摘要：

目的: 分析非疫区神经型布鲁菌病的临床特点，以提高对非疫区神经型布鲁菌病的认识，减少误诊。方法与结果: 青岛大学附属医院2024年10月10日收治1例54岁男性患者，入院前6个月突发双侧听觉障碍，病程中出现发作性肢体无力（后考虑症状性癫痫）、体温升高、谵妄；脑脊液显示淋巴细胞计数增加、蛋白定量升高、葡萄糖降低；脑脊液培养分离出马耳他布鲁菌，血清布鲁菌乳胶凝集试验阳性；头部MRI增强扫描显示右侧额叶局灶性异常强化影。追问接触史，为肉牛饲养员且饲养环境不卫生，遂明确诊断为神经型布鲁菌病。予以头孢曲松、利福平、多西环素联合抗感染治疗后病情好转。出院后4个月随访症状无复发，血清布鲁菌乳胶凝集试验仍阳性，遗留严重听觉障碍。结论: 非疫区不明原因的听觉障碍伴发热及神经系统症状时，应警惕神经型布鲁菌病的可能，早期病原学筛查及长疗程头孢曲松、利福平、多西环素联合治疗对改善预后至关重要。

关键词: 布鲁杆菌病, 神经系统, 听觉障碍, 癫痫, 胶乳结合试验, 血液, 脑脊髓液

Abstract:

Objective: To analyze the clinical characteristics of neurobrucellosis in non-endemic areas, improve awareness of the disease in such regions, and reduce misdiagnosis. Methods and Results: A 54-year-old male patient was admitted in The Affiliated Hospital of Qingdao University on October 10, 2024 presented with sudden bilateral hearing impairment 6 months before admission. During the course of the disease, he developed paroxysmal limb weakness (later considered symptomatic epilepsy), fever and delirium. Cerebrospinal fluid (CSF) examination showed increased lymphocyte count, elevated protein, and decreased glucose levels. Brucella melitensis was isolated from CSF culture, and the serum brucella latex agglutination test was positive. Cranial MRI revealed focal abnormal enhancing lesion in the right frontal lobe. Further inquiry of exposure history confirmed that he was a beef cattle breeder with unsanitary breeding conditions. A definite diagnosis of neurobrucellosis was established. The patient was treated with a combination regimen of ceftriaxone, rifampicin and doxycycline, and his clinical condition improved. He completed 4 months of standard therapy after discharge. At 4 months' follow-up, there was no symptom recurrence; however, the serum brucella latex agglutination test remained positive, and severe hearing impairment persisted as a sequela. Conclusions: Neurobrucellosis should be highly suspected in patients from non-endemic areas presenting with unexplained hearing impairment accompanied by fever and neurological symptoms. Early etiological screening and long-term combination antimicrobial therapy of ceftriaxone, rifampicin and doxycycline are critical for improving prognosis.

Key words: Brucellosis, Nervous system, Auditory perceptual disorders, Epilepsy, Latex fixation tests, Blood, Cerebrospinal fluid

中图分类号: 

• R741.04