Razaghi Reza, Kourkinejad Gharaei Fatemeh, Faroughi Forough
Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.
Department of Infectious Diseases, Emam Reza Hospital, Sirjan School of Medical Sciences, Sirjan, Iran.
IDCases. 2025 Mar 6;40:e02193. doi: 10.1016/j.idcr.2025.e02193. eCollection 2025.
Brucellosis is an endemic zoonotic disease in LMIC countries. Neurobrucellosis is a rare and serious complication that affects 3-5 % of cases worldwide. We report the successful treatment of a 31-year-old woman who presented with a chief complaint of headache and nausea. Headache was started six months before admission in the frontal and occipital area with radiation to the neck. The patient hospitalized three times within last six months with diagnosis of aseptic meningitis. Brucellosis, tuberculosis, and syphilis tests and CSF fluid analysis were requested. Neutrophilia and pleocytosis in CSF fluid. Analysis of CSF fluid for cytology and PCR test for HSV-1&2 was negative. Rheumatologic tests for SLE, Behcet's disease and sarcoidosis were also negative. Test results was as follow: Wright: 1/320, Coombs Wright: 1/640, 2ME: 1/160, Brucella IgG: 25(Positive). According to the test results, combined treatment with rifampin, Co-trimoxazole, and ceftriaxone was performed for neurobrucellosis for nine months. Considering the endemic prevalence of brucellosis in this region, the rare manifestations of this disease should be considered.
布鲁氏菌病是低收入和中等收入国家的一种地方性人畜共患病。神经型布鲁氏菌病是一种罕见且严重的并发症，在全球范围内3%-5%的病例会受到影响。我们报告了一名31岁女性的成功治疗案例，该患者的主要症状为头痛和恶心。头痛在入院前6个月开始，位于额部和枕部，并向颈部放射。患者在过去6个月内曾3次住院，诊断为无菌性脑膜炎。进行了布鲁氏菌病、结核病和梅毒检测以及脑脊液分析。脑脊液中出现中性粒细胞增多和细胞增多。脑脊液细胞学分析和单纯疱疹病毒1型和2型的聚合酶链反应检测均为阴性。系统性红斑狼疮、白塞病和结节病的风湿学检测也为阴性。检测结果如下：wright试验：1/320，Coombs wright试验：1/640，2ME试验：1/160，布鲁氏菌IgG：25（阳性）。根据检测结果，对神经型布鲁氏菌病采用利福平、复方新诺明和头孢曲松联合治疗9个月。考虑到该地区布鲁氏菌病的地方流行情况，应考虑这种疾病的罕见表现。
