背景:神经布鲁氏菌病存在各种临床挑战和长期并发症的风险。
目的:我们旨在评估抗生素治疗持续时间之间的关系,临床因素,并结合文献系统回顾了一例病例报告和神经布鲁氏菌病的转归。
方法:我们介绍了一例31岁男性在我们机构成功治疗的病例。然后我们搜索了OvidMEDLINE,Embase和Scopus涵盖神经布鲁氏菌病病例的文章,治疗持续时间,和结果。主要结果是评估治疗持续时间与后遗症或复发风险之间的关联。单变量,进行了多变量和敏感性分析,以确定哪些变量会影响临床结果。使用专用工具进行质量评估。
结果:共纳入123项研究,共221名患者。中位治疗时间为4个月(IQR3-6),69%的患者恢复无后遗症,27%有后遗症。此外,五名患者复发,4名患者死亡。多因素分析发现,治疗时间,年龄,头孢曲松的使用与较高的后遗症或复发风险无关。发现皮质类固醇的使用存在显着关联(OR0.39,95%IC0.16-0.96,p=0.038),运动障碍(OR0.29,95%IC0.14-0.62,p=0.002),和听力损失(OR0.037,95%IC0.01-0.11,p<0.001)。
结论:本研究强调了神经布鲁氏菌病临床表现和治疗方法的差异性。具有较高后遗症风险因素的患者需要细致的随访。
BACKGROUND: Neurobrucellosis presents diverse clinical challenges and risks of long-term complications.
OBJECTIVE: We aimed to assess the relationship between the duration of antibiotic therapy, clinical factors, and the outcome of neurobrucellosis with a case report combined with a systematic review of the literature.
METHODS: We present a case of a 31 years-old man successfully treated at our Institution. We then searched Ovid MEDLINE, Embase and Scopus for articles that encompassed neurobrucellosis cases, duration of treatment, and outcome. The primary outcome was to assess an association between the duration of treatment and the risk of sequelae or relapses. Univariate, multivariate and sensitivity analysis were carried out to define which variables affected the clinical outcome. Quality assessment was performed using a dedicated tool.
RESULTS: A total of 123 studies were included, totaling 221 patients. Median duration of treatment was 4 months (IQR 3 - 6), 69% patients recovered without sequelae, 27% had sequelae. Additionally, five patients had a relapse, and 4 patients died. Multivariate analysis found that the duration of treatment, age, and the use of ceftriaxone were not associated with a higher risk of sequelae or relapses. A significant association was found for corticosteroids use (OR 0.39, 95% IC 0.16 - 0.96, p = 0.038), motor impairment (OR 0.29, 95% IC 0.14 - 0.62, p = 0.002), and hearing loss (OR 0.037, 95% IC 0.01 - 0.11, p < 0.001).
CONCLUSIONS: This study highlights the variability in clinical presentations and treatment approaches for neurobrucellosis. Patients with factors indicating higher sequelae risk require meticulous follow-up.