布鲁氏菌病合并中枢神经系统结核感染2例报告

doi:10.19871/j.cnki.xfcrbzz.2026.01.015

摘要/Abstract

摘要： 本文报道了2例布鲁氏菌病合并中枢神经系统结核感染的病例。此类合并感染在临床较为少见。布鲁氏菌与结核分枝杆菌均可累及中枢神经系统,且二者临床症状重叠,鉴别诊断困难。本文2例患者均因出现明确的神经功能缺损症状就诊于内蒙古医科大学附属医院,通过病原微生物宏基因组测序最终诊断为中枢神经系统结核感染,1例为结核性脊髓炎,另1例为结核性脑膜炎继发急性脑梗死。同时2例患者的布鲁氏菌病血清学检测均呈阳性,证实了两种病原体的合并感染。2例患者经规范的抗结核分枝杆菌联合抗布鲁氏菌治疗后,神经功能缺损症状及实验室指标均显著改善,预后良好。通过对本组病例的深入分析,旨在提高临床医生对布鲁氏菌病合并中枢神经系统结核感染的认识,强调当布鲁氏菌病患者发生中枢神经系统感染时,需高度警惕合并结核分枝杆菌感染的可能。病原微生物宏基因组测序有助于精准识别病原体,对诊断和制定个体化治疗方案有重要价值。

关键词: 布鲁氏菌病, 中枢神经系统, 结核感染, 病原微生物宏基因组测序

Abstract: This article reports two cases of brucellosis complicated by central nervous system tuberculosis infection. Such co-infections are clinically rare. Brucella and Mycobacterium tuberculosis can both involve the central nervous system, and their clinical symptoms overlap, making differential diagnosis challenging. Both patients presented to the Affiliated Hospital of Inner Mongolia Medical University with definitive neurological deficits. Metagenomic next-generation sequencing of cerebrospinal fluid ultimately confirmed the diagnosis of central nervous system tuberculosis infection: one case of tuberculous myelitis and one case of acute cerebral infarction secondary to tuberculous meningitis. Serological tests for Brucella were positive in both patients, confirming co-infection with both pathogens. Following combined anti-tuberculosis and anti-brucellosis therapy, both patients showed significant improvement in neurological deficits and laboratory parameters, resulting in a favorable prognosis. Through in-depth analysis of these cases, this article aims to enhance clinicians' awareness of central nervous system tuberculosis co-infection in patients with brucellosis. It emphasizes that when central nervous system infection occurs in brucellosis patients, a high index of suspicion for co-infection with Mycobacterium tuberculosis is warranted. Metagenomic next-generation sequencing is valuable for precise pathogen identification, which is crucial for diagnosis and the development of individualized treatment strategies.

Key words: Brucellosis, Central nervous system, Tuberculosis infection, Metagenomic next-generation sequencing

中图分类号:

R563.1
R535

郭婧, 赵世刚, 王晓慧, 仝秀清. 布鲁氏菌病合并中枢神经系统结核感染2例报告[J]. 新发传染病电子杂志, 2026, 11(1): 97-101.

Guo Jing, Zhao Shigang, Wang Xiaohui, Tong Xiuqing. Brucellosis combined with central nervous system tuberculosis infection in 2 cases[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(1): 97-101.

