Reply to Kesav et al

TO THE EDITOR—We read the letter of Kesav et al [1] with great interest, and we are pleased to see the reflections from our report on neurobrucellosis [2]. We would like to emphasize some important points regarding the diagnosis and treatment of neurobrucellosis. Cerebrospinal fluid (CSF) findings (abnormal tube agglutination of isolation of bacteria) are still one of the most important supportive tool for diagnosis, although they could be negative in some cases. Performing CSF analysis could be difficult in limited-resource settings, but still is a valuable tool in diagnosis. The sensitivity of tube agglutination in CSF was 0.94, specificity 0.96, positive predictive value 0.94, and negative predictive value 0.96 by using a cutoff of ≥1/8. Regarding the lack of positivity in some neurobrucellosis cases, we broadened the definition of neurobrucellosis, and we defined neurobrucellosis with presence of any 1 of these findings: (1) symptoms and signs consistent with neurobrucellosis; (2) isolation of Brucella spp from CSF and/or presence of anti-Brucella antibodies in CSF; (3) the presence of lymphocytosis, increased protein levels, and decreased glucose levels in CSF; or (4) diagnostic findings in cranial magnetic resonance imaging or computed tomography. This definition keeps its validity in also resource-poor settings, where performing some tests would not be possible. We agree with Kesav et al [1] that tuberculosis is one of the diseases to be considered in the differential diagnosis of neurobrucellosis. However, the clinical findings of neurobrucellosis are so diverse that a unique diagnostic clinical feature of neurobrucellosis is not