12例神经型布鲁氏菌病患者的临床特点及诊治分析

Clinical features, diagnostic and treatment analysis of 12 patients with neurobrucellosis

目的探究神经型布鲁氏菌病的临床特征、诊断标准及治疗方案的选择。方法对2005年3月至2018年2月焦作煤业(集团)有限责任公司中央医院神经内科收治的12例神经型布鲁氏菌病患者的临床资料进行回顾性总结分析。结果本组共12例患者,平均发病年龄35.8岁,男∶女为3∶1,均有明确的流行病学史,临床表现为脑膜炎、脑炎和脑脊髓膜炎。所有患者血清布鲁杆菌凝集试验阳性。12例患者均行血培养及脑脊液培养,其中5例血培养阳性,3例脑脊液培养阳性。所有患者均行腰椎穿刺检查,白细胞计数均增多,以淋巴细胞为主,9例蛋白升高,8例葡萄糖和氯化物下降。初始抗菌治疗采用四环素类和利福霉素类加用三代头孢菌素、复方新诺明、氟喹诺酮类中的1种或2种,治疗6~8周,部分患者需要治疗2~3个周期。结论神经型布鲁氏菌病的临床表现无特异性,容易漏诊,多数预后良好,严重者可留有后遗症。采用联合、足量、足疗程的抗菌药物治疗方案,可以减少患者的复发及慢性化。

Objective To investigate the clinical characteristics, diagnostic criteria and treatment protocol of neurobrucellosis. Methods The clinical data of 12 patients with neurobrucellosis admitted to Department of Neurology of Jiaozuo Coal-mining Groups Hospital from March 2005 to February 2018 were retrospectively summarized and analyzed. Results This trial included 12 patients. Among them the average age of onset was 35.8 years old, and ratio of male to female was 3∶1. All patients had certain contact history of the source of infection of brucellosis. Meningitis, encephalitis, and cerebrospinal meningitis were the main clinical manifestations. Brucella blood serum agglutination test of all patients were positive. Blood and cerebrospinal fluid (CSF) culture were performed in all 12 cases, blood culture was positive in 5 cases, and cerebrospinal fluid cultivate was positive in 3 cases. All patients underwent lumbar puncture examination. Analysis of CSF revealed increased leukocytes, mainly in the lymphocytes, in all patients, increased protein in 9 cases, and decreased glucose and chloride in 8 cases. Initial antibiotic therapy was based on tetracycline class and rifamycin class combined with one or two drugs of three generations of cephalosporins, cotrimoxazole and fluoroquinolone. Patients were treated for 6 to 8 weeks, and some of them were required for 2 to 3 course of treatment. Conclusions Brucellosis is lack of characteristic clinical manifestations, which is easy to be misdiagnosed. Most patients with neurobrucellosis have good prognosis, however, severe patients may have sequel. The combined treatment by antibiotics with full dose and adequate course should be adopted in order to reduce the recurrent and progress into chronicity.