5例不典型神经型布鲁氏菌病临床病例分析

Clinical analysis of 5 cases of atypical neurobrucellosis

目的探讨不典型神经型布鲁氏菌病(以下简称布病)病例的临床特点。方法回顾性分析内蒙古自治区人民医院2020年12月至2021年6月收治的5例不典型神经型布病病例的流行病学特征、临床表现、实验室检查及影像学检查结果等。结果5例病例的年龄范围为4~69岁,其中女性3例、男性2例,4例有明确的羊接触史。5例病例血清布病抗体均为阳性,3例血清试管凝集试验(SAT)阳性,4例腰穿脑脊液(CSF)检查颅内压升高,5例细菌涂片及结核菌培养均为阴性。经磁共振(MRI)检查,2例颅内异常高信号,其中1例异常部位为双侧额顶叶及右侧颞枕叶,表现为长T1、T2信号,液体衰减反转恢复序列(FLAIR)高信号;另1例异常部位为双侧放射冠-内囊后肢-双侧大脑脚,表现为连续T2、FLAIR稍高信号。1例脊髓信号异常,表现为C2-3间盘水平椎管内脊髓右侧见小斑片样长T2信号。1例肌电图检查异常。5例病例中,2例诊断为布病性脑炎,1例诊断为布病性脊髓炎,1例诊断为布病性舌咽神经损害,1例诊断为布病性脑脊髓神经病。5例病例均应用多西环素、利福平及头孢曲松3种药物联合治疗,有3例预后良好。结论不典型神经型布病临床表现多样,应加强临床医生对其的认知,减少漏诊及误诊。

Objective To investigate the clinical characteristics of atypical neurobrucellosis.Methods Retrospective analysis was made on the epidemiological characteristics,clinical manifestations,laboratory and imaging findings of five cases of atypical neurobrucellosis admitted to the People's Hospital of Inner Mongolia Autonomous Region from December 2020 to June 2021.Results The age of the five cases ranged from four to sixty-nine years old,including three females and two males.Four cases had a clear history of sheep contact.Serum F1 antibody against brucellosis was positive in all five cases,serum tube agglutination test(SAT)was positive in three cases,lumbar puncture cerebrospinal fluid(CSF)examination showed increased intracranial pressure in four cases,and bacterial smear and tuberculosis culture were negative in all of the five cases.After magnetic resonance imaging(MRI),two cases were found to have abnormal intracranial high signals,of which one case was abnormal in bilateral frontal parietal lobe and right temporal occipital lobe,showing long T1 and T2 signals and increased fluid-attenuated inversion recovery sequence(FLAIR)signal;and another case was abnormal in bilateral corona radiata,posterior limbs of internal capsule and bilateral cerebral peduncles,it showed continuous T2 and FLAIR slightly high signal intensity.One case had abnormal signal in the spinal cord,showing a small patch like long T2 signal on the right side of the spinal cord at the level of C2-3 discs.Electromyography was abnormal in one case.Among the five cases,two cases presented with brucellosis encephalitis,one case with brucellosis myelitis,one case with glossopharyngeal nerve damage caused by brucellosis,and one case with brucellosis cerebrospinal neuropathy.All five patients were treated with a combination of doxycycline,rifampicin and ceftriaxone,and three patients had a good prognosis.Conclusions The clinical manifestations of atypical neurobrucellosis are various.Clinicians should strengthen their understanding of the disease and reduce the chance of missed diagnosis and misdiagnosis.