Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study

Abstract

No detailed data exist in the literature on the accurate diagnosis of chronic brucellar meningitis or meningoencephalitis. A multicentre retrospective chart review was performed at 19 health centres to determine sensitivities of the diagnostic tests. This study included 177 patients. The mean values of CSF biochemical test results were as follows: CSF protein, 330.64 ± 493.28 mg/dL; CSF/ blood-glucose ratio, 0.35 ± 0.16; CSF sodium, 140.61 ± 8.14 mMt; CSF leucocyte count, 215.99 ± 306.87. The sensitivities of the tests were as follows: serum standard tube agglutination (STA), 94%; cerebrospinal fluid (CSF) STA, 78%; serum Rose Bengal test (RBT), 96%; CSF RBT, 71%; automated blood culture, 37%; automated CSF culture, 25%; conventional CSF culture, 9%. The clinician should use every possible means to diagnose chronic neurobrucellosis. The high seropositivitiy in brucellar blood tests must facilitate the use of blood serology. Although STA should be preferred over RBT in CSF in probable neurobrucellosis other than the acute form of the disease, RBT is not as weak as expected. Moreover, automated culture systems should be applied when CSF culture is needed.

Neurobrucellosis: A Case Report from Himachal Pradesh, India, and Review of the Literature

“…The sensitivities of the tests were 94% for serum SAT, 96% for serum RBT, 78% for CSF SAT, and 71% for CSF RBT. The data supported the view that blood serological tests were significantly more sensitive than CSF tests [13]. CSF culture, when positive, is considered the gold standard in the laboratory diagnosis of neurobrucellosis [14].…”

“…However, serological approaches are the mainstays in the diagnosis of neurobrucellosis due to the relatively lower efficacy of bacterial culture. Our patient fulfilled all the four criteria of neurobrucellosis as laid in the case definition by Erdem et al [13]. …”

“…Recently Guven et al [4] diagnosed neurobrucellosis by the presence of any one of the following criteria: (1) symptoms and signs suspect of neurobrucellosis, (2) isolation of Brucella species from cerebrospinal fluid (CSF) and/or presence of anti- Brucella antibodies in CSF, (3) the presence of lymphocytosis, increased protein, and decreased glucose levels in the CSF, or (4) findings in cranial MRI or computed tomography (CT). Erdem et al [13] defined chronic Brucella meningitis on the basis of following criteria:The manifestation of clinical neurological symptoms for over 4 weeksThe presence of typical CSF evidence with meningitis (protein concentrations >50 mg/dL, pleocytosis over 10/mm 3 , and CSF glucose to serum glucose ratios <0.5)Positive bacterial culture or serological test results for brucellosis in CSF (positive Rose Bengal Test or serum tube agglutination) or in blood (positive Rose Bengal Test and serum tube agglutination with a titer ≥1/160) or positive bone marrow cultureNonappearance of any alternative neurological diagnosisThese criteria were applied in the case definition of 177 patients with chronic brucellar meningitis or meningoencephalitis in a multicenter, retrospective Istanbul 2 study. Based on the results of the study, the sensitivities of the principal serological tests like serum SAT, RBT, and ELISA as well as CSF RBT and SAT were analyzed.…”

Cerebrospinal fluid cytology in nonmalignant aseptic meningeal disorders

“…16 Neurobrucellosis may develop at any stage of disease. 19 Lyme disease (borrelliosis) is a bacterial infection primarily transmitted by Ixodes ticks. 17 The diagnosis usually depends on the detection of specific antibodies in CSF.…”

“…18 Moreover, the presence of lymphocytosis, increased protein, and decreased glucose levels may be observed in CSF. 19 Lyme disease (borrelliosis) is a bacterial infection primarily transmitted by Ixodes ticks. The infectious agent is the bacterium Borrelia burgdorferi.…”