Acharya Aakash, Regmi Anil, Manandhar Kabita, Yaday Jayant, Karki Pragya
Department of Internal Medicine, Dr Iwamura Memorial Hospital, Sallaghari, Bhaktapur, Nepal.
Department of Internal Medicine, Thankot Primary Hospital, Kathmandu, Nepal.
Ann Med Surg (Lond). 2022 Aug 6;80:104278. doi: 10.1016/j.amsu.2022.104278. eCollection 2022 Aug.
Brucellosis or Malta fever is a zoonotic disease caused by the Brucella species. Patients with neurobrucellosis may present with features of meningoencephalitis. Thus, a high degree of suspicion is required for the diagnosis in the endemic region.
A 13-year old female with a history of exposure to domestic animals presented with the features of meningoencephalitis (intermittent fever with chills and rigor and generalized tonic-clonic seizure).
Examination revealed drowsy and lethargic patient with bilateral edema up to mid-shin. Neck rigidity was present. Lab findings include leukocytosis with neutrophilic and erythrocyte sedimentation rate (25 mm/hr). CECT of the brain revealed vasogenic edema. Routine CSF examination was insignificant for common bacterial, viral, fungal or tubercular etiology. CSF ELISA confirmed the presence of Brucella antibody.
When patients present with undulant fever, lethargy, seizure, or other features of meningitis/encephalitis, the diagnosis of neurobrucellosis must be considered after common pathological causes are ruled out.
布鲁氏菌病或马耳他热是一种由布鲁氏菌属引起的人畜共患病。神经型布鲁氏菌病患者可能表现出脑膜脑炎的症状。因此，在流行地区进行诊断时需要高度怀疑。
一名13岁女性，有接触家畜史，表现出脑膜脑炎症状（间歇性发热伴寒战和强直，全身性强直阵挛发作）。
检查发现患者嗜睡、昏睡，双侧小腿中部以下水肿。存在颈部强直。实验室检查结果包括白细胞增多伴中性粒细胞增多，红细胞沉降率为25毫米/小时。脑部CT增强扫描显示血管源性水肿。常规脑脊液检查对常见细菌、病毒、真菌或结核病因无明显异常。脑脊液酶联免疫吸附测定证实存在布鲁氏菌抗体。
当患者出现波状热、嗜睡、癫痫发作或其他脑膜炎/脑炎症状时，在排除常见病理原因后，必须考虑神经型布鲁氏菌病的诊断。
