Unveiling Neurobrucellosis: A Case Report Emphasizing Early Diagnosis for Better Outcomes

  1. Sivakumar Haripriya
  2. Shikhir Malhotra
  3. Ravisekhar Gadepalli
  4. Vibhor Tak
  5. Bharat Kumar

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Abstract

Introduction. Brucellosis is a pervasive zoonotic disease causing considerable human morbidity worldwide. This report focuses on a case of neurobrucellosis in a rural Indian patient, emphasizing the need for timely microbiological confirmation given its nonspecific clinical presentation.

Case Presentation. A 55-year-old rural Indian farmer presented with a 3 week history of insidious, low-grade fever, myalgia, and arthralgia. He developed acute right-sided weakness and neurological symptoms, including disorientation and neck rigidity. Laboratory tests indicated abnormal blood counts, elevated inflammatory markers, and liver dysfunction. Cerebrospinal fluid analysis showed pleocytosis with lymphomononuclear cells and elevated protein levels. Blood cultures eventually grew Gram-negative coccobacilli. Serological tests confirmed neurobrucellosis. Prompt antibiotic therapy led to clinical and laboratory improvement.

Conclusion. This case underscores the importance of recognizing neurobrucellosis, particularly in endemic areas, given its nonspecific clinical presentation. Early microbiological diagnosis, supported by positive blood cultures and serological tests, was crucial. The patient’s rapid response to appropriate antibiotics emphasizes the significance of timely recognition and management.

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  1. Version published to 10.1099/acmi.0.000705.v3 on Access Microbiology
  3. Access Microbiology

    Comments to Author

    The authors have modified a key figure and have included a line on availing conent from the patient in cocern. Though the reviewer feels an extended explanation on the ehical ground was warranted, the manuscript is recommended for pulblication.

    Please rate the quality of the presentation and structure of the manuscript

    Satisfactory

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  4. Version published to 10.1099/acmi.0.000705.v2 on Access Microbiology
  6. Access Microbiology

    Comments to Author

    In their case report entitles 'Unveiling Neurobrucellosis: A Case Report Emphasizing Early Diagnosis for Better Outcomes' Haripriya et al., a case of Neurobrucellosis in a rural Indian patient. The report is concise yet comprehensive and described all major aspects of neurobrucellosis of the patient alongside outlining the pathophysiology of the ailment. The reviewer recommends the report for publication, however one or two issue needs to get addressed. 1. The positive control does not show the typical urease positive colour. Klebsiella is urease positive but the test does not reflect so. 2. Consent was obtained from the patient, but it is not clear whether IEC (institutional ethical committee) approval was obtained or not. Ethical approval segment mustbe included/ elaborated. 3. Minor spelling and formatting (italics for 'Brucella') rectification is warranted.

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    No: I am not sure about the kind of ethical approval (IEC etc.) required for such studies and whether consent from the patient is adequet.

  7. Access Microbiology

    Comments to Author

    Comment: Kindly clarify on the nature of contact history of tuberculosis, is it tuberculosis in animal or humans? 80 milk, handling and residing in close proximity to the livestock, but no history of tuberculosis 81 contact.

    Please rate the quality of the presentation and structure of the manuscript

    Very good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  8. Access Microbiology

    Comments to Author

    Dear author: I am writing to you about your paper with title (Unveiling Neurobrucellosis: A Case Report Emphasizing Early Diagnosis for Better Outcomes). I have some notes that need your revision. . 1- Line 78 (The patient received unknown antibiotics for the same by a local practitioner). Please rephrase this sentence explaining what do you mean. . 2- Line 128,129 (The colonies were processed by VITEK® MS (BioMérieux, Inc.) and VITEK 2.0 Compact system. Why did you use both systems for identification, one of them is not enough? . 3- Please add the safety measures the personnel of your laboratory took after identification of Brucella species (the type of biosafety cabinet, personnel protective equipment ) during the manipulation of the organism. . 4- Line 158 (In India, Brucellosis is regarded as a deceiving infectious disease. In India, the incidence …) you repeat in India in 
line twice. . 5- Line 178, 179 (In our country, TB is the most common differential diagnosis for brucellosis. In India, both chronic…) another repetition. . 6- Line 192 (automated reading within 2 to 6 days and just one culture spotted by blind subculture at the end 
of the first week. For days 1 to 7, the automated detection rates …). What do you mean by automated reading and detection? If you mean getting results by using one of automated blood culture systems, please explain and mention the instrument name. . Thank you

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  9. Access Microbiology

    Comments to Author

    1. The case study was well described 2. Results presentation was logical 3. The paper's organisation was appropriate. In the discussion part, I expect more work to be done on effectively distinguishing between the diagnosis of neurobrucellosis and tuberculosis since their symptoms overlap. Can you provide some definitive papers that have used the pillars of diagnosis you mentioned and briefly describe the outcomes? 4.The paper is generally good. I advise that grammar appropriateness is checked.

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  10. Version published to 10.1099/acmi.0.000705.v1 on Access Microbiology