Habeeb Y K, Al-Najdi A K, Sadek S A, Al-Onaizi E
Department of Paediatrics, Adan Hospital, Kuwait.
J Infect. 1998 Jul;37(1):59-62. doi: 10.1016/s0163-4453(98)90647-8.
Neurological complications are rare in childhood brucellosis: there are only 33 reported cases. In children, neurobrucellosis is usually of acute presentation involving the central nervous system. We report our experience with an 8-year-old boy with brucella meningitis who demonstrated a Jarisch-Herxheimer-like reaction, i.e. initial clinical deterioration following the commencement of antibrucella treatment, associated with increased pleocytosis and shift from lymphocytic to polymorphic predominance and an already increased CSF lactate. These CSF findings have not been previously described. The patient recovered completely after 3 months' therapy consisting of rifampicin, doxycycline and gentamicin. Paediatric neurobrucellosis therapy should be a combination of three antibrucella antibiotic that include an aminoglycoside; for a period of 8-12 weeks, steroids may be added to treat complications. The prognosis of neurobrucellosis in children is usually good.
仅有33例报告病例。在儿童中，神经型布鲁氏菌病通常急性起病，累及中枢神经系统。我们报告了一名8岁患布鲁氏菌性脑膜炎男孩的病例，该患儿出现了类赫氏反应，即在抗布鲁氏菌治疗开始后最初出现临床病情恶化，伴有脑脊液细胞数增多，且从以淋巴细胞为主转变为以多形核细胞为主，同时脑脊液乳酸水平已升高。这些脑脊液检查结果此前未见报道。该患者在接受由利福平、强力霉素和庆大霉素组成的3个月治疗后完全康复。儿童神经型布鲁氏菌病的治疗应采用三种抗布鲁氏菌抗生素联合使用，其中包括一种氨基糖苷类抗生素；疗程为8至12周，可加用类固醇激素治疗并发症。儿童神经型布鲁氏菌病的预后通常良好。
