From the Research
Diagnosis of Neurobrucellosis
The diagnosis of neurobrucellosis can be challenging due to the variable sensitivity and specificity of routine culture and serological methods 1. However, several studies have reported the use of advanced diagnostic techniques to diagnose neurobrucellosis.
- Next-generation sequencing (NGS) of cerebrospinal fluid (CSF) has been shown to be a powerful tool in detecting Brucella species, even in cases with variable medical history and clinical manifestations 2.
- A study reported the use of NGS to diagnose eight consecutive cases of neurobrucellosis, with Brucella species detected in CSF within 1-4 days 2.
- Another study established the diagnosis of neurobrucellosis using criteria such as signs and symptoms of neurological infection, isolation of Brucella spp. from blood and/or CSF, and detection of anti-Brucella antibodies in CSF 3.
- A case series and review of literature highlighted the importance of a multimodal diagnostic approach, including clinical features, laboratory findings, and treatment outcomes, to diagnose neurobrucellosis 3.
- The use of Rose Bengal Plate Test (RBPT), standard tube agglutination test (STAT), indirect Enzyme linked immunosorbent assay (iELISA), and polymerase chain reaction (PCR) to detect BCSP31 gene has also been reported in the diagnosis of neurobrucellosis 4.
Diagnostic Criteria
The diagnostic criteria for neurobrucellosis include:
- Signs and symptoms of neurological infection with examination of CSF revealing signs of meningitis 3
- Isolation of Brucella spp. from blood and/or CSF 3
- Antibody titer ≥1:160 in serum using standard agglutination test (SAT) 3
- Presence of anti-Brucella antibodies in CSF 3
- Detection of Brucella spp.-specific DNA from CSF using PCR 3
Importance of Early Diagnosis
Early and accurate diagnosis of neurobrucellosis is essential to prevent morbidity and mortality associated with the disease 3, 4. A high degree of suspicion is required, and neurobrucellosis should always be considered in the differential diagnosis of chronic meningitis and other neurological disorders 5.