Ge Y, Guan H Z, Fan S Y, Zhu R, Ma X J, Li T S
Department of Infectious Disease, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2017 Oct 1;56(10):729-733. doi: 10.3760/cma.j.issn.0578-1426.2017.10.004.
To investigate the epidemiological and clinical features of 20 patients with neurobrucellosis (NB) . The epidemiological, clinical, laboratory and treatment data of patients diagnosed with NB from 2010 to 2016 in Peking Union Medical College Hospital were retrospectively analyzed. Twelve (60%) patients reported the history of contact with infected animals and intake of raw milk product. The common manifestations included headache (85%, 17/20), fatigue (85%, 17/20), fever (80%, 16/20), weight loss (70%, 15/20), the signs included pathological reflection (70%, 15/20), decreased muscle strength(45%, 9/20). The mean time to diagnosis was 7.9 months. All patients were diagnosed by positive serum antibody against . Body fluid culture revealed positive blood in 5 (31.2%, 5/16) patients and positive cerebrospinal fluid in 3 (16.7%, 3/18) patients. The medication consisted of rifampicin and minocycline based regimens or combined with ceftriaxone, fluroquinolone, streptomycin or trimethoprim-sulfamethoxazole (TMP-SMX). Ninety percent(18/20) patients obtained clinical improvement, whereas mild sequelae were observed in 5 patients. Clinical features of NB are heterogeneous. Carefully seek for epidemiological clues and early tests for may lead to well outcome. Combination therapy with two or more active antimicrobial agents is suggested.
为研究20例神经型布鲁氏菌病（NB）患者的流行病学及临床特征。回顾性分析2010年至2016年在北京协和医院诊断为NB患者的流行病学、临床、实验室及治疗资料。12例（60%）患者有接触感染动物及摄入生奶制品史。常见表现包括头痛（85%，17/20）、乏力（85%，17/20）、发热（80%，16/20）、体重减轻（70%，15/20）；体征包括病理反射（70%，15/20）、肌力下降（45%，9/20）。平均诊断时间为7.9个月。所有患者均通过血清抗体阳性确诊。体液培养显示5例（31.2%，5/16）患者血培养阳性，3例（16.7%，3/18）患者脑脊液培养阳性。治疗药物包括基于利福平及米诺环素的方案，或联合头孢曲松、氟喹诺酮、链霉素或复方磺胺甲恶唑（TMP-SMX）。90%（18/20）的患者临床症状改善，5例患者出现轻度后遗症。NB的临床特征具有异质性。仔细寻找流行病学线索并早期检测可能带来良好预后。建议采用两种或更多种活性抗菌药物联合治疗。
