摘要
目的分析中山大学孙逸仙纪念医院急诊病区布鲁菌病的临床特征,为非牧区布鲁菌病的早期诊治和提高疗效提供临床依据。方法回顾性分析中山大学孙逸仙纪念医院急诊病区2013年12月至2016年4月收治的12例布鲁菌病患者的流行病学资料,就临床表现、实验室检查、治疗和转归情况进行回顾性分析。结果 58%的患者有牛羊接触史。高热为主要临床表现(100%),同时伴有畏寒、寒战、全身乏力、多汗,皮疹、头痛、耳后疼痛、咽痛、颈肩痛、腰背痛、肌肉关节痛、咳嗽、肝脾淋巴结肿大等。外周血象白细胞计数多数正常(83%)及少数轻度升高(17%);多数中性粒细胞百分比正常(75%),少数升高(17%)或下降(8%);少数血小板计数减少(17%);所有患者无贫血。多数患者(83%)伴有肝功能轻度异常,无黄疸。多数患者(92%)PCT轻度升高,所有患者(100%)C反应蛋白(CRP)呈不同程度升高。所有患者(100%)在广州市疾病预防控制中心(CDC)检测的布鲁菌试管凝集试验均为阳性,50%患者血培养或骨髓培养阳性。治疗方案包括多西环素+利福平、多西环素+链霉素、多西环素+复方磺胺甲恶唑、多西环素+莫西沙星或左氧氟沙星,所有患者经规范化联合抗菌药物治疗后总有效率为100%。结论布鲁菌病的临床表现多样,非牧区患者易漏诊误诊,尤其对于长时间不明原因发热的患者,要详细询问接触史,警惕本病的可能,尽早进行血培养或布鲁杆菌凝集试验检查,规范化联合治疗方案具有良好的疗效。
Objective To provide clinical evidence for early diagnosis and treatment of Brucellosis by analyzing the clinical characteristics of patient with brucellosis admitted in the Department of Emergency,Sun Yat-sun Memorial Hospital of Sun Yat-sen University.Methods Epidemiological,clinical,laboratory and treatment data,as well as outcomes of 12 patients diagnosed as brucellosis during December 201 3 to April 2015 were retrospectively analyzed in this hospital.Results The majority of patients were the middle-aged;seven (58.3%)patients had a history of close contact with sheep or cows infected with brucellosis.All patients had a high fever (100%),accompanied with chilly,fatigue,sweating,rash,headache,ear pain,sore throat, cervicobrachialgia,lumbodorsal pain,myalgia and arthralgia,cough,and lymphadenectasis.White blood cell count were normal in 10 cases (83%),and decreased in 2 cases (17%).The percentage of neutrophilic granulocytes was normal in 7 cases (75%),decreased in 2 cases (17%)and increased in 1 case (8%). Platelet count decreased in 2 cases (17%).All patients had no anemia.10 patients (83 %)had hepatic dysfunction,but without jaundice.Almost 92% patients had mild elevation of PCT level,and the CRP level was variably elevated in all patients (100%).All 12 patients were positive in serum agglutination test for Brucella,and 6 (50%)positive in blood and bone marrow culture for Brucella.All patients had effective prognosis after standard treatment, including doxycycline combined rifampicin, doxycycline combined streptomycin, doxycycline combined TMP-SMZ, doxycycline combined moxifloxacin or levofloxacin. Conclusions Due to the diversity of clinical manifestation,doctors often make a misdiagnosis or a missed diagnosis of Brucellosis in non-pasture area.Detailed history of exposure to infectious agents,as well as blood culture or brucella aggregation test,should be performed as early as possible for patients with long-term fever of unknown origin.Standard combined treatment has good clinical efficacy.
出处
《中华卫生应急电子杂志》
2016年第4期-,共3页
Chinese Journal of Hygiene Rescue(Electronic Edition)
关键词
非牧区
布鲁菌病
临床特征
治疗效果
Non-pasture area
Brucellosis
Clinical characteristics
Therapeutic effect
