喀什地区神经型布鲁氏菌病的临床特征分析  

Clinical Characterization of Neurobrucellosis in Kashi Region

作　　者：潘淑芳 常艳宇 王晓红 祖丽皮亚·莫明[1] 买买提艾力·吐尔逊 崇雨田[1,2] 朱建芸 PAN Shufang;CHANG Yanyu;WANG Xiaohong;Zulipiya·Moming;Maimaitiaili·Tuerxun;CHONG Yutian;ZHU Jianyun(Department of Infectious Diseases,The First People’s Hospital of Kashi Prefecture,Kashi 844000,China;Department of Infectious Diseases,The Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China;Department of Neurology,The First People’s Hospital of Kashi Prefecture,Kashi 844000,China;Department of Neurology,The Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China;Department of Radiology,The First People’s Hospital of Kashi Prefecture,Kashi 844000,China;Department of Radiology,The Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]喀什地区第一人民医院感染科,新疆喀什844000 [2]中山大学附属第三医院感染科,广东广州510630 [3]喀什地区第一人民医院神经内科,新疆喀什844000 [4]中山大学附属第三医院神经内科,广东广州510630 [5]喀什地区第一人民医院放射科,新疆喀什844000 [6]中山大学附属第三医院放射科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2024年第4期649-656,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：中山大学临床研究5010项目(2016009);。

摘　　要：【目的】探讨喀什地区神经型布鲁氏菌病的临床特征,提高诊疗水平。【方法】对2019年12月至2024年1月喀什地区第一人民医院收治的18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】18例神经型布鲁氏菌病患者中,男性9例,女性9例,中位年龄36(17~54.5)岁。所有患者均有布鲁氏菌病流行病学史。诊断为脑膜脑炎12例,脑膜炎5例,脑炎1例。其中2例患者合并脊髓膜炎。2例患者合并骨关节炎,1例患者合并附睾炎。最常见的临床表现是头痛、发热、乏力。虎红平板试验(RBPT)及试管凝集试验(SAT)的阳性比分别为11/12、8/9,血培养阳性比2/10,脑脊液培养阳性比4/16,脑脊液病原高通量测序(NGS)阳性比5/5。脑脊液呈渗出性改变,白细胞升高,以单个核细胞升高为主。所有患者均应用多西环素、利福平、头孢曲松、头孢克肟、左氧氟沙星、米诺环素或磺胺中的2~4种联合治疗。多数患者预后较好。【结论】来自布鲁菌病疫区的患者存在中枢神经系统表现需要考虑神经型布鲁菌病的可能性。当脑脊液出现渗出性改变时,可以通过结合布鲁氏菌血清学、血培养、脑脊液培养和NGS来鉴别其他病原体导致的中枢神经系统感染;NGS可以明显提高神经型布鲁菌病诊断率。【Objective】To explore the clinical characteristics of neurobrucellosis in Kashi,Xinjiang Uygur Autonomous Region,thus improve the diagnosis and treatment.【Methods】A retrospective analysis was conducted on the clinical data of 18 cases of neurobrucellosis who were admitted to the First People's Hospital of Kashi Prefecture between December 2019 and January 2024.【Results】The study included 9 males and 9 females,with a median age of 36 years(range:17-54.5).A clear epidemiological history was found in all the 18 brucllosis patients,12 of whom presented with meningo‐encephalitis,5 meningitis,and 1 encephalitis.Two comorbided with spinal meningitis,2 osteoarthritis and 1 epididymitis.Most frequently reported clinical symptoms were headache,fever and fatigue.The prevalence rates of brucellosis by rose bengal plate agglutination test(RBPT)and serum agglutination test(SAT)were 11/12 and 8/9,respectively.Two of 10 patients had positive blood cultures,four of 16 had positive cerebrospinal fluid(CSF)cultures and five of five were detect‐ed to be positive by next-generation sequencing(NGS)for pathogens in CSF.CSF showed exudative changes and elevated number of leukocytes,with predominance of single nucleated cells.All patients were treated with the combined use of two to four from the drugs like doxycycline,rifampicin,ceftriaxone,cefixime,minocycline,levofloxacin and sulfanilamide.Most patients had a favorable prognosis.【Conclusions】Neurobrucellosis should be considered in all patients with central nervous system manifestations from endemic areas.If there are exudative changes in CSF,differential diagnoses can be made by serological testing,blood culture,CSF culture and NGS.NGS could significantly increase the accuracy for neurobrucellosis diagnosis.

关 键 词：神经布鲁氏菌病 布鲁氏菌病 脑炎 脑膜炎 脑膜脑炎 

分 类 号：R516.7[医药卫生—内科学]