Clinical presentions and features of diagnostic examinations of neurobrucellosis

doi:10.3877/cma.j.issn.1674-1358.2018.03.007

Abstract

Abstract:

Objective

To investigate the clinical and laboratory diagnosis of neurobrucellosis (NB), and to provide the experience for improving the early diagnosis and treatment of NB in clinical and laboratory practice.

Methods

The clinical manifestations, epidemiological data and cerebrospinal fluid (CSF) culture of 12 patients with NB confirmed in Xuanwu Hospital of Capital Medical University from January 2015 to January 2017 were analyzed, retrospectively. The results of other laboratory examination including average age of patients, level of CSF leukocyte count, protein content, chloride, glucose were examined and compared with patients with non-NB.

Results

Among the 12 cases of neurobrucellosis, 9 cases were males and 3 cases were femals, with an average age of (43 ± 14) years old. Ten patients came from epidemic areas of brucellosis and 9 had a clear history of epidemiological contact. Three of them had previously been diagnosed as brucellosis. All the 12 cases had fever of different degrees, 6 with headache and meningeal irritation, 3 cases presented diplopia and decreased vision. Hearing loss with gait instability, limbs numbness and mental status changed occured in 4 cases, respectively. The positive rate of Brucella blood agglutination test (100%) was higher than that of CSF agglutination test (58.3%) and CSF culture (46.1%) in clinical diagnosis of NB, with significant differences (χ² = 52.68, P = 0.005; χ² = 73.79, P = 0.005). The count of CSF leukocyte (monocyte) and levels of protein increased in 12 patients with NB. The glucose and chloride levels were normal or decreased. Compared with other non-NB diseases, CSF glucose detection was with great value in patients with NB (P < 0.05). All 12 cases with NB who treated with doxycycline or minocycline + rifampin + ceftriaxone were with a good prognosis.

Conclusions

The clinical presentation of neurobrucellosis are diverse and easy to be misdiagnosed or missed. CSF blood culture and brucellosis agglutination should be emphasized by medical staff in non-endemic areas. In addition, the multidisciplinary cooperation is proved to be helpful for early diagnosis and treatment of neurobrucellosis.

Key words: Neurobrucellosis, Cerebrospinal fluid, 16S rRNA, Brucella blood serum agglutination test

Jingrong Cao, Yan Wang, Yuying Wang, Wei Xie, Diandian Chen, Yuanyuan Duan, Rong Min, Peichang Wang. Clinical presentions and features of diagnostic examinations of neurobrucellosis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(03): 235-239.

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References 20

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组别	性别（例）		年龄（岁）		CSF（ ± s）
组别	男	女	年龄	平均年龄（ ± s）	白细胞（× 10⁶/L）	蛋白（mg/dl）	葡萄糖（mmol/L）	氯化物（mmol/L）
神经型布鲁菌病	9	3	22~60	43.0 ± 14.0	157.8 ± 69.0	167.7 ± 88.7	1.85 ± 0.5	111.1 ± 6.9
神经梅毒	16	4	29~78	52.6 ± 12.0	78.8 ± 69.0	64.9 ± 22.8	3.19 ± 1.1	115.3 ± 3.5
细菌性脑膜炎	20	15	9~80	49.1 ± 16.0	355.5 ± 290.8	267.7 ± 88.7	1.25 ± 0.5	105.1 ± 5.9
隐球菌脑膜炎	5	1	22~53	40.2 ± 12.8	70.8 ± 18.8	82.2 ± 16.5	1.42 ± 0.3	107.0 ± 4.6
病毒性脑炎	12	10	16~56	36.3 ± 14.7	75.8 ± 18.0	54.2 ± 18.2	3.3 ± 0.6	121.3 ± 4.1
非感染	10	10	25~65	40.0 ± 12.0	5.0 ± 18.0	30.0 ± 15.2	3.0 ± 1.25	122.0 ± 2.2
F值				1.087	176.880	22.630	9.700	5.440
P值				0.521	0.001	0.001	0.001	0.001

组别	性别（例）		年龄（岁）		CSF（ ± s）
组别	男	女	年龄	平均年龄（ ± s）	白细胞（× 10⁶/L）	蛋白（mg/dl）	葡萄糖（mmol/L）	氯化物（mmol/L）
神经型布鲁菌病	9	3	22~60	43.0 ± 14.0	157.8 ± 69.0	167.7 ± 88.7	1.85 ± 0.5	111.1 ± 6.9
神经梅毒	16	4	29~78	52.6 ± 12.0	78.8 ± 69.0	64.9 ± 22.8	3.19 ± 1.1	115.3 ± 3.5
细菌性脑膜炎	20	15	9~80	49.1 ± 16.0	355.5 ± 290.8	267.7 ± 88.7	1.25 ± 0.5	105.1 ± 5.9
隐球菌脑膜炎	5	1	22~53	40.2 ± 12.8	70.8 ± 18.8	82.2 ± 16.5	1.42 ± 0.3	107.0 ± 4.6
病毒性脑炎	12	10	16~56	36.3 ± 14.7	75.8 ± 18.0	54.2 ± 18.2	3.3 ± 0.6	121.3 ± 4.1
非感染	10	10	25~65	40.0 ± 12.0	5.0 ± 18.0	30.0 ± 15.2	3.0 ± 1.25	122.0 ± 2.2
F值				1.087	176.880	22.630	9.700	5.440
P值				0.521	0.001	0.001	0.001	0.001

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