J Neurol Surg A Cent Eur Neurosurg 2021; 82(02): 186-188
DOI: 10.1055/s-0040-1720981
Case Report

Atypical Presentation of Neurobrucellosis as Infection of Ventriculoperitoneal Shunt

Raul-Ciprian Covrig
1   Department of Neurosurgery, Johannes Wesling Hospital, University Hospital of the Ruhr-University Bochum, Minden, Germany
Jasmina Petridou
2   Institute for Microbiology, Hospital Hygiene and Transfusion Medicine, Johannes Wesling Hospital, University Hospital of the Ruhr-University Bochum, Minden, Germany
Ulrich J. Knappe
1   Department of Neurosurgery, Johannes Wesling Hospital, University Hospital of the Ruhr-University Bochum, Minden, Germany
› Author Affiliations


Brucellosis is a frequent zoonosis in some regions of the world and may cause various symptoms. Neurobrucellosis is a rare but serious complication of the infection. Our case report describes the course of neurobrucellosis in a patient who had received a ventriculoperitoneal shunt in his native country 13 years prior to diagnosis of brucellosis. He initially presented to us with symptoms of peritonitis, which misled us to perform abdominal surgery first. After the diagnosis of neurobrucellosis was confirmed and appropriate antibiotics were initiated, the symptoms soon disappeared. Although the ventriculoperitoneal shunt was subsequently removed, the patient did not develop a symptomatic hydrocephalus further on. This case displays the challenges in diagnosing an infection that occurred sporadically in Europe and may be missed by currently applied routine microbiological workup. Considering the political context, with increasing relocation from endemic areas to European countries, it is to be expected that the cases of brucellosis and neurobrucellosis will rise. Brucellosis should be considered and adequate investigations should be performed.

Publication History

Received: 29 May 2020

Accepted: 07 July 2020

Article published online:
05 December 2020

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  • References

  • 1 Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis 2006; 6 (02) 91-99
  • 2 Rossi M, Tascini C, Carannante N, Di Caprio G, Sofia S, Iacobello C. Neurobrucellosis: diagnostic and clinical management of an atypical case. New Microbiol 2018; 41 (02) 165-167
  • 3 Demiroğlu YZ, Turunç T, Karaca S. et al. Neurological involvement in brucellosis; clinical classification, treatment and results. Mikrobiyol Bul 2011; 45 (03) 401-410
  • 4 Al-Otaibi A, Almuneef M, Shaalan MA. Brucella melitensis infection of ventriculo-peritoneal shunt: a form of neurobrucellosis manifested as gastrointestinal symptoms. J Infect Public Health 2014; 7 (01) 62-65
  • 5 Sudhamshu KC, Kumar AR, Dias M, Shubha AM, Das K. Neurobrucellosis infection of ventriculoperitoneal shunt presenting as peritonitis. Indian J Pediatr 2016; 83 (09) 1024
  • 6 Robert Koch Institute. Epidemiological Bulletin of the Robert Koch Institute 01/2014. Berlin, BB: Robert Koch Institute; January 06, 2014. Available at: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2014/Ausgaben/01_14.pdf?__blob=publicationFile. Accessed November 1, 2020
  • 7 Corbel MJ. Food and Agriculture Organization of the United Nations, World Health Organization & World Organisation for Animal Health. Brucellosis in Humans and Animals. Geneva: World Health Organization; 2006. . Available at: https://apps.who.int/iris/handle/10665/43597. Accessed January 2, 2020
  • 8 Alexiou GA, Manolakos I, Prodromou N. Ventriculo-peritoneal shunt infection caused by Brucella melitensis. Pediatr Infect Dis J 2008; 27 (12) 1120
  • 9 Chowdhary UM, Twum-Danso K. Brucella meningoencephalitis associated with cerebrospinal fluid shunt in a child: case report. Surg Neurol 1991; 35 (06) 468-470
  • 10 Abdinia B, Barzegar M, Malaki M, Behbod H, Oskoui S. Association of Brucella meningoencephalitis with cerebrospinal fluid shunt in a child: a case report. Iran J Child Neurol 2013; 7 (01) 35-38
  • 11 Mermer S, Sipahi OR, Aydemir S. et al. Brucella melitensis shunt infection. Neurol India 2013; 61 (06) 670-671
  • 12 Anderson H, Mortensen A. Unrecognised neurobrucellosis giving rise to Brucella melitensis peritonitis via a ventriculoperitoneal shunt. Eur J Clin Microbiol Infect Dis 1992; 11 (10) 953-954
  • 13 Black JA, Challacombe DN, Ockenden BG. Nephrotic syndrome associated with bacteraemia after shunt operations for hydrocephalus. Lancet 1965; 2 (7419): 921-924
  • 14 Haffner D, Schindera F, Aschoff A, Matthias S, Waldherr R, Schärer K. The clinical spectrum of shunt nephritis. Nephrol Dial Transplant 1997; 12 (06) 1143-1148
  • 15 Solomon HM, Jackson D. Rapid diagnosis of Brucella melitensis in blood: some operational characteristics of the BACT/ALERT. J Clin Microbiol 1992; 30 (01) 222-224
  • 16 Zimmerman SJ, Gillikin S, Sofat N, Bartholomew WR, Amsterdam D. Case report and seeded blood culture study of Brucella bacteremia. J Clin Microbiol 1990; 28 (09) 2139-2141
  • 17 Yagupsky P, Peled N, Press J, Abramson O, Abu-Rashid M. Comparison of BACTEC 9240 Peds Plus medium and isolator 1.5 microbial tube for detection of Brucella melitensis from blood cultures. J Clin Microbiol 1997; 35 (06) 1382-1384
  • 18 Sümerkan B, Gökahmetoglu S, Esel D. Brucella detection in blood: comparison of the BacT/Alert standard aerobic bottle, BacT/Alert FAN aerobic bottle and BacT/Alert enhanced FAN aerobic bottle in simulated blood culture. Clin Microbiol Infect 2001; 7 (07) 369-372
  • 19 Searle M, Lee HA. Ventriculo-atrial shunt nephritis. Postgrad Med J 1982; 58 (683) 566-569
  • 20 Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med 2001; 345 (18) 1318-1330