Department of Rheumatology and Immunology, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an, 710003, People's Republic of China.
BMC Infect Dis. 2020 Sep 7;20(1):654. doi: 10.1186/s12879-020-05358-z.
Brucellosis is a zoonotic disease caused by brucella. It has been an increasing trend in recent years (Wang H, Xu WM, Zhu KJ, Zhu SJ, Zhang HF, Wang J, Yang Y, Shao FY, Jiang NM, Tao ZY, Jin HY, Tang Y, Huo LL, Dong F, Li ZJ, Ding H, Liu ZG, Emerg Microbes Infect 9:889-99, 2020). Brucellosis is capable to invade multiple systems throughout the body, lacking in typical clinical manifestations, and easily misdiagnosed and mistreated.
We report a case of a male, 5-year-and-11-month old child without relevant medical history, who was admitted to hospital for 20 days of fever. When admitted to the hospital, we found that he was enervated, irritable and sleepy, accompanied with red eyes phenomenon. After anti-infection treatment with meropenem, no improvement observed. Lumbar puncture revealed normal CSF protein, normal cells, and negative culture. Later, doppler echocardiography suggested coronary aneurysms, and incomplete Kawasaki Disease with coronary aneurysms was proposed. The next day, brucellosis agglutination test was positive. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid suggested B.melitensis, which was confirmed again by blood culture. The child was finally diagnosed as brucellosis with meningocephalitis, coronary aneurysm and keratitis. According to our preliminary research and review, such case has never been reported in detail before. After diagnosis confirmation, the child was treated with rifampicin, compound sulfamethoxazole, and ceftriaxone for cocktail anti-infection therapy. Aspirin and dipyridamole were also applied for anticoagulant therapy. After medical treatment, body temperature of the child has reached normal level, eye symptoms alleviated, and mental condition gradually turned normal. Re-examination of the doppler echocardiographic indicated that the coronary aneurysm was aggravated, so warfarin was added for amplification of anticoagulation treatment. At present, 3 months of follow-up, the coronary artery dilatation gradually assuaged, and the condition is continued to alleviate.
Brucellosis can invade nervous system, coronary artery, and cornea. Brucellosis lacks specific signs for clinical diagnosis. The traditional agglutination test and the new mNGS are convenient and effective, which can provide the reference for clinical diagnosis.
布鲁氏菌病是一种由布鲁氏菌引起的人畜共患疾病。近年来呈上升趋势（Wang H、Xu WM、Zhu KJ、Zhu SJ、Zhang HF、Wang J、Yang Y、Shao FY、Jiang NM、Tao ZY、Jin HY、Tang Y、Huo LL、Dong F、Li ZJ、Ding H、Liu ZG、Emerg Microbes Infect 9:889-99, 2020）。布鲁氏菌病能够侵犯全身多个系统，缺乏典型的临床表现，容易误诊和误治。
我们报告了一例 5 岁 11 个月的男性患儿，无相关病史，因发热住院 20 天。入院时，患儿精神萎靡，烦躁，嗜睡，伴有眼红现象。经美罗培南抗感染治疗后无改善。腰椎穿刺显示脑脊液蛋白正常，细胞正常，培养阴性。后来，多普勒超声心动图提示冠状动脉瘤，不典型川崎病合并冠状动脉瘤被提出。次日，布氏菌凝集试验阳性。脑脊液宏基因组下一代测序（mNGS）提示 B.melitensis，血培养再次证实。患儿最终诊断为布鲁氏菌病伴脑膜脑炎、冠状动脉瘤和角膜炎。根据我们的初步研究和综述，以前从未详细报道过此类病例。确诊后，患儿接受利福平、复方磺胺甲噁唑和头孢曲松鸡尾酒抗感染治疗。还应用阿司匹林和双嘧达莫进行抗凝治疗。经过治疗，患儿体温恢复正常，眼部症状缓解，精神状态逐渐恢复正常。再次检查多普勒超声心动图提示冠状动脉瘤加重，故加用华法林强化抗凝治疗。目前，随访 3 个月，冠状动脉扩张逐渐缓解，病情持续缓解。
布鲁氏菌病可侵犯神经系统、冠状动脉和角膜。布鲁氏菌病缺乏特异性的临床诊断体征。传统的凝集试验和新的 mNGS 既方便又有效，可为临床诊断提供参考。
