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: NO SIGNIFICANT PAST HISTORY
• Fever [1 month]
• Lower back pain [ 1month] Personal History:
• Chronic alcoholic - stopped 1 month
History of Presenting Illness: back
• Fever:
-Type: Intermittent General Examination:
-High Grade • Lymphadenopathy
-Associated with Chills, Malaise and • Edema.
Myalgia

• Soft Stools [ 2 times/day ]

• Lower Back Pain [1month]
• Loss of appetite [1month] NO SIGNIFICANT FINDING IN
• Increased frequency of Micturition SYSTEMIC EXAMINATION
[1month]
 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.