摘要
Q热临床表现多样且无特异性,多表现为高热、头痛、肌肉酸痛、全身乏力等症状,病原体可通过小血管及毛细血管播散累及心、肝、脾、肾、脑等全身各脏器组织。本文报道1例罕见Q热脑炎病例,其脑脊液检查呈现淋巴细胞增多、蛋白升高、糖降低等类似结核性脑膜炎的改变,γ-干扰素释放试验阳性但抗结核治疗无效。经脑脊液宏基因组测序(metagenomics next-generation sequencing,mNGS)检出贝氏柯克斯体核酸序列,确诊为Q热脑炎。予多西环素联合利福平抗感染治疗后,患者脑脊液指标恢复正常,临床症状显著改善。该病例提示,对于疑似中枢神经系统感染但常规治疗无效的患者,应考虑Q热可能,及时应用mNGS技术可提高诊断准确性。
Q fever manifests with diverse and nonspecific clinical presentations,primarily characterized by high fever,headache,myalgia,and generalized fatigue.The pathogen can disseminate through small blood vessels and capillaries to involve multiple organ systems including the heart,liver,spleen,kidneys,and brain.This article reports a rare case of Q fever encephalitis in which cerebrospinal fluid(CSF)examination revealed changes consistent with tuberculous meningitis,including lymphocytic pleocytosis,elevated protein,and decreased glucose.Although the interferon-gamma release assay(IGRA)was confirmed by metagenomic next-generation sequencing(mNGS)of CSF,which detected Coxiella burnetii nucleic acid sequences.Treatment with doxycycline combined with rifampin resulted in normalization of CSF parameters and significant clinical improvement.This case highlights that Q fever should be considered in patients with suspected central nervous system infections refractory to conventional therapy,and prompt application of mNGS technology can enhance diagnostic accuracy.
作者
马红艳
张国丽
杨磊
吴金福
MA Hongyan;ZHANG Guoli;YANG Lei;WU Jinfu(Department of Infectious Diseases,People’s Hospital of Dali Bai Autonomous Pr efecture,671000,China)
出处
《传染病信息》
2025年第4期413-416,共4页
Infectious Disease Information
关键词
Q热脑炎
Q热立克次体
误诊
结核性脑膜炎
Q fever encephalitis
Coxiella burnetii
misdiagnose
tuberculous meningitis
