儿童布氏杆菌脑膜炎1例并文献复习

Case Report of Brucellar Meningitis in Children and Literature Review

目的探讨布氏杆菌脑膜炎的临床特征及治疗措施。方法布氏杆菌脑膜炎患儿1例。患儿,男,10岁。因发热、咳嗽0.5个月,头痛3d入院。家中养羊,但否认与羊密切接触。回顾性分析该患儿临床资料。检索国内外文献,进行总结分析。结果患儿为亚急性病程,主要表现为发热、头痛和脑膜刺激征阳性,脑脊液的改变类似于结核性脑膜炎,WBC轻度升高,以淋巴细胞为主,蛋白增高,糖和氯化物降低。血清布氏杆菌抗体阳性,凝集效价为1160。经利福平、米诺环素和头孢曲松钠三联抗生素治疗,2周后脑脊液恢复正常。出院后继续口服米诺环素、利福平和复方磺胺甲唑8周,恢复良好。检索国内外文献发现,儿童布氏杆菌病神经系统并发症的发生率明显低于成人,以急性脑膜炎/脑膜脑炎为主。布氏杆菌脑膜炎为亚急性病程,脑脊液改变与结核性脑膜炎类似,临床易误诊为结核性脑膜炎。本病的治疗目前主张3种抗生素联合治疗,应选用易通过血脑脊液屏障的药物,总疗程不短于8周。结论对于儿童诊断不明的脑膜炎/脑膜脑炎,尤其表现与结核性脑膜炎类似者,应考虑布氏杆菌脑膜炎,需进行流行病学调查,并行血清凝集试验和脑脊液培养,以早期确诊。

Objective To explore the clinical characteristics and therapy of brucellar meningitis in children. Method One case of brucellar meningitis was reported and relevant literatures were reviewed. A 10 years old boy was admitted to hospital with a history of half a month fever and cough and 3 days headache. His family raised sheep, hut he denied contacting closely with sheep and eating raw goat＇s milk and mutton. Results The course of this reported child was subacute. Clinical manifestations included fever, headache and meningeal irritation sign positive. The eerebrospinal fluid （CSF） findings were similar to those of tuberculous meningitis, where WBC count was elevated with predominant lymphoeytes, glucose and chloride decreased and protein increased. The serum bacterium burgeri antibody was positive, agglutination titer was 1 ： 160. After brueellar meningitis was diagnosed, three antibiotics including rifampin, minoeyeline and eeftriaxone sodium and other ＇symptomatic treatuient were used. The CSF findings were normal 2 weeks later. This child taked orally minocyeline, rifampin and trimethoprim-sulfamethoxazole for 8 weeks post discharge,the recovery was good. The domestic and foreign documents showed that the incidence of the nervous system complications of brucellosis in children was lower than that in adult. The main clinical manifestations were acute meningitis/meningoeephalitis. Brucellar meningitis could be misdiagnosed as tuberculous meningitis, because the course of disease, clinical manifestations and CSF findings were similar. Therapeutic alliance including 3 kinds of antibiotics, which could easily pass through blood-brain barrier, was used to treat brucellar meningitis. The total course of treatment shouldn＇t be shorter than 8 weeks. Conclusions Brucellar meningitis should be screened through epidemiological investigation, serum agglutination test and eerehrospinal fluid culture, in case the reason of meningitis of meningoencephalitis is unknown, especially its clinical manifestation resembles to tuberculous meningitis.