
- Meningococcal meningitis: The symptoms of headache, vomiting, fever, and stiff neck (rigidity of the occipital muscles and positive Kernig's symptom) could suggest meningococcal meningitis. However, the patient's history and the presence of other systemic symptoms like joint pain and fatigue make this less likely compared to brucellosis meningitis.
- Tick-borne encephalitis: Given the patient's rural residence and occupation with small cattle, exposure to ticks is possible. However, the lack of specific mention of a tick bite or a more typical presentation of tick-borne encephalitis (such as a biphasic illness) makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Meningococcal meningitis: Although considered in the "other likely diagnoses," it's crucial to emphasize that missing meningococcal meningitis could be fatal due to its rapid progression and severity. Prompt diagnosis and treatment are essential.
- Polio: While polio is rare in many parts of the world due to vaccination efforts, it's a critical diagnosis not to miss due to its potential for severe neurological sequelae. The patient's symptoms of weakness and the potential for meningitis could be consistent with polio, especially if the patient is not fully vaccinated.
- Rare diagnoses
- Measles meningoencephalitis: This is a rare complication of measles infection. Given the patient's age and the fact that measles meningoencephalitis typically occurs in individuals with compromised immune systems or in the context of a measles outbreak, this diagnosis seems less likely without additional context (such as a recent measles infection or exposure).