Neuropsychiatric evaluation of patients with brucellosis

Abstract

Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. Neurobrucellosis is one of the complications. The objective of this study was to determine neuropsychiatric manifestations among patients with brucellosis. Twenty-seven consecutive patients with brucellosis (14 patients with manifest neurological manifestation and 13 patients without apparent neurological manifestation) were recruited from Assiut University hospital and compared with 50 healthy controls matched with respect to age, sex, and social economic and educational levels. They were subjected to systemic, meticulous neuropsychiatric evaluations, laboratory, radiological, neurophysiology, and psychometric assessment with Mini-Mental State Examination, Wechsler Memory Scale-Revised. and Hamilton Depression Rating. Overt or apparent neurological manifestation was recorded in 14 patients (51.85%) and 13 patients (48.15%) with brucellosis without apparent neuropsychiatric involvement. Central nervous system (CNS) involvement (vascular stroke, meningeoencephalitis, and dementia) was recorded in 9 patients (33.3%) and 6 patients (22.2%) had peripheral nervous sytem (PNS) involvement (polyneuropathy, radiculoapathy, and polyradiculoneuropathy). Depression was recorded in 7 (29.2%) patients; 3 patients (21.4%) of the neurobrucellosis group and 4 patients (30.8%) with brucellosis without neurological manifestations. Patients with brucellosis (neurobrucellosis and patients without neurological manifestations) reported highly significant impairment in some cognitive function measures (mental control, logical memory, visual reproduction) and higher scores on depressive symptoms compared with controls. Patients with a Brucella infection usually manifest central nervous system involvement. Clinicians, especially serving in endemic areas or serving patients coming from endemic areas, should consider the likelihood of neurobrucellosis in patients with unexplained neurological and psychiatric symptoms, and should perform the necessary tests, including cognitive function and depression tests.