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Abstract：
BACKGROUND: Neurobrucellosis (NB) is a rare and serious complication of brucellosis. Its clinical manifestations vary, with no obvious specificity. At present, there is no clear clinical diagnosis or treatment for reference. In this study, we retrospectively analyzed the clinical data for 21 patients with NB to provide reference data for its further study.
METHODS: We analyzed the epidemiological and clinical manifestations, laboratory tests, imaging examinations, cerebrospinal fluid, and treatment plans of 21 patients diagnosed with NB in the Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China.
RESULTS: The ages of the patients ranged from 15 to 60 years old (mean age 40.1 ± 13.33 years), the male: female ratio was 4.25:1. Thirteen patients had a history of animal (sheep, cattle) contact, three had no history of animal contact, and the contact status of four was unknown. Brucella can invade various systems of the body and show multi-system symptoms, the main general manifestations were fever (66.67%), fatigue (57.14%) and functional urination or defecation disturbance (42.86%). The main nervous system manifestations were limb weakness (52.38%) and hearing loss (47.62%).The main positive signs of the nervous system included positive pathological signs (71.43%), sensory abnormalities (52.38%), limb paralysis (42.86%). Nervous system lesions mainly included spinal cord damage (66.67%), cranial nerve involvement (61.90%), central demyelination (28.57%) and meningitis (28.57%). In patients with cranial nerve involvement, 69.23% of auditory nerve, 15.38% of optic nerve and 15.38% of oculomotor nerve were involved. The blood of eight patients was cultured for Brucella, and three (37.5%) cultures were positive and five (63.5%) negative. The cerebrospinal fluid (CSF) of eight patients was cultured for Brucella, and two (25.00%) cultures were positive and six (75.00%) negative. Nineteen of the patients underwent a serum agglutination test (SAT), 18 (94.74%) of whom were positive and one (5.26%) of whom were negative. A biochemical analysis of the CSF was performed in 21 patients, and the results were all abnormal. Nineteen patients underwent magnetic resonance imaging (MRI). Twenty-one patients were treated with doxycycline and/or rifampicin, combined with ceftriaxone, quinolone, aminoglycoside, or minocycline. After hospitalization, 15 patients improved (71.43%), two patients did not recover, and the status of four patients was unknown.
CONCLUSIONS: The clinical manifestations, CSF parameters, and neurological imaging data for patients with NB show no significant specificity or correlations. When patients with unexplained neurological symptoms accompanied by fever, fatigue, and other systemic manifestations in a brucellosis epidemic area or with a history of contact with cattle, sheep, animals, or raw food are encountered in clinical practice, the possibility of NB should be considered. Treatment is based on the principles of an early, combined, and long course of treatment, and the general prognosis is good.
METHODS: We analyzed the epidemiological and clinical manifestations, laboratory tests, imaging examinations, cerebrospinal fluid, and treatment plans of 21 patients diagnosed with NB in the Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China.
RESULTS: The ages of the patients ranged from 15 to 60 years old (mean age 40.1 ± 13.33 years), the male: female ratio was 4.25:1. Thirteen patients had a history of animal (sheep, cattle) contact, three had no history of animal contact, and the contact status of four was unknown. Brucella can invade various systems of the body and show multi-system symptoms, the main general manifestations were fever (66.67%), fatigue (57.14%) and functional urination or defecation disturbance (42.86%). The main nervous system manifestations were limb weakness (52.38%) and hearing loss (47.62%).The main positive signs of the nervous system included positive pathological signs (71.43%), sensory abnormalities (52.38%), limb paralysis (42.86%). Nervous system lesions mainly included spinal cord damage (66.67%), cranial nerve involvement (61.90%), central demyelination (28.57%) and meningitis (28.57%). In patients with cranial nerve involvement, 69.23% of auditory nerve, 15.38% of optic nerve and 15.38% of oculomotor nerve were involved. The blood of eight patients was cultured for Brucella, and three (37.5%) cultures were positive and five (63.5%) negative. The cerebrospinal fluid (CSF) of eight patients was cultured for Brucella, and two (25.00%) cultures were positive and six (75.00%) negative. Nineteen of the patients underwent a serum agglutination test (SAT), 18 (94.74%) of whom were positive and one (5.26%) of whom were negative. A biochemical analysis of the CSF was performed in 21 patients, and the results were all abnormal. Nineteen patients underwent magnetic resonance imaging (MRI). Twenty-one patients were treated with doxycycline and/or rifampicin, combined with ceftriaxone, quinolone, aminoglycoside, or minocycline. After hospitalization, 15 patients improved (71.43%), two patients did not recover, and the status of four patients was unknown.
CONCLUSIONS: The clinical manifestations, CSF parameters, and neurological imaging data for patients with NB show no significant specificity or correlations. When patients with unexplained neurological symptoms accompanied by fever, fatigue, and other systemic manifestations in a brucellosis epidemic area or with a history of contact with cattle, sheep, animals, or raw food are encountered in clinical practice, the possibility of NB should be considered. Treatment is based on the principles of an early, combined, and long course of treatment, and the general prognosis is good.
