神经型布氏杆菌病18例临床分析

Clinical analysis of 18 cases of neurobrucellosis

目的探讨神经型布氏杆菌病的临床特点。方法回顾性分析北京宣武医院神经内科2014年4月~2016年4月收治的18例神经型布氏杆菌病患者的流行病学、临床表现、实验室检查结果及影像学资料。结果男15例,女3例,年龄22~60岁,平均41.1±12.3岁;12例有明确牛羊接触史,1例父亲患有布氏杆菌病,1例从事动物粪便处理工作,4例无明确接触史;10例为亚急性起病,6例为慢性起病;10例发热;12例听力减退;6例复视;10例尿便障碍;1例癫痫发作;10例腰穿压力升高;17例脑脊液白细胞升高;16例脑脊液葡萄糖降低;18例脑脊液蛋白升高。全部患者给予头孢曲松、多西环素、利福平、链霉素、氧氟沙星、环丙沙星中的2种或3种不同组合治疗,症状均有不同程度好转。结论神经型布氏杆菌病临床表现多样,脑脊液白细胞计数、葡萄糖、蛋白含量在不同个体间变化较大,布氏杆菌虎红试验可能存在假阴性,影像学表现以大脑白质区类脱髓鞘改变为特点,需要结合患者流行病学资料、临床表现及病原学检查做出诊断。

Objective To investigate the clinical features of neurobrucellosis.Methods The epidemiological information,clinical manifestation,etiology,laboratory data and imaging characteristics of 18 cases with neurobrucellosis during 2014-4 to 2016-4 in Beijing Xuanwu hospital were retrospectively summarized.Results 18 cases of neurobrucellosis including 15 males and 3 females were reported;The mean age of patients was 41.1±12.3 years ranging from 22 to 60 years;Of the cases,12 had a history of raising livestock,while 2 had other risk for neurobrucellosis.Four cases had none of the fisk factors for neurobrucellosis.With regard to clinical findings,2 cases were evaluated as acute,10 cases as subacute,and 6 cases as chronic.Clinical manifestations of neurobrucellosis were diverse and comlicated,including 10 cases of fever,12 cases of dysacusis,6 cases of diplopia,10 cases of bowel and bladder disturbances,and 1 cases of seizure.There were 10 with increased CSF pressure,17 with increased leukocyte count,16 with decreased glucose level,and 18 with increased proteins.The combined treatment with two or three kinds of ceftriaxone,doxycycline,rifampicin,streptomycin,ofloxacin or ciprofloxacin were given to these cases.Clinical symptoms of all cases were improved to different extent.Conclusion The clinical presentation of neurobrucellosis varies greatly.Cerebrospinal fluid leukocyte count,glucose and protein content were varied between different individuals.Brucellosis rose bengal plate test may be a false negatives.Demyelination of white matter was the imaging characteristic in these cases.Epidemiological data,clinical manifestation and etiology are needed to make a diagnosis.