Serological diagnosis of neurobrucellosis.

Sánchez‐Sousa, A.; Torres, Cristina Huebner; Campello, Mauro; García, Carmen Isabel Gómez; Parras, F; Cercenado, Emilia; Baquero, Fernando

doi:10.1136/jcp.43.1.79

Cited by 47 publications

(43 citation statements)

References 7 publications

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“…Moreover, the neuroimaging of neurobrucellosis may appear normal or mimic many other infectious or inflammatory conditions (3). These factors may contribute to false-negative diagnoses (6,29). In the case described here, blood and CSF samples initially tested negative for anti-Brucella antibodies by using the Wright test which also excluded the presence of incomplete antibodies, causing false-negative reactions.…”

Section: Case Reportmentioning

confidence: 99%

Neurobrucellosis Associated with Syndrome of Inappropriate Antidiuretic Hormone with Resultant Diabetes Insipidus and Hypothyroidism

Sturniolo

Mondello

Bruno³

et al. 2010

J Clin Microbiol

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Neurological involvement of the central nervous system in brucellosis is uncommon. We describe a rare case of meningoencephalitis due to Brucella melitensis infection, associated with the syndrome of inappropriate antidiuretic hormone secretion and leading to diabetes insipidus and hypothyroidism. Neurobrucellosis, although rare, should be considered in cases of neurological disease of unknown etiology. CASE REPORTA 17-year-old male patient presented with headache, backache, fever, and marked asthenia. After 10 days, his headache worsened and vomiting occurred. He was admitted to the Department of Infectious Diseases of the Cutroni Zodda Hospital, Barcellona P.G., Sicily, Italy. Neurological examination upon admission revealed diffuse hyperreflexia, nuchal rigidity, and hyposthenia of both legs. Laboratory examinations revealed leukopenia with lymphocytosis and severe hyponatremia (118 mEq/liter) with reduced serum osmolality (241 mOsm/kg) and elevated urine osmolality (455 mOsm/kg). Renal, thyroid, and adrenal functions were normal. These data were consistent with the diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). The patient was treated with intravenous NaCl (3%) and water restriction. His plasma sodium concentration increased to 125 mmol/liter.Analysis of the cerebrospinal fluid (CSF) showed pleocytosis (175 white blood cells/mm 3 , predominantly polymorphonuclear leukocytes), low glucose levels (11 mg/dl), and high protein levels (1,020 mg/dl), indicating a disruption of the bloodbrain barrier. Both serum and CSF samples tested negative for Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae antigens. At admission, the standard Brucella tube agglutination test (Wright test) result was also negative (titer Ͻ 1:100). This result was further confirmed by the slide agglutination rose bengal test (4). While waiting for microbiological results, the patient was treated with ceftriaxone (4 g/day), ampicillin/sulbactam (12 g/day), and dexamethasone (16 mg/day).Suspected Brucella colonies were isolated from both blood and CSF 7-day cultures and identified following standard procedures (4). Biochemical and agglutination tests identified the pathogen isolated from both body fluids as Brucella melitensis biovar 3. A diagnosis of meningoencephalitis due to Brucella infection was made, and the therapy was promptly modified as follows: ampicillin-sulbactam was discontinued, and chloramphenicol (4 g/day), rifampin (900 mg/day), and trimethoprim (Trimetoprim)-sulfamethoxazole (1,600/320 mg/day) were started. The serum agglutination test for Brucella bacteria was repeated a week after admission: the patient had seroconverted (anti-Brucella antibody titer, 1:320).To characterize the isolate at the molecular level, rpoB sequencing and typing by the multiple-locus variable-number repeat analysis of 16 loci (MLVA-16) were performed as previously described (22). The former showed the presence of a nucleotide substitution (ATC to ATA) at codon position 1249 (M1249I), identifyi...

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Section: Case Reportmentioning

confidence: 99%

Neurobrucellosis Associated with Syndrome of Inappropriate Antidiuretic Hormone with Resultant Diabetes Insipidus and Hypothyroidism

Sturniolo

Mondello

Bruno³

et al. 2010

J Clin Microbiol

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“…We observed that brucella agglutination and Coombs' tests were the two most common positive tests in CSF in our patients (three patients). As different from the study of SanchezSousa, a positive reaction with Rose-Bengal test (one case) was less frequent than that obtained by the standard agglutination test (25). Case 1 had negative tests for brucella antibodies in CSF but the diagnosis was confirmed by isolation of Brucella species from CSF cultures.…”

