| 冀小波,毛敏杰,汪彩红,徐节坤,潘晓鸿,潘蕾,邱君克,黄晓庆.羊布鲁氏菌脑病误诊为结核性脑膜炎一例及文献复习[J].浙江中西医结合杂志,2022,32(10): |
| 羊布鲁氏菌脑病误诊为结核性脑膜炎一例及文献复习 |
| Brucella encephalopathy of sheep misdiagnosed as tuberculous meningitis: a case report and review of literature |
| 投稿时间：2022-01-13 修订日期：2022-04-18 |
| DOI： |
| 中文关键词: 布鲁氏菌脑膜炎，误诊，结核性脑膜炎 |
| 英文关键词:Brucellosis, meningitis, misdiagnosis, tuberculosis meningitis |
| 基金项目: |
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| 中文摘要: |
| 布鲁氏菌病可累及全身多个系统，累及神经系统者在我国较为少见，临床表现不典型，容易引起误诊。作者报道了1例羊布鲁氏菌脑病误诊为结核性脑膜炎患者。该患者发生在不典型地区，病程长，辗转于多家医院，以发热和神经系统为主要表现，无关节疼痛、肝脾淋巴结肿大及生殖系统受累表现，血常规示白细胞不高，脑脊液提示“淋巴细胞比例增高，葡萄糖和氯化物降低”，头颅MRI增强脑膜炎考虑，临床考虑“结核性脑膜炎”给予诊断性治疗后效果欠佳。后脑脊液二代基因测序、血培养、脑脊液培养提示“羊布鲁氏菌”，诊断更正为“布鲁氏菌脑病”，给予正规抗感染治疗后好转出院。作者通过复习相关文献，讨论了布鲁氏菌脑病的治疗方法及与结核性脑膜炎的鉴别，警惕临床医生加强病史采集意识、可借助二代基因测序等手段以加快疾病诊断、减少误诊率。 |
| 英文摘要: |
| Brucellosis can involve multiple systems throughout the body, but involvement of the nervous system is rare in China, and the clinical manifestations are atypical, which can easily lead to misdiagnosis. The authors reported a case of brucellosis in sheep misdiagnosed as tuberculous meningitis.The patient had a long course of disease in an atypical area and was transferred to several hospitals. The main manifestations were fever and neurological, without joint pain, enlarged liver and spleen lymph nodes, or reproductive system involvement. Meningitis was considered, and clinical consideration was given to "tuberculous meningitis" with poor results after diagnostic treatment.The diagnosis was corrected to "brucellosis encephalopathy" after cerebrospinal fluid second-generation gene sequencing, blood culture and cerebrospinal fluid culture suggested "brucella sheep", and the patient was discharged after regular anti-infection treatment. By reviewing the relevant literature, theauthors discussed the treatment of Brucella encephalopathy and the differentiation from tuberculous meningitis.At the same time, to accelerate disease diagnosis and reduce misdiagnosis rate, we should strengthen the awareness of history collection and use second-generation gene sequencing. |
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