Neurological Involvement as a Manifestation of Brucellosis Infection:
a case report
Abstract
Introduction: Neurobrucellosis is a rare complication of brucellosis, accounting for 3–5% of cases and may present with a wide range of neurological manifestations. Diagnosis is often challenging due to nonspecific clinical findings and the low sensitivity of conventional microbiological methods.
Case report: We describe a 26-year-old male with type 1 diabetes mellitus and occupational exposure to cattle who presented with progressive, painless bilateral visual loss. During follow-up, he developed bilateral sensorineural hearing loss. Neuroimaging was normal, and serology was positive for Brucella abortus (IgG positive, IgM negative, agglutination 1:320). Cerebrospinal fluid analysis and genetic testing for alternative causes were negative. The patient received combination therapy with doxycycline,
rifampicin, and trimethoprim-sulfamethoxazole for six months, achieving complete recovery of visual and auditory function.
Discussion: The coexistence of optic and auditory neuropathy in a patient with metabolic and occupational risk factors represents an uncommon form of neurobrucellosis. Clinical–serological correlation and prolonged combined antibiotic therapy are essential for accurate diagnosis and management.
Conclusion: This case underscores the importance of considering neurobrucellosis in patients with atypical neurological manifestations and of initiating early, prolonged, and combined antimicrobial therapy to prevent relapse and neurological sequelae.
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References
Qureshi KA, Parvez A, Fahmy NA, Hady BHA, Kumar S, Ganguly A, et al. Brucellosis: epidemiology, pathogenesis, diagnosis and treatment – a comprehensive review. Ann Med. 2023;55(2). https://doi.org/10.1080/07853890.2023.2295398
Laine CG, Johnson VE, Scott H, Arenas-Gamboa ÁM. Global estimate of human brucellosis incidence. Emerg Infect Dis. 2023;29(9). https://doi.org/10.3201/eid2909.230052
Pereira CRC, Almeida JVFC, Oliveira IRC, Oliveira LF, Pereira LJ, Zangerônimo MG, et al. Occupational exposure to Brucella spp.: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2020;14(5):e0008164. https://doi.org/10.1371/journal.pntd.0008164
Pisani A. Estudio de 14 casos de brucelosis en trabajadores de un frigorífico como enfermedad profesional. Uruguay 2009–2010. Rev Med Urug. 2017;33(3):168-73. https://doi.org/10.29193/rmu.33.3.1
Moreno E, Barquero-Calvo E. The role of neutrophils in brucellosis. Microbiol Mol Biol Rev. 2020;84(4). https://doi.org/10.1128/mmbr.00048-20
Bouferraa Y, Bou Zerdan M, Hamouche R, Azar E, Afif C, Jabbour R. Neurobrucellosis: brief review. Neurologist. 2021;26(6):248-52. https://doi.org/10.1097/NRL.0000000000000348
Kacem I, Mrabet S, Gargouri-Berrechid A, Ben Djebara M. Neurobrucellose. EMC Neurol. 2018;1-10. https://doi.org/10.1016/S0246-0378(17)79772-2
Gül HC, Erdem H, Bek S. Overview of neurobrucellosis: a pooled analysis of 187 cases. Int J Infect Dis. 2009;13(6):e339-43. https://doi.org/10.1016/j.ijid.2009.02.015
Tajerian A, Sofian M, Zarinfar N, Ramezani A. Manifestations, complications, and treatment of neurobrucellosis: a systematic review and meta-analysis. 2022. https://doi.org/10.21203/rs.3.rs-1424537/v1
Yagupsky P, Morata P, Colmenero J. Laboratory diagnosis of human brucellosis. Clin Microbiol Rev. 2019;33(1). https://doi.org/10.1128/cmr.00073-19
Soares CN, Angelim AIM, Brandão CO, Santos RQ, Mehta R, Silva MTT. Neurobrucellosis: the great mimicker. Rev Soc Bras Med Trop. 2022;55:e05672021. https://doi.org/10.1590/0037-8682-0567-2021
Ceran N, Turkoglu R, Erdem I, Inan A, Engin D, Tireli H, et al. Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Braz J Infect Dis. 2011;15(1):52-9. https://doi.org/10.1016/s1413-8670(11)70140-4
Rodríguez AM, Delpino MV, Miraglia MC, Giambartolomei GH. Immune mediators of pathology in neurobrucellosis: from blood to central nervous system. Neuroscience. 264-273. https://doi.org/10.1016/j.neuroscience.2019.05.018
Zhang X, Yao X, Chen H, Han D, Yang M. Meta-genomic next-generation sequencing in the diagnosis of brucellosis: five cases from a non-endemic area. Future Microbiol. 2024;19(13):1111-7. https://doi.org/10.1080/17460913.2024.2363632
Liu H, Li Q, Ouyang X, Li Q, Yu M, Dai L. Diagnosis of early neurobrucellosis using metagenomic next-generation sequencing of cerebrospinal fluid in a non-epidemic zone: case report and literature review. Medicine (Baltimore). 2025;104(7):e41481. https://doi.org/10.1097/md.0000000000041481
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