关键词: 布鲁杆菌病, 中枢神经系统细菌感染, 疾病特征, 诊断,鉴别, 治疗结果

Abstract:

To investigate the clinical features of neurobrucellosis patients and reduce misdiagnosis,a retrospective study was conducted on 27 cases with neurobrucellosis in Taiyuan Tuberculosis Hospital during Jan 2009 to Dec 2019. Epidemiological information, clinical manifestations, etiology/laboratory data and imaging characteristics,diagnosis and treatment outcomes were collected from medical record. All of 27 patients were misdiagnosed as suspected tuberculosis meningitis and transferred to our hospital,18 (66.7%) had a history of raising livestock,and 1 had brucellosis history; 27 cases (100.0%) had headache, other common symptoms were fever (88.9%, 24/27), dysuria or urinary incontinence and constipation (37.0%, 10/27),etc. Laboratory tests showed that 22 cases (81.5%) had meningeal irritation signs, 22 cases (81.5%) had increased cerebrospinal fluid pressure,27 cases (100.0%) had increased leukocyte counts and proteins, 25 (92.6%) had decreased glucose level, and 23(85.2%) had chloride decrease. Imaging findings all patients were characterized by demyelinating changes and encephalitis in white matter area of the brain.Twenty-five patients were diagnosed by RBPT and 2 by next-generation sequencing of cerebrospinal fluid. The time of disease onset to diagnosis ranged from 2 week to 8 months, with 20 cases (74.1%) more than 1 month. Based on treatment of doxycycline combined with rifampicin, adding ceftriaxone, levofloxacin, amikacin could improve patients’ symptoms after 2 weeks’ treatment,25 cases (92.6%) were cured after 6-12 month’ treatment and 2 cases were in medical terms.Consider that compared with other central nervous system diseases,the neurobrucellosis has diverse clinical manifestations, lack specificity, resulting in the high rate of misdiagnosis; RBPT should be performed to detect neurobrucellosis if there was a history of living or traveling in pastoral areas or unexplained neurological symptoms accompanied with fever,and the treatment outcomes is obvious and the prognosis is good.

Key words: Brucellosis, Central nervous system bacterial infections, Disease attributes, Diagnosis,differential, Treatment outcome