参考文献

[1] GUO X, ZENG H, LI M, et al.The mechanism of chronic intracellular infection with Brucella spp[J]. Front Cell Infect Microbiol, 2023, 13: 1129172.
[2] SHI L, WANG S, LI X, et al.Acute Brucella infection associated with splenic infarction: a case report and review of the literature[J]. Front Cell Infect Microbiol, 2023, 13: 1234447.
[3] 李媛媛, 谢晶晶, 李树涛, 等.2024年WHO全球结核病报告:全球与中国关键数据分析[J/CD]. 新发传染病电子杂志,2024, 9(6):92-98.
[4] LI T, YAN X, DU X, et al.Extrapulmonary tuberculosis in China: A national survey[J]. Int J Infect Dis, 2023, 128: 69-77.
[5] GARG RK, KUMAR N, UNIYAL R, et al.Tuberculous myelitis: A systematic review of published case reports and case series[J]. Spinal Cord Ser Cases, 2025, 11(1): 6.
[6] JIANG Y, XU X, GUO Z, et al.Myelitis: A Common Complication of Tuberculous Meningitis Predicting Poor Outcome[J]. Front Neurol, 2022, 13: 830029.
[7] KHAN MI, GARG RK, RIZVI I, et al.Tuberculous myelitis: a prospective follow-up study[J]. Neurol Sci, 2022, 43(9): 5615-5624.
[8] XIAO Y, LI M, GUO X, et al.Inflammatory Mechanism of Brucella Infection in Placental Trophoblast Cells[J]. Int J Mol Sci, 2022, 23(21): 13417.
[9] SHARP JT, WHEELWRIGHT HJ, NICE PO.Concomitant brucellosis and tuberculosis; report of a case[J]. N Engl J Med, 1952, 246(13): 485-487.
[10] ZOU D, ZHOU J, JIANG X.Diagnosis and management of spinal tuberculosis combined with brucellosis: A case report and literature review[J]. Exp Ther Med, 2018, 15(4): 3455-3458.
[11] PAPACHRISTODOULOU E, KAKOULLIS L, LOUPPIDES S, et al.Granulomatous infective spondylitis in a patient presenting with progressive difficulty in walking: The differential between tuberculosis and brucellosis[J]. BMJ Case Rep, 2019, 12(11): e232540.
[12] ZHAO G, WANG J, XIANG G, et al.Cervical spinal tuberculosis combined with brucellosis[J]. J Infect Dev Ctries, 2020, 14(10): 1217-1220.
[13] JIN M, FAN Z, GAO R, et al.Research progress on complications of brucellosis[J]. Front Cell Infect Microbiol, 2023,13: 1136674.
[14] TIAN Z, LIU Y, WANG X, et al.Brucellosis seroprevalence in cattle in China during 2014-2024: A systematic review and meta-analysis[J]. Emerg Microbes Infect, 2024, 13(1): 2417859.
[15] PARK M, GUPTA RK.Central nervous system mycobacterium infection: Tuberculosis and beyond[J]. Neuroimaging Clin N Am, 2023, 33(1): 105-124.
[16] LIU D, WANG H, ZHANG Y, et al.Transmission characteristics in tuberculosis by WGS: Nationwide cross-sectional surveillance in China[J]. Emerg Microbes Infect, 2024, 13(1): 2348505.
[17] DIAN S, GANIEM AR, VAN LAARHOVEN A.Central nervous system tuberculosis[J]. Curr Opin Neurol, 2021, 34(3): 396-402.
[18] SOARES C N, DA SILVA M T T, LIMA M A. Neurobrucellosis[J]. Curr Opin Infect Dis, 2023, 36(3): 192-197.
[19] 王艺霖, 唐子涵, 尚媛媛, 等. 布鲁菌病与结核病:临床特征的异同比对及合并感染的特征分析[J]. 中国人兽共患病学报, 2025,1-6.
[20] 李章珺, 马世武. 布鲁菌和结核分枝杆菌合并感染给临床诊疗带来的矛盾与应对[J]. 中华传染病杂志, 2024, 42(11): 701-704.
[21] RAHLWES KC, DIAS B RS, CAMPOS PC, et al.Pathogenicity and virulence of Mycobacterium tuberculosis[J]. Virulence, 2023, 14(1): 2150449.
[22] KHATIWADA A, KC S, JHA A, et al.A case of tubercular meningoencephalitis with transverse myelitis[J]. Radiol Case Rep, 2024, 19(8): 3555-3560.
[23] GUPTA M, TOBIN EH, MUNAKOMI S.CNS Tuberculosis[M]Treasure Island: StatPearls Publishing, 2025, 36256788.
[24] FENG L, WANG X, ZHANG Y, et al.mNGS facilitates the accurate diagnosis and antibiotic treatment of suspicious critical CNS infection in real practice: A retrospective study[J]. Open Life Sci, 2023, 18(1): 20220578.
[25] ZHAO Y, ZHANG W, ZHANG X.Application of metagenomic next-generation sequencing in diagnosis of infectious diseases[J]. Front Cell Infect Microbiol, 2024, 14:1458316.
[26] SU L D, CHEN Y, WANG J, et al.Clinical metagenomic next-generation sequencing for diagnosis of central nervous system infections: Advances and challenges[J]. Mol Diagn Ther, 2024, 28(5): 513-523.
[27] BENOIT P, SMITH J, JOHNSON K, et al.Seven-year performance of a clinical metagenomic next-generation sequencing test for diagnosis of central nervous system infections[J]. Nat Med, 2024, 30(12): 3522-3533.
[28] STAHL JP, AZOUVI P, BRUNEEL F, et al.Guidelines on the management of infectious encephalitis in adults[J]. Med Mal Infect, 2017, 47(3): 179-194.
[29] WANG S, CHEN Y, WANG D, et al.The feasibility of metagenomic next-generation sequencing to identify pathogens causing tuberculous meningitis in cerebrospinal fluid[J]. Front Microbiol, 2019, 10: 1993.
[30] LIU Z, ZHANG Q, WANG R, et al.Comparative study of pathogen detection methods for central nervous system infections: Laboratory testing of tuberculous meningitis[J]. BMC Infect Dis, 2024, 24(1): 1172.
[31] XIANG Z B, LIU X, WANG H, et al.A systematic review and meta-analysis of the diagnostic accuracy of metagenomic next-generation sequencing for diagnosing tuberculous meningitis[J]. Front Immunol, 2023, 14: 1223675.