神经布氏杆菌病三例并文献复习

Neurobrucellosis:three case reports and literature review

研究背景神经布氏杆菌病临床罕见,本文报告3例神经布氏杆菌病患者临床资料,分析其发病特点,以为临床提供参考。方法回顾分析3例临床诊断明确的神经布氏杆菌病患者的临床表现、实验室和辅助检查结果及诊断与治疗经过,并结合文献讨论其发病特点。结果 3例患者均有明确疫区、传染病接触史或生食牛奶感染布氏杆菌病病史,并在不明原因发热筛查过程中获得布氏杆菌感染病原学或血清学证据。临床主要表现为头痛、发热,可伴脑膜炎症状与体征;或病程中出现脊柱炎症性改变;或伴尿潴留、便秘(可能与腰骶神经根病变有关);病程中也可出现听力减退和复视等听神经和外展神经病变表现。结论神经布氏杆菌病临床表现多样,常伴有全身系统性感染症状,在不明原因发热筛查中应进行布氏杆菌相关检查,诊断过程中需注意与结核分枝杆菌感染相鉴别。不同药理学机制的抗生素足量、长程联合治疗有效,患者预后良好。

Background Brucellos is mulyisystrem disrase which may present with a broad spectrum of clinical manifestations and complications.Neurcellosis is an uncommon complication of this infection.This article aims to present clinical manifestations and to discuss the clinical features and manifestations and complications.Neurobrucellosis is an uncommon complication of is a multisystem disease which may present with a broad management of 3 neurobrucellosis cases.Methods accessory examination findings of 3 patients with neurobrucellosis between August 2010 and March 2012 The diagnosis,treatment,laboratory results and were retrospectively analyzed,and relevant literature was reviewed.Results All the 3 cases had definite history of exposure to epidemic areas or infectious diseases,and history of being infected with Brucella by drinking raw milk.During the screening because of fever for reasons unknown,they were proved to be infected with Brucella by etiological or serological tests.Initial clinical manifestations consisted of fever and headache,with meningitis symptoms and signs,spondylitis,uroschesis and constipation（which might be caused by lumbosacral nerve root lesion）,or neurological manifestations in auditory nerve and abducent nerve,such as hearing loss and diplopia.All patients were treated with rifampicin,doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone.Conclusion Neurobrucellosis presents with various clinical signs and symptoms,and is often accompanied by systemic infection.Brucellosis should be kept in mind during the screening of fever for reasons unknown,and be differentiated from Mycobacterium tuberculosis infection.Theeffective,by antibotics of different pharmacological mechanisms with full dose and long range iswords combined treatment agentsKey and the prognosis is favorable.