Infectious Diseases and Clinical Microbiology Clinic, Ataturk Training and Research Hospital, Ankara, Turkey.
Clin Infect Dis. 2013 May;56(10):1407-12. doi: 10.1093/cid/cit072. Epub 2013 Feb 27.
We describe the neurological involvement in brucellosis and revisited diagnostic criteria for neurobrucellosis.
Patients with laboratory-confirmed brucellosis who were consequently hospitalized were observed prospectively in a brucellosis-endemic region. The neurobrucellosis was diagnosed by any one of the following criteria: (1) symptoms and signs consistent with neurobrucellosis; (2) isolation of Brucella species from cerebrospinal fluid (CSF) and/or presence of anti-Brucella antibodies in CSF; (3) the presence of lymphocytosis, increased protein, and decreased glucose levels in CSF; or (4) diagnostic findings in cranial magnetic resonance imaging or CT.
Lumbar puncture was performed in 128 laboratory-confirmed brucellosis cases who had neurological symptoms and signs, and 48 (37.5%) were diagnosed as neurobrucellosis. The sensitivity of tube agglutination (TA) in CSF was 0.94, specificity 0.96, positive predictive value 0.94, and negative predictive value 0.96. Brucella bacteria were isolated from CSF in 7 of 48 patients (15%). The mean age of 48 neurobrucellosis patients was 42 years (SD, 19 years), and 16 (33%) were female. The most common neurological findings were agitation (25%), behavioral disorders (25%), muscle weakness (23%), disorientation (21%), and neck rigidity (17%). Cranial nerves were involved in 9 of 48 patients (19%). One patient was left with a sequela of peripheral facial paralysis and 2 patients with sensorineural hearing loss.
Patients with severe and persistent headache and other neurologic symptoms and signs should be considered for neurobrucellosis in endemic regions and to possibly receive longer therapy than 6 weeks. Brucella TA with Coombs test in CSF is sensitive and specific by using a cutoff of ≥1:8.
我们描述了布鲁氏菌病的神经受累情况，并重新审视了神经布鲁氏菌病的诊断标准。
在布鲁氏菌病流行地区，我们对经实验室确诊为布鲁氏菌病且随后住院的患者进行前瞻性观察。神经布鲁氏菌病的诊断依据以下标准之一：（1）有符合神经布鲁氏菌病的症状和体征；（2）从脑脊液（CSF）中分离出布鲁氏菌属物种和/或 CSF 中存在抗布鲁氏菌抗体；（3）CSF 中存在淋巴细胞增多、蛋白增加和葡萄糖水平降低；或（4）头颅磁共振成像或 CT 的诊断结果。
对 128 例有神经系统症状和体征且经实验室确诊为布鲁氏菌病的患者进行了腰椎穿刺，其中 48 例（37.5%）被诊断为神经布鲁氏菌病。CSF 试管凝集试验（TA）的灵敏度为 0.94，特异性为 0.96，阳性预测值为 0.94，阴性预测值为 0.96。从 48 例患者的 CSF 中分离出布鲁氏菌的有 7 例（15%）。48 例神经布鲁氏菌病患者的平均年龄为 42 岁（标准差为 19 岁），16 例（33%）为女性。最常见的神经学发现是激越（25%）、行为障碍（25%）、肌无力（23%）、定向障碍（21%）和颈项强直（17%）。颅神经受累的有 9 例（19%）。1 例患者遗留周围性面瘫后遗症，2 例患者遗留感觉神经性听力损失。
在流行地区，如果患者有严重和持续的头痛以及其他神经系统症状和体征，应考虑神经布鲁氏菌病的可能，并可能需要接受比 6 周更长的治疗。用 1:8 作为截断值时，CSF 中的布鲁氏菌 TA 结合库姆斯试验具有较高的灵敏度和特异性。
