Kochar D K, Agarwal N, Jain N, Sharma B V, Rastogi A, Meena C B
SP Medical College, Bikaner, Rajasthan.
J Assoc Physicians India. 2000 Apr;48(4):376-80.
To study the spectrum of neurobrucellosis in a prospective study at Bikaner which is supposed to be uncommon in India.
This study was done on admitted patients of brucellosis from June 1996 to June 1999 in whom the diagnosis was done by history of exposure to animals, fever and arthralgia and demonstration of brucella antibody titres in serum 1:160. CSF examination was done in all the patients. All cases were treated by combination of doxycycline 100 mg twice daily, rifampicin 900 mg daily for 6-8 weeks and injection streptomycin 0.75 to 1 gm i.m. per day for initial 14 days. Detailed neurological examination and antibody titres of serum and CSF again measured at the end of treatment.
Twelve out of 92 patients revealed evidence of neurobrucellosis in which four cases were of meningoencephalitis, two cases of myelitis leading to spastic paraparesis, five cases of polyradiculoneuropathy and one case of polyneuroradiculomyeloencephalopathy. The treatment regimen used was associated with a high cure rate and significant reduction in antibody titres in serum and CSF.
Neurobrucellosis is an uncommon but serious manifestation affecting central and peripheral nervous system. The clinical profile of the disease mimicks closely to commonly seen neurological infective diseases like tubercular meningitis, viral encephalitis, aseptic meningitis, cerebral malaria and viral encephalopathy. Serum and CSF testing for brucella antibody titre is an important test for the diagnosis. Blood culture is not an ideal test for neurobrucellosis because of low yield and longer time required for the diagnosis. High degree of suspicion is prudent for the diagnosis. High degree of cure rate can be achieved by treatment with present regimen in a disease which is otherwise having high mortality and morbidity.
在比卡内尔进行一项前瞻性研究，以研究神经型布鲁氏菌病的谱，该病在印度被认为不常见。
本研究针对1996年6月至1999年6月收治的布鲁氏菌病患者进行，这些患者通过接触动物史、发热和关节痛以及血清中布鲁氏菌抗体滴度为1:160来确诊。对所有患者进行了脑脊液检查。所有病例均采用多西环素100毫克每日两次、利福平900毫克每日一次，持续6 - 8周，以及链霉素注射液0.75至1克肌肉注射，每日一次，共14天的联合治疗。治疗结束时再次进行详细的神经系统检查以及血清和脑脊液抗体滴度检测。
92例患者中有12例显示有神经型布鲁氏菌病的证据，其中4例为脑膜脑炎，2例为脊髓炎导致痉挛性截瘫，5例为多神经根神经病，1例为多神经根脊髓脑脊髓病。所采用的治疗方案治愈率高，血清和脑脊液中的抗体滴度显著降低。
神经型布鲁氏菌病是一种不常见但严重的表现，影响中枢和周围神经系统。该疾病的临床特征与常见的神经感染性疾病如结核性脑膜炎、病毒性脑炎、无菌性脑膜炎、脑型疟疾和病毒性脑病非常相似。血清和脑脊液布鲁氏菌抗体滴度检测是诊断的重要检查。血培养对于神经型布鲁氏菌病不是理想的检查，因为其阳性率低且诊断所需时间长。高度怀疑对于诊断很谨慎。通过目前的治疗方案可以在这种原本具有高死亡率和高发病率的疾病中实现高治愈率。
