Karsen Hasan, Karahocagil Mustafa Kasim, Irmak Hasan, Demiröz Ali Pekcan
Yüzüncü Yil Universitesi Tip Fakültesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Anabilim Dali, Van.
Mikrobiyol Bul. 2008 Oct;42(4):689-94.
Turkey is located at an endemic area for brusellosis and tuberculosis which are both important public health problems. Meningitis caused by Brucella and Mycobacterium spp. may be confused since the clinical and laboratory findings are similar. In this report, a meningitis case with Brucella and tuberculosis co-infection has been presented. A 19-years-old woman was admitted to our clinic with severe headache, fever, vomiting, meningeal irritation symptoms, confusion and diplopia. The patient was initially diagnosed as Brucella meningitis based on her history (stockbreeding, consuming raw milk products, clinical symptoms concordant to brucellosis lasting for 4-5 months), physical examination and laboratory findings of cerebrospinal fluid (CSF). Standard tube agglutination test for brucellosis was positive at 1/80 titer in CSF and at 1/640 titer in serum, whereas no growth of Brucella spp. was detected in CSF and blood cultures. Antibiotic therapy with ceftriaxone, rifampicin and doxycyclin was started, however, there was no clinical improvement and agitation and confusion of the patient continued by the end of second day of treatment. Repeated CSF examination yielded acid-fast bacteria. The patient was then diagnosed as meningitis with double etiology and the therapy was changed to ceftriaxone, streptomycin, morphozinamide, rifampicin and isoniazid for thirty days. Tuberculosis meningitis was confirmed with the growth of Mycobacterium tuberculosis on the 14th day of cultivation (BACTEC, Becton Dickinson, USA) of the CSF sample. On the 30th day of treatment she was discharged on anti-tuberculous treatment with isoniazid and rifampicin for 12 months. The follow-up of the patient on the first and third months of treatment revealed clinical and laboratory improvement. Since this was a rare case of Brucella and tuberculosis co-infection, this report emphasizes that such co-infections should be kept in mind especially in the endemic areas for tuberculosis and brucellosis.
土耳其位于布鲁氏菌病和结核病的地方流行区，这两种疾病都是重要的公共卫生问题。由布鲁氏菌属和分枝杆菌属引起的脑膜炎可能会相互混淆，因为其临床和实验室检查结果相似。在本报告中，呈现了一例布鲁氏菌和结核杆菌合并感染的脑膜炎病例。一名19岁女性因严重头痛、发热、呕吐、脑膜刺激征、意识模糊和复视而入住我院。根据患者病史（从事畜牧业、食用生奶制品、有持续4 - 5个月与布鲁氏菌病相符的临床症状）、体格检查以及脑脊液（CSF）实验室检查结果，患者最初被诊断为布鲁氏菌性脑膜炎。布鲁氏菌病的标准试管凝集试验在脑脊液中滴度为1/80呈阳性，在血清中滴度为1/640呈阳性，然而，脑脊液和血培养均未检测到布鲁氏菌属生长。开始使用头孢曲松、利福平及多西环素进行抗生素治疗，但患者无临床改善，且在治疗第二天结束时仍持续烦躁和意识模糊。重复脑脊液检查发现抗酸杆菌。随后患者被诊断为双病因脑膜炎，治疗改为使用头孢曲松、链霉素、莫西酰胺、利福平和异烟肼，持续30天。脑脊液样本在培养第14天（美国BD公司的BACTEC法）培养出结核分枝杆菌，从而确诊为结核性脑膜炎。治疗第30天，患者出院，继续使用异烟肼和利福平进行12个月的抗结核治疗。在治疗的第一个月和第三个月对患者进行随访，结果显示临床和实验室检查均有改善。由于这是一例罕见的布鲁氏菌和结核杆菌合并感染病例，本报告强调，尤其是在结核病和布鲁氏菌病的地方流行区，应考虑到这种合并感染情况。
