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This seemed to be the case in our study. On the other hand, CSF PCR was not applied to any of our cases, and we could not present data for PCR. However, in one study real-time PCR assay was positive in all of six neurobrucellosis cases [14]. According to these preliminary data, molecular diagnostic methods seem to be promising in the diagnosis and follow-up of neurobrucellosis [34]. The microbiological TRIB1 evidence of neurobrucellosis has been known to be accompanied by lymphocytic pleocytosis, elevated protein levels and hypoglycorrhachia [11, 15, 35]. Normal CSF values have been accepted to be 0.6 and leucocyte counts Ibrutinib datasheet abnormalities of the cerebrospinal fluid were reported to include a pleocytosis of 10�C200 leucocytes [15]. In our study, CSF leucocyte counts (215.99?��?306.87) and CSF protein levels (330.64 �� 493.28?mg/dL) ranged over a wide spectrum and were apparently higher than expected. Moreover, although the increased CSF protein levels slightly reduced CSF-to-serum glucose ratios, leucocyte counts had a moderate effect on this issue. The pathogenesis of CSF hypoglycorrhachia is multifactorial and may include an increased glycolysis by leucocytes and bacteria and increased metabolic rate of the brain and spinal cord [36]. These data appear to indicate the effect of an inflammatory response on CSF glucose consumption. A similar correlation existed between CSF protein levels and leucocyte counts, which both increased concordantly. On the other hand, CSF leucocyte counts and CSF/blood-glucose ratios, as the indicators of inflammation and cellular metabolism, did not affect CSF-STA titres. This is probably due to the chronic nature of our neurobrucellosis patients, where STA titres were already established. However, CSF protein levels altered CSF-STA titres because Brucella immunoglobulins are one of the direct contributors to CSF protein, although the effect was moderate, indicating the presence of other sources. It is reported that advanced age did not affect CSF leucocytes, CSF/blood-glucose ratios MK-2206 chemical structure and CSF protein levels during the course of acute purulent meningitis in the elderly population [7]. In this chronic form of CNS disease, the results were similar, and serum or CSF-STA titres, protein levels and CSF/blood-glucose ratios were unaffected by ageing. However, there was a slight decrease in leucocyte counts with advancing age in our study. Chronic brucellar meningitis and meningoencephalitis frequently have a subtle nature and cannot be diagnosed easily due to the relatively silent course of the disease [6]. Thus, the clinician should use every diagnostic modality available in the diagnosis of the disease.