Mycobacterium tuberculosis and Cryptococcus neoformans co-infection meningitis in a young immuncompetent woman

Meningitis is a severe and potentially fatal form of tuberculosis. The diagnostic workup involves detection of acid-fast bacilli [AFB] in the cerebrospinal fluid [CSF] by microscopy or culture. However, the difficulty in detecting the organism poses a challenge in diagnosis. Cryptococcosis is an opportunistic fungal infection caused by cryptococcus neoformans. We presented central nervous system co-infection of tuberculosis and Cryptococcus neoformans which is extremely rare. The patient was a 35 year-old woman who was admitted in hospital due to fever, headache and changes of mental status. Physical examination revealed neck stiffness and positive Kernig's and Brudsinsky's signs. Cerebrospinal fluid analysis showed lymphocytic pleocytosis and culture of cerebrospinal fluid revealed mycobacterium tuberculosis and cryptococcus neoformans. Tuberculosis meningitis should be considered in patients with chronic meningitis especially in endemic areas. Cryptococcus neoformans meningitis may occur in immunocompromised and immuncompetent patients. Central nervous system co-infection with tuberculosis and Cryptococcus neoformans is possible

Neurobrucellosis; a case report

Brucellosis with different pictures is common in our country and should be noticed in high risk patients. A 23 years old male farmer, presented with headache, vomiting, and tremor. Disease had begun 6 months ago with right side orchitis, fever, chills, then, gradually illness, weakness, tremor, anorexia, vomiting, nonproductive cough, retrosternal pain and dysphagia, blurred vision, generalized muscular rigidity and disability in daily activities were added. In physical exam illness, weakness, fever, wet skin, tremor, generalized muscular rigidity, papillary edema were detected. He had positive Wright test [1/1250] and lymphocytic pleocytosis in CSF. Three drug regimen and steroid [1 month] were administered and he responded well to this initial therapy, however, during his 3[rd] month follow up, he developed severe bilateral hearing loss unresponsive to steroids and 6 months later he had a self-limiting 20 hours left sided hemiparesis. Neurobrucellosis may present with parkinsonism [tremor and generalized muscular rigidity] and meningovascular involvement. This may even progress under 3 antibiotic regimen treatment