Section: S Su Um MM Ma Ar Ry Ymentioning

confidence: 88%

“…The most frequently used method for screening brucellosis is still the standard agglutination test. In active brucellosis high titres of Ig M antibodies can be detected by standard agglutination and RoseBengal tests which is followed by an increase of Ig G and Ig A in chronic stage of the disease (2,25). The anti-Brucella Coombs' test is of great value in the diagnosis of chronic NB.…”

Section: S Su Um MM Ma Ar Ry Ymentioning

confidence: 99%

Neurobrucellosis as an Exceptional Cause of Transient Ischemic Attacks

Bingöl¹

2003

Journal of Ankara Medical School

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“…The plates were incubated for 18 to 24 h at 37°C. The Coombs test was performed by microtitration according to the method described by Otero et al (19), with some modifications (15,26,28), using anti-human immunoglobulin G (IgG) (Operon, Saragossa, Spain) diluted 1:1,000 in PBS. The BCAP test was carried out according to the manufacturer's instructions (Vircell SL, Santa Fé, Granada, Spain).…”

Section: Methodsmentioning

confidence: 99%

BrucellaCapt versus Classical Tests in the Serological Diagnosis and Management of Human Brucellosis

Casanova

Ariza

Rubio

et al. 2009

Clin Vaccine Immunol

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The BrucellaCapt test is an immunocapture agglutination test suggested as a possible substitute for the Coombs test in the diagnosis of human brucellosis. Here it is compared with classical tests using 321 samples from 48 patients with brucellosis (6.9 ؎ 1.7 samples per patient), including 20 patients with focal disease and 8 patients with a total of 9 relapse episodes (mean follow-up, 18 months). The BrucellaCapt test was used according to the manufacturer's instructions, and we also used a variant of the BrucellaCapt test in which the microtiter plates were not coated with antibodies against total human immunoglobulin ( Human brucellosis continues to be a major health problem worldwide. Although the endemicity of this disease is limited to some areas of the Mediterranean basin and developing countries in Asia, Africa, and Latin America, sporadic cases may develop in any area where the disease is not endemic. Thus, the illness is currently included among travelers' diseases (20).The definite diagnosis of the disease is based on the isolation of Brucella spp. in blood cultures (12, 32), but under certain clinical conditions the microorganism cannot be finally recovered. In the past decade, PCR has emerged as a promising alternative method to confirm the presence of the microorganism (16, 23), although its use has not been standardized. Thus, serological tests continue to play a relevant role in the diagnosis and management of patients with brucellosis (12, 31). Most classical tests used, along with the enzyme-linked immunosorbent assay method, offer good detection of anti-lipopolysaccharide agglutinating and/or nonagglutinating antibodies. However, problems in serological diagnosis continue, mainly in chronic forms of the disease and in the course of follow-up, when the meaning of persistent titers could be difficult to interpret, especially since no definite criteria of cure have yet been established (2,12,13,18,24,25).In recent years, the new immunocapture agglutination antiBrucella (BrucellaCapt [BCAP]) test has been reported to detect agglutinating and nonagglutinating antibodies with very high sensitivity (1,5,6,8,10,15,17,18,27,29). It has been suggested as a possible substitute for the anti-human immunoglobulin (Coombs) test and, perhaps, as a better marker of disease activity (1,17,27,29). The aim of the present study was to investigate the basis and mechanisms of the high sensitivity of the BCAP test and to conduct an accurate evaluation of its performance in comparison with those of classical tests for a large group of brucellosis patients with several forms of the disease over a prolonged follow-up period. MATERIALS AND METHODSPatients and serum samples. Serum samples from 48 patients diagnosed with brucellosis at Bellvitge Hospital, a tertiary teaching hospital in Barcelona, Spain, were included. These patients were part of a series of patients with brucellosis who were treated and prospectively followed up in our hospital over a period of years, as reported elsewhere (2, 3). For all patients with po...

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Serological diagnosis of neurobrucellosis.

Cited by 47 publications

References 7 publications

Neurobrucellosis Associated with Syndrome of Inappropriate Antidiuretic Hormone with Resultant Diabetes Insipidus and Hypothyroidism

Neurobrucellosis Associated with Syndrome of Inappropriate Antidiuretic Hormone with Resultant Diabetes Insipidus and Hypothyroidism

Neurobrucellosis as an Exceptional Cause of Transient Ischemic Attacks

BrucellaCapt versus Classical Tests in the Serological Diagnosis and Management of Human Brucellosis

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