|
|
癫痫发作：三例神经型布氏杆菌病的不典型临床表现
|
Abstract:
背景：神经型布氏杆菌病(NB)是由布氏杆菌引起的一种累及中枢神经系统的感染性疾病，它的临床表现多变，包括脑炎、脑膜炎、脑膜脑炎、神经根炎、脊髓炎、外周神经和颅神经病变等，癫痫是NB较为少见的临床表现。结果：本文报道了三例NB伴癫痫的病例。他们均出现头痛、发热等神经系统表现，布氏杆菌凝集试验均为阳性，且均有癫痫发作表现或脑电图有异常癫痫放电表现，经过利福平、多西环素等抗布氏杆菌治疗后症状均好转。结论：在布氏杆菌病流行的地区出现精神行为异常的患者应及时考虑癫痫发作的可能，并积极完善动态脑电图等相关检查，及时给予抗癫痫等相应治疗。
Background: Neurological brucellosis (NB) is an infectious disease affecting the central nervous system caused by Brucella. Its clinical manifestations vary widely, including encephalitis, meningitis, meningoencephalitis, radiculitis, myelitis, peripheral nerve, and cranial nerve involvement. Seizure is a rare clinical manifestation of NB. Results: This article reports three cases of NB accompanied by seizures. All patients presented with neurological symptoms such as headache and fever. Brucella agglutination test was positive in all cases, and they exhibited seizure episodes or abnormal epileptic discharges on electroencephalogram (EEG). Symptoms improved after treatment with antibiotics effective against Brucella such as rifampicin and doxycycline. Conclusion: Patients with psychiatric abnormalities in areas endemic for brucellosis should be promptly evaluated for the possibility of seizures. It is essential to conduct comprehensive evaluations including dynamic EEG and initiate appropriate anti-epileptic therapy in a timely manner.
| [1] | Gul, S. and Khan, A. (2007) Epidemiology and Epizootology of Brucellosis: A Review. Pakistan Veterinary Journal, 27, 145-151. |
| [2] | Inayat, A., Marwat, Q.U., Hayat, W., et al. (2020) Brucellosis Presenting with Pancytopenia and Foot Drop. Cureus, 12, E10293. https://doi.org/10.7759/cureus.10293 |
| [3] | Hull, N.C. and Schumaker, B.A. (2018) Comparisons of Brucellosis between Human and Veterinary Medicine. Infection Ecology & Epidemiology, 8, Article 1500846. https://doi.org/10.1080/20008686.2018.1500846 |
| [4] | Inayat, F., Mahboob, M., Ali, N.S., et al. (2018) Brucellosis in Renal Transplant Recipients: A Comparative Review of 5 Cases. BMJ Case Reports, 2018, Article 225065. https://doi.org/10.1136/bcr-2018-225865 |
| [5] | Yang, H., Wang, Z., Shi, S., et al. (2022) Identification of Cerebrospinal Fluid Metabolites as Biomarkers for Neurobrucellosis by Liquid Chromatography-Mass Spectrometry Approach. Bioengineered, 13, 6996-7010. https://doi.org/10.1080/21655979.2022.2037954 |
| [6] | Algahtani, H., Shirah, B., Abdulghani, D., et al. (2017) Occupational Neurobrucellosis Mimicking a Brain Tumor: A Case Report and Review of the Literature. Case Reports in Infectious Diseases, 2017, Article 1434051. https://doi.org/10.1155/2017/1434051 |
| [7] | Mehrabian, F., Abdi Layaee, Z. and Ahmadinejad, Z. (2019) Brucella Shunt Infection as a Rare Presentation of Neurobrucellosis. Case Reports in Infectious Diseases, 2019, Article 7291482. https://doi.org/10.1155/2019/7291482 |
| [8] | Naderi, H., Sheybani, F., Parsa, A., et al. (2022) Neurobrucellosis: Report of 54 Cases. Tropical Medicine and Health, 50, Article No. 77. https://doi.org/10.1186/s41182-022-00472-x |
| [9] | Khurana, D., Rajan, R., Turgut, A.T., et al. (2016) Cerebrovascular Involvement in Neurobrucellosis and Mycotic Aneurysms. In: Turgut, M., Haddad, F.S. and de Divitiis, O., Eds., Neurobrucellosis: Clinical, Diagnostic and Therapeutic Features, Springer International Publishing, 61-67. https://doi.org/10.1007/978-3-319-24639-0_9 |
