Epidemiological, clinical, and laboratory features of brucellar meningitis.

Background: One of the rare complications of brucellosis is mononuclear meningitis, which usually imitates systemic disease.

Methods: Documents of patients with confirmed brucellar meningitis hospitalized in Sina Hospital (Western Iran) between 1988-2005 were collected.

Results: The average age was 26.9. 64% were female and 36% were male. There were 25% confirmed cases in the spring, 21% in summer, 33% in autumn and 21% in winter.Patient complaints in order of frequency were: headache (95%), vomiting (77%), fatigue (39%), myalgia (15%), movement disorders (15%), arthralgia (13%), sleepiness (13%), and aphasia (3%). The main clinical findings were: nuchal rigidity (74%), splenomegaly (49%), fever (41%), Kernig's (41%), and Brudzinski's signs (39%). Leukopenia (WBC<4.5×109/L; 18%), leukocytosis (WBC>9.5×109/L; 20%), and anemia (hemoglobin level<13 g/dL in men and 12 g/dL in women) were detected in 16% of patients. The Wright agglutination test, with a titer of 1:80 to 1:1280 was present in the serum of all patients, CSF Wright test or Coombs test was positive in half of the patients. Blood, bone marrow and CSF cultures were positive in 6 out of 10 patients.

Discussion: The epidemiological aspects of brucellar meningitis are similar to systemic brucellosis and, in most studies; there is no significant difference between them. The sex distribution of patients was different from most studies. Seasonal distribution of the disease did not follow seasonal distribution of systemic brucellosis, however, clinical findings or laboratory changes were similar to Turkey and other studies in Iran. A definite response, without complications and next recurrence, in this study, was achieved with co-trimoxasole plus rifampin for 45 days of therapy.