Omasits M, Brainin M
Neurologische Abteilung des Niederösterreichischen Landeskrankenhauses Klosterneuburg.
Fortschr Neurol Psychiatr. 1987 Oct;55(10):291-3. doi: 10.1055/s-2007-1001831.
Brucellosis involving the nervous system usually shows meningomyelitis and/or radiculoneuritis and can by their clinical appearance not be differentiated from other chronic proliferative diseases of the nervous system. Sporadic cases can only be suspected on clinical grounds if a previous exposition is known. The cerebrospinal fluid showing a proliferative or granulomatous cytological picture is strongly suggestive of the diagnosis, which is confirmed by two rising titer values in the complement binding reaction for Brucella-specific antigen. The agglutination method of Widal is not reliable due to blocking incomplete antibodies. A 46 year-old man developed a transverse myelitis within several months accompanied by fluctuating meningeal signs, segmental irritation and transient cranial nerve palsies. No involvement of other organs and no general symptoms of infectious diseases were seen throughout the clinical course. Most importantly, starting treatment as early as possible is decisive for the outcome using a combination of streptomycin, sulfonamides, gentamycin, rifampicin and tetracyclines.
累及神经系统的布鲁氏菌病通常表现为脑脊膜炎和/或神经根神经炎，从其临床表现来看，无法与神经系统的其他慢性增殖性疾病相鉴别。如果已知有既往接触史，仅根据临床症状只能怀疑为散发病例。脑脊液呈现增殖性或肉芽肿性细胞学图像强烈提示该诊断，通过布鲁氏菌特异性抗原补体结合反应中两次滴度升高得以确诊。由于不完全抗体的封闭作用，肥达氏凝集法不可靠。一名46岁男性在数月内发展为横贯性脊髓炎，伴有波动的脑膜刺激征、节段性刺激和短暂的颅神经麻痹。在整个临床病程中未见其他器官受累及传染病的全身症状。最重要的是，尽早开始使用链霉素、磺胺类药物、庆大霉素、利福平及四环素联合治疗对预后起决定性作用。