摘要：
背景：神经布鲁氏菌病（NB）是布鲁氏菌病的一种罕见且严重的并发症。其临床表现各异,没有明显的特异性。目前,目前尚无明确的临床诊断或治疗方法可供参考。在这项研究中,我们对21例NB患者的临床资料进行回顾性分析，为其进一步研究提供参考数据。
方法：我们分析了流行病学和临床表现，实验室测试,影像学检查,脑脊液,神经内科诊断为NB的21例患者的治疗计划，宣武医院,首都医科大学,北京,中国。
结果：患者的年龄范围为15至60岁（平均年龄40.1±13.33岁），男女比例为4.25:1。13例患者有动物史（绵羊，牛)接触，三人没有动物接触史,四个人的接触状态不详.布鲁氏菌可以侵入身体的各个系统并显示多系统症状，主要表现为发热(66.67%),疲劳(57.14%)和功能性排尿或排便障碍(42.86%)。神经系统主要表现为肢体无力(52.38%)和听力损失(47.62%)。神经系统的主要阳性体征包括阳性病理体征(71.43%),感觉异常（52.38%），肢体瘫痪(42.86%)。神经系统病变主要包括脊髓损伤(66.67%),颅神经受累（61.90%），中央脱髓鞘（28.57％）和脑膜炎（28.57％）。在脑神经受累的患者中，69.23%的听觉神经，15.38%的视神经和15.38%的动眼神经受累。对8名病人的血液进行布鲁氏菌培养,3例（37.5%）培养阳性，5例（63.5%）阴性。8例患者的脑脊液（CSF）进行布鲁氏菌培养，2例（25.00%）培养阳性，6例（75.00%）阴性。19例患者接受了血清凝集试验(SAT),其中18例（94.74%）为阳性，1例（5.26%）为阴性。对21例患者进行了脑脊液生化分析，结果都不正常.19例患者接受了磁共振成像（MRI）。21例患者接受多西环素和/或利福平治疗，联合头孢曲松,喹诺酮,氨基糖苷类,或者米诺环素。住院后,改善15例（71.43%），两名患者没有康复，4名患者的状态不详。
结论：临床表现，CSF参数，NB患者的神经影像学数据显示没有明显的特异性或相关性。当患者出现无法解释的神经系统症状并伴有发热时，疲劳,以及布鲁氏菌病流行地区或有与牛接触史的其他系统性表现，绵羊,动物,或者在临床实践中遇到生食，应该考虑NB的可能性。治疗是基于早期的原则，合并,和长期的治疗过程，一般预后良好。
方法：我们分析了流行病学和临床表现，实验室测试,影像学检查,脑脊液,神经内科诊断为NB的21例患者的治疗计划，宣武医院,首都医科大学,北京,中国。
结果：患者的年龄范围为15至60岁（平均年龄40.1±13.33岁），男女比例为4.25:1。13例患者有动物史（绵羊，牛)接触，三人没有动物接触史,四个人的接触状态不详.布鲁氏菌可以侵入身体的各个系统并显示多系统症状，主要表现为发热(66.67%),疲劳(57.14%)和功能性排尿或排便障碍(42.86%)。神经系统主要表现为肢体无力(52.38%)和听力损失(47.62%)。神经系统的主要阳性体征包括阳性病理体征(71.43%),感觉异常（52.38%），肢体瘫痪(42.86%)。神经系统病变主要包括脊髓损伤(66.67%),颅神经受累（61.90%），中央脱髓鞘（28.57％）和脑膜炎（28.57％）。在脑神经受累的患者中，69.23%的听觉神经，15.38%的视神经和15.38%的动眼神经受累。对8名病人的血液进行布鲁氏菌培养,3例（37.5%）培养阳性，5例（63.5%）阴性。8例患者的脑脊液（CSF）进行布鲁氏菌培养，2例（25.00%）培养阳性，6例（75.00%）阴性。19例患者接受了血清凝集试验(SAT),其中18例（94.74%）为阳性，1例（5.26%）为阴性。对21例患者进行了脑脊液生化分析，结果都不正常.19例患者接受了磁共振成像（MRI）。21例患者接受多西环素和/或利福平治疗，联合头孢曲松,喹诺酮,氨基糖苷类,或者米诺环素。住院后,改善15例（71.43%），两名患者没有康复，4名患者的状态不详。
结论：临床表现，CSF参数，NB患者的神经影像学数据显示没有明显的特异性或相关性。当患者出现无法解释的神经系统症状并伴有发热时，疲劳,以及布鲁氏菌病流行地区或有与牛接触史的其他系统性表现，绵羊,动物,或者在临床实践中遇到生食，应该考虑NB的可能性。治疗是基于早期的原则，合并,和长期的治疗过程，一般预后良好。
