Serological and molecular evaluation of Crimean-Congo Haemorrhagic Fever in Iranian probable patients

Abstract

Background: Neurological manifestations of Brucellosis are rare. We came across nine children with predominant symptomatology of neurological involvement amongst 68 patients of active brucellosis seen in last three years. Methods: The study is related to patients of brucellosis whose principal presenting features were related to neurological symptom (headache, seizure, altered sensorium and encepalopathy) along with fever and other constitutional symptoms. It included nine patients amongst 68 patients of active brucellosis seen during January2009 toDecember2011at SardarPatelMedical collegehospital, Bikaner. The diagnosis of active brucellosis was confirmed by demonstration of the raised brucella agglutination titre of 1:320 or more in the serum and confirmation of neurobrucellosis was done by demonstration of the raised brucella agglutination titre of 1:640 or more in the cerebrospinal fluid. All children were treated with combination of cotrimoxazole, rifampicin and doxycyclin accordingly to age for six week duration. The treatment was extended for another fourweeks in two children because of persistence of raised brucella agglutination titre of 1:640 or more in the cerebrospinal fluid. Results: Fever with seizures was the most common presentation (100%). Other associated manifestations included irritability (88.9%), hepatosplenomegaly (88.9%), vomiting (88.9%) and impaired consciousness (33.3%). CSF lymphocytosis was observed in 77.8% cases. MRI showed encephalomyelitis in 22.2% children and normal changes in remaining. CSF Culture was negative in all cases to rule out the possibilities of associated comorbid illness. The response of treatment started with 10-15 days and all the children became symptom-free at the end of six weeks except two, in them treatment was extended for further four weeks. Follow up brucella agglutination titre in serumand cerebrospinal fluid at the end of six months and twelve months was normal in all children. There was no evidence of relapse in any patient at the end of one year follow up. Liver function tests remained within normal range and no drug toxicity was observed. Conclusion:Neurologicalmanifestations of brucellosis are rare. Treatment of cotrimoxazole, rifampicin and doxycyclin showed marked clinical and radiological improvement. All children were completely disease-free at the end of one year follow up.