Abstract

Introduction

Brucellosis is a disease of livestock animals such as cattle, swine, goats, sheep, dogs and humans are the accidental hosts. Human brucellosis is a known occupational hazard among adults working with livestock however, most cases in children are associated with consumption of unpasteurised milk products. It causes more than 5,00,000 human infections per year worldwide¹. In the state of Himachal Pradesh (India), the seroprevalence of brucellosis among occupationally exposed human beings was observed to be 6.66%¹. Symptoms can be acute or insidious and are usually nonspecific. Serious manifestations of brucellosis include endocarditis, meningitis, osteomyelitis and spondylitis. Invasion of nervous system occurs only in 1 to 4 % of patients. Neurological complications include encephalitis, myelitis, meningoencephalitis, peripheral and cranial neuropathies, subarachnoid haemorrhage, psychiatric manifestations, brain abscess, and demyelinating syndrome².

Case Report

We present a case of a 17 year female adolescent who presented with 10 days history of fever, headache, altered sensorium and one episode of seizure. Her bowel and bladder habits were normal. There was history of undocumented weight loss, loss of appetite and night sweats for the last 4 months. The patient belonged to a rural area of district Chamba, Himachal pradesh and her family was associated with livestock rearing. She used to consume raw milk of goat. On examination she was thin built, had neck stiffness and disc hyperaemia bilaterally on fundus. Kernig’s sign was positive. There were no other localising signs on systemic examination. Her CSF analysis was suggestive of pyogenic meningitis and CT scan brain was normal. She was treated with intravenous ceftriaxone for 14 days after which she improved however her papilledema did not settle. So she was advised for two weekly follow up regarding papilledema however she was lost to follow up.