| [10] | Oueslati, I., Berriche, A., Ammari, L., et al. (2016) Epidemiological and Clinical Characteristics of Neurobrucellosis Case Patients in Tunisia. Médecine et Maladies Infectieuses, 46, 123-130. https://doi.org/10.1016/j.medmal.2016.01.005 |
| [11] | Gul, H.C., Erdem, H. and Bek, S. (2009) Overview of Neurobrucellosis: A Pooled Analysis of 187 Cases. International Journal of Infectious Diseases, 13, E339-E343. https://doi.org/10.1016/j.ijid.2009.02.015 |
| [12] | Sathyanarayanan, V., Ragini, B., Razak, A., et al. (2010) Brucella Meningoencephalitis with Hydrocephalus Masquerading as Tuberculosis. Asian Pacific Journal of Tropical Medicine, 3, 835-837. https://doi.org/10.1016/S1995-7645(10)60201-5 |
| [13] | Patra, S., Kalwaje, E.V., Pai, A.R., et al. (2022) Evaluation of Clinical, Diagnostic Features and Therapeutic Outcome of Neurobrucellosis: A Case Series and Review of Literature. International Journal of Neuroscience, 132, 1080-1090. https://doi.org/10.1080/00207454.2020.1860969 |
| [14] | Erdem, H., Senbayrak, S., Gencer, S., et al. (2015) Tuberculous and Brucellosis Meningitis Differential Diagnosis. Travel Medicine and Infectious Disease, 13, Article 185-191. https://doi.org/10.1016/j.tmaid.2015.02.008 |
| [15] | Wang, Z., Wang, Y., Yang, H., et al. (2021) Doxycycline Induces Apoptosis of Brucella Suis S2 Strain-Infected HMC3 Microglial Cells by Activating Calreticulin-Dependent JNK/P53 Signaling Pathway. Frontiers in Cellular and Infection Microbiology, 11, Article 640847. https://doi.org/10.3389/fcimb.2021.640847 |
| [16] | Bains, R., Dahhan, T., Belzowski, A., et al. (2018) An Interesting Case of Neurobrucellosis Mimicking Neuropsychiatric Lupus. Case Reports in Rheumatology, 2018, Article 9793535. https://doi.org/10.1155/2018/9793535 |
| [17] | Fan, S., Ren, H., Wei, Y., et al. (2018) Next-Generation Sequencing of the Cerebrospinal Fluid in the Diagnosis of Neurobrucellosis. International Journal of Infectious Diseases, 67, 20-24. https://doi.org/10.1016/j.ijid.2017.11.028 |
| [18] | Nepal, G., Balayar, R., Bhatta, S., et al. (2021) Neurobrucellosis: A Differential Not to Be Missed in Patients Presenting with Neuropsychiatric Features. Clinical Case Reports, 9, E04190. https://doi.org/10.1002/ccr3.4190 |
| [19] | Saeed, M., Al Bishri, A., Gammaa, S., et al. (2022) Neurobrucellosis Presenting with Features of Demyelinating Disorder in a Pediatric Patient. Journal of the College of Physicians and Surgeons Pakistan, 32, 247-249. https://doi.org/10.29271/jcpsp.2022.02.247 |
| [20] | Acharya, A., Regmi, A., Manandhar, K., et al. (2022) Neurobrucellosis Presenting with the Features of Meningoencephalitis: A Case Report from Nepal. Annals of Medicine and Surgery, 80, Article 104278. https://doi.org/10.1016/j.amsu.2022.104278 |
| [21] | Erdem, H., Ulu-Kilic, A., Kilic, S., et al. (2012) Efficacy and Tolerability of Antibiotic Combinations in Neurobrucellosis: Results of the Istanbul Study. Antimicrobial Agents and Chemotherapy, 56, 1523-1528. https://doi.org/10.1128/AAC.05974-11 |
| [22] | Alqwaifly, M., Al-Ajlan, F.S., Al-Hindi, H., et al. (2017) Central Nervous System Brucellosis Granuloma and White Matter Disease in Immunocompromised Patient. Emerging Infectious Diseases, 23, 978-981. https://doi.org/10.3201/eid2306.161173 |
| [23] | Faraji, F., Didgar, F., Talaie-Zanjani, A., et al. (2013) Uncontrolled Seizures Resulting from Cerebral Venous Sinus Thrombosis Complicating Neurobrucellosis. Journal of Neurosciences in Rural Practice, 4, 313-316. https://doi.org/10.4103/0976-3147.118780 |
