布氏杆菌脑膜炎1例报告并文献复习.doc

　　布氏杆菌脑膜炎1例报告并文献复习 【摘要】 目的 探讨布氏杆菌脑膜炎的临床特征及治疗措施。方法 布氏杆菌脑膜炎患儿1例。患儿,男, 14岁。因“间断发热、头痛16d”入院。家中养猪、羊,但否认密切接触。回顾性分析该患儿临床资料。检索国内外文献,进行总结分析。结果 患儿为亚急性病程,主要表现为发热、头痛和脑膜刺激征阳性,脑脊液检查示ethod: One case of bru-cellarmeningitis itted to hospital ily raised pig and sheep, but he denied contacting closely ilk and mutton. Results:　The course of this reported child anifestations included fever, headache and meningeal irritation sign positive. The cerebrospinal fluid (CSF) findings shoildly elevated phocyte predominance, increased protein, sugar and chloride reduction.The serum bacterium burgeri antibody pin, doxycycline and ceftriaxone sodium and other symptomatic treatment al 2 pin for 8 estic and foreign documents sho plications of brucellosis in children ain clinical manifestations eningitis/meningocephalitis. Neurobrucellosis could be misdiagnosed as tuberculous meningitis, because the course of disease, clinical manifestations and CSF findings iilar. Therapeutic alliance including 3 kinds of antibiotics, eningitis. The total course of treatment shouldn’t be shorter than 8 iological investigation, serum agglutination test and cerebrospinal fluid culture, for early diagnosis. 【Key mol/L,蛋白1.2g/l，氯103mmol/l,考虑中枢神经系统感染转来我院。患儿发病以来精神欠佳,无皮疹、关节痛、乏力和多汗及体重下降等。家住山西农村，家中养猪，羊等牲畜,但否认密切接触,否认生食羊奶及肉制品,既往曾于4月前反复发热1月，在当地医院确诊布鲁氏杆菌病，予头孢曲松及四环素治疗半月后痊愈，家中其他成员体健。常规接种疫苗。入院查体: 体温37.5℃, 脉搏65次/min, 呼吸25次/min,体重42kg,神清,精神欠佳,皮肤未见皮疹及出血点，左上臂可见卡疤，双侧瞳孔等大等圆，对光反射灵敏，右眼内斜视，视物模糊，有复视，颈抵抗阳性，心音有力，律齐，未闻及杂音，肺腹查体无特殊,四肢肌张力正常，角膜反射及腹壁反射正常引出，双膝腱反射活跃,双侧克氏征及布氏征阳性。入院后查血g/L。ESR 20mm/1h。肝肾功能正常，血Ig系列和CD系列正常。脑脊液压力2.74kPa,外观无色清亮，潘迪氏实验弱阳性，细胞数26×106/L，多核细胞数8，单核细胞数18,糖1.82mmol/L,氯化物110mmol/L,蛋白1.18g/L。PPD（-）。脑脊液涂片未找到细菌,培养阴性,抗酸染色未找到抗酸杆菌,结核杆菌抗体、支原体抗体、墨汁染色均阴性。血鲎试验阴性。血布氏杆菌虎红平板凝集试验阳性,滴度1∶160。脑脊液Coombs试验阳性，诊断为布氏杆菌脑膜炎。 给予头孢曲松钠针2.0g/次,静脉滴注,口服多西环素100mg(早上), 50mg(晚上)和利福平450mg/次，1 次/d,三联抗布氏杆菌治疗18d。甘露醇150mL (每8h 1次，3d后改为每12h 1次,再隔3d后1次/d)静脉推注,降颅压治疗10d,醋酸泼尼松片22.5mg口服, 3天后渐减量停药。患儿体温很快降到正常,精神好转,脑膜刺激征消失,住院2周复查脑脊液已基本正常。出院后继续口服多西环素、利福平。8周后停药。3月后随诊,患儿无不适主诉,恢复良好