5例神经型布鲁菌病的临床与实验室特征
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顾兵

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R516.7

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国家自然科学基金(81471994)


Clinical and laboratory characteristics of 5 cases of neurobrucellosis
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    摘要:

    目的通过对5例神经型布鲁菌病的临床资料进行分析,以提高对该病的临床和实验室诊断能力。方法回顾性分析2015年1月—2017年6月某院收治的5例神经型布鲁菌病患者的临床和实验室资料。结果5例患者均有牛羊接触史或牛羊制品食用史,就诊时均以反复发热伴有头痛为主要症状。脑脊液常规显示潘氏试验阳性、白细胞增多且以单核细胞为主;脑脊液生化显示蛋白含量均增高、氯化物均降低,3例患者葡萄糖降低;脑脊液免疫球蛋白IgA、IgG均高于正常值数倍以上;5例患者均培养出马耳他布鲁菌;4例患者脑部影像学检查显示异常。3例患者血常规白细胞计数略高,5例患者的肝功能(丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ氨基转肽酶)均正常,4例患者超敏C反应蛋白正常,1例患者血清布鲁菌抗体试管凝集试验阳性。5例患者均使用多西环素联合利福平或利福霉素治疗2 W后,体温均恢复正常,头痛、头晕症状均有所改善;脑脊液白细胞计数和蛋白定量均有所下降。结论超敏C反应蛋白和血常规白细胞计数在神经型布鲁菌病诊断中未见特征性改变。神经型布鲁菌病临床表现形式多样,故易造成漏诊、误诊,应提高临床医务人员对该病的认识。

    Abstract:

    ObjectiveTo improve clinical and laboratory diagnosis of neurobrucellosis through analysis on clinical data of 5 cases of neurobrucellosis.MethodsClinical and laboratory data of 5 patients with neurobrucellosis in a hospital from January 2015 to June 2017 were analyzed retrospectively.ResultsAll 5 patients had history of cattle and sheep contact or history of eating cattle and sheep products, recurrent fever accompanied by headache was the main symptom. Routine cerebrospinal fluid(CSF) test showed that all patients were positive for pandy test and with leukocytosis (mainly mononuclear cells); biochemical analysis of CSF revealed that protein increased and chloride decreased in all patients, glucose decreased in 3 patients; immunoglobulin IgA and IgG in CSF were several times higher than the normal value; 5 patients were cultured Brucella melitensis, 4 patients showed abnormal brain imaging. Blood routine test showed that white blood cell count(WBC) was slightly higher in 3 patients, liver function (alanine aminotransferase, aspartate aminotransferase, γglutamyltranspeptidase) was normal in 5 patients, highsensitivity Creactive protein(hsCRP) was normal in 4 patients, Brucella antibody tube agglutination test was positive in 1 patient. After 2week treatment with doxycycline combined with rifampin or rifamycin, 5 patients’ body temperature all returned to normal, symptoms of headache and dizziness all relieved; WBC count and protein in CSF all decreased.ConclusionNo characteristic changes in hsCRP and blood routine WBC count are found in the diagnosis of neurobrucellosis. Clinical manifestations of neurobrucellosis are diversity, it is easy to cause missed diagnosis and misdiagnosis, health care workers should improve the understanding of the disease.

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引用本文

许晶晶,朱玉秋,邓丽华,等.5例神经型布鲁菌病的临床与实验室特征[J]. 中国感染控制杂志,2018,17(7):615-618. DOI:10.3969/j. issn.1671-9638.2018.07.012.
XU Jingjing, ZHU Yuqiu, DENG Lihua, et al. Clinical and laboratory characteristics of 5 cases of neurobrucellosis[J]. Chin J Infect Control, 2018,17(7):615-618. DOI:10.3969/j. issn.1671-9638.2018.07.012.

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  • 收稿日期:2017-08-14
  • 最后修改日期:2017-10-16
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  • 在线发布日期: 2018-07-28
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