布鲁菌病合并脑膜炎32例的临床诊治

Clinical diagnosis and treatment of 32 cases of brucella cephalomeningitis

目的探讨布鲁菌病合并脑膜炎的临床特点及治疗措施。方法回顾性分析32例布鲁菌病合并脑膜炎患者的流行病学资料、临床表现、病原学特异性检查、腰椎穿刺检查结果和影像学表现,以及诊治经过和预后。结果入组患者中男性28例,女性4例,平均年龄(43±16)岁;均可追溯到明确流行病学史;临床症状以发热、乏力、多汗、头痛、呕吐、颈抵抗多见,神志障碍少见。32例布鲁菌试管凝集实验均为阳性,9例(28.1%)血培养阳性;脑脊液改变类似于病毒性脑膜炎或结核性脑膜炎。3例(9.4%)头颅MRI发现脑脓肿,其中2例(6.2%)并发垂体脓肿,其他发现包括3例(9.4%)脑积水,3例(9.4%)脱髓鞘病灶,3例(9.4%)陈旧梗塞灶,1例(3.1%)左侧额叶皮层下缺血灶。全部病例均应用多西环素+利福平治疗基础上,静点头孢噻肟舒巴坦钠或头孢曲松至少3种药物联合治疗,治疗时间中位数为6个月。难治性病例联合氟喹诺酮类、氨基糖苷类治疗或复方新诺明治疗,预后良好。结论布鲁菌病合并脑膜炎临床表现多样,当以脑膜炎为主要表现时,对流行病学史的问诊有助于早期发现布鲁菌病,及时诊断和积极治疗是改善预后的关键。

Objective To investigate the clinical manifestation and treatment of brucella cephalomeningitis.Methods The clinical data about the epidemiological information,clinical manifestations,etiologies,CSF examination,and imaging features of32patients with brucella cephalomeningitis were analyzed,retrospectively.Results The research objects included28male and4female patients,with the mean age of(43±16)years old,while unambiguous epidemiologic evidence had been found in all of patients.The main clinical features of patients included fever,fatigue,sweating,headache,vomiting and neck resistance,while consciousness obstacle was rarely found.The Brucella serum agglutination test were positive,7cases were positive for the Brucella cerebrospinal fluid(CSF)agglutination test and9cases(28.1%)were positive for blood culture of Brucella.The biochemical results in cerebrospinal fluid were similar with those in viral meningitis or tuberculous meningitis.Head MRI examinations had found3cases(9.4%)with brain abscess,2cases(6.3%)with pituitary abscess,3cases(9.4%)with hydrocephalus,3cases(9.4%)with demyelinating lesions,3cases(9.4%)with old infarction,and1case(3.1%)with left frontal subcortical ischemic focal.All the patients got a favorable prognosis,after receiving combined treatment with doxycycline,rifampicin,cefotaxime sodium and sulbactam tantra or ceftriaxone.The median duration of treatment is6months.Refractory cases received fluoroquinolone,aminoglycoside treatment or compound paediatric compound sulfamethoxazole tablets treatment.Conclusions A comprehensive inquiry of epidemiology were conducive to diagnose Brucellosis earlier.Whether a nervous system lesion was the complication of brucellosis should be distinguished by doctor.Interrogation of epidemiologic history could be used to early detection of undulant disease,timely diagnosis and aggressive treatment was the key to improve the prognosis.