CAJ | 학술논문

目的研究非布鲁杆菌病流行区布鲁杆菌病患者的流行病学、临床特征,提高非流行区医务工作者对布鲁杆菌病的认识.方法回顾性分析南京医科大学第一附属医院2011年收治的7例布鲁杆菌病患者的流行病学资料、临床表现、辅助检查、治疗情况.结果 7例患者均有与来自布鲁杆菌病流行地区羊的密切接触史；临床上以非波状热型的中高热、乏力、纳差、体质量下降、关节痛等症状为主,同时呼吸系统症状亦较为突出,多汗、肝脾肿大等多不明显,同时有较为少见的帕金森样震颤等神经系统损害表现；T淋巴细胞及B淋巴细胞比例异常,血培养耗时较长；药敏试验结果显示,布鲁杆菌对甲氧苄氨嘧啶/磺胺甲恶唑、左氧氟沙星、四环素、阿米卡星敏感,而对头孢类抗生素则多有耐药；经左氧氟沙星联合甲氧苄氨嘧啶/磺胺甲恶唑治疗后均痊愈.结论布鲁杆菌病有从传统流行区向外扩散的趋势；发热待查患者如有羊密切接触史,应考虑布鲁杆菌病的可能,且临床上需注意呼吸系统损伤、帕金森样震颤等非常见的表现；治疗上可选用左氧氟沙星联合甲氧苄氨嘧啶/磺胺甲噁唑.
목적 연구비포로간균병류행구포로간균병환자적류행병학、림상특정,제고비류행구의무공작자대포로간균병적인식.방법 회고성분석남경의과대학제일부속의원2011년수치적7례포로간균병환자적류행병학자료、림상표현、보조검사、치료정황.결과 7례환자균유여래자포로간균병류행지구양적밀절접촉사；림상상이비파상열형적중고열、핍력、납차、체질량하강、관절통등증상위주,동시호흡계통증상역교위돌출,다한、간비종대등다불명현,동시유교위소견적파금삼양진전등신경계통손해표현；T림파세포급B림파세포비례이상,혈배양모시교장；약민시험결과현시,포로간균대갑양변안밀정/광알갑악서、좌양불사성、사배소、아미잡성민감,이대두포류항생소칙다유내약；경좌양불사성연합갑양변안밀정/광알갑악서치료후균전유.결론 포로간균병유종전통류행구향외확산적추세；발열대사환자여유양밀절접촉사,응고필포로간균병적가능,차림상상수주의호흡계통손상、파금삼양진전등비상견적표현；치료상가선용좌양불사성연합갑양변안밀정/광알갑오서.
Objective To investigate the epidemiological and clinical features of patients with brucellosis from a non-endemic area.Methods The epidemiological,clinical,laboratory and treatment data of patients with brucellosis during 2011 in the First Affiliated Hospital with Nanjing Medