Diagnosis of neurobrucellosis in resource-limited real-world settings: A case-series of 8 patients

• Published in: Journal of the neurological sciences Vol. 379; pp. 293 - 295
• Main Authors: Despotopoulos, S, Akinosoglou, K, Tzimas, T, Akritidis, N, Gogos, C
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.08.2017
• Subjects: Neurobrucellosis; Neurology; Rose Bengal; Serum agglutination test; Wright; Neurobrucellosis; Wright; Serum agglutination test; Rose Bengal
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2017.06.024

Abstract Brucellosis is a common zoonotic infection in many parts of the world including the areas around the Mediterranean. Neurobrucellosis represents an uncommon site in < 5% of cases. Diagnosis is based on high clinical suspicion, as well as a combination of complex serologic testing and abnormal cranial imaging. Unfortunately, real-word settings often lack sophisticated diagnostic modalities, while stringent budget does not allow for repeated confirmatory testing with alternative methods. In response to the recent article by Erdem et al. reporting the presence of diffuse inflammation in MRI, in approximately 45% of patients with neurobrucellosis, we hereby report our experience with 8 patients presenting with neurobrucellosis in an endemic area, whose diagnosis and management was successfully driven by common agglutination tests and neglected Rose Bengal Test (RBT) in serum and CSF. The authors argue that even though these methods have raised concerns upon their sensitivity and specificity – currently being surpassed by more complex methodology including ELISA or PCR-, in resource-limited settings that burden of the disease in high, re-introduction and simple modification of cheap, non-complex methods like RBT could suffice. Complementary methods should be employed if and where available.