Brucella vs. tuberculous central nervous system infection in a tertiary medical center in Lebanon: A case series

Neurobrucellosis (NB) and Neurotuberculosis (NT) are rare central nervous system infections, but pose significant diagnostic and therapeutic challenges. If not diagnosed and treated early, they can have high mortality. Clinical presentations for both are nonspecific, mimicking diverse pathologies. Therefore, it is crucial to identify distinguishing features to ensure timely treatment. We conducted a retrospective review of cases of NB and NT admitted to the American University of Beirut Medical Center (AUBMC) between January 1982 and December 2022, identifying 20 patients with NT, and five cases of NB. Their presentation and diagnostic work-up were compared. NT patients were mostly male and presented earlier than NB patients (median symptom duration 150 days). Patients with NT had higher rates of systemic and neurologic symptoms compared to NB. Both groups had hyponatremia. NB patients had higher cerebrospinal fluid lymphocyte counts. Imaging in NT revealed diverse brain abnormalities such as hydrocephalus and small nodules whereas mostly meningeal enhancement in NB. Despite severe presentations no 30-day mortality occurred in either group. Neurological complications were more frequent in NT. Finally, NT patients generally present earlier with more severe symptoms than NB. Due to overlapping features but differing treatments, larger scale studies are crucial to better understand and manage these infections.