神经型布鲁氏菌病的临床特点分析

Clinical features of neurobrucellosis

目的 探讨神经型布鲁氏菌病的临床特点,提高诊治水平。方法 对2017年4月至2021年10月河南科技大学第一附属医院收治的17例神经型布鲁氏菌病患者的临床资料进行回顾性分析。结果 17例神经型布鲁氏菌病患者中,男性13例,女性4例,平均年龄(48.8±15.1)岁。16例患者有与牛羊或奶制品接触史。临床表现为脑膜炎9例,脑炎3例,脑膜脑炎1例,椎管内脓肿并脊髓压迫1例,椎管内脓肿并脊髓损害1例,脑血管病1例,周围神经病变1例。布鲁氏菌血清凝集试验阳性16例,其中1例患者血培养标本中发现羊布鲁氏菌,1例患者的脑脊液中通过二代测序技术发现了羊布鲁氏菌。脑脊液白细胞计数升高15例,蛋白升高13例,葡萄糖降低10例,氯化物降低12例。所有患者均应用了多西环素、利福平、头孢曲松、左氧氟沙星、链霉素中的2种或3种联合治疗。多数患者预后良好。结论 神经型布鲁氏菌病患者临床表现多样,脑脊液检查缺乏特异性,对伴有发热的不明原因的神经系统病变,需要考虑到该病。

Objective To study the clinical features of neurobrucellosis.Methods A retrospective analysis was performed for the clinical data of 17 patients with neurobrucellosis who were admitted to the First Affiliated Hospital of Henan University of Science and Technology from April 2017 to October 2021.Results Among the 17 patients with neurobrucellosis,there were 13 male patients and 4 female patients,with a mean age of(48.8±15.1) years,and 16patients had a history of contact with cattle and sheep or dairy products.Clinical manifestations included meningitis in 9patients,encephalitis in 3 patients,meningoencephalitis in 1 patient,intraspinal abscess with spinal cord compression in 1patient,intraspinal abscess with spinal cord lesion in 1 patient,cerebrovascular disease in 1 patient,and peripheral neuropathy in 1 patient.Of all patients,16 tested positive for Brucella serum agglutination test,among whom 1 patient was found to have Brucella melitensis in blood culture,and 1 patient was found to have Brucella melitensis in cerebrospinal fluid by next-generation sequencing.Among the 17 patients,15 had elevated leukocyte count in cerebrospinal fluid,13 had elevated protein,10 had a reduction in glucose,and 12 had a reduction in chloride.All patients were given combined treatment with two or three drugs out of doxycycline,rifampicin,ceftriaxone,levofloxacin,and streptomycin.Most patients had a good prognosis.Conclusions Patients with neurobrucellosis tend to have diverse clinical manifestations,and there is a lack of specificity in cerebrospinal fluid examination.Neurobrucellosis should be considered for unexplained nervous system lesions with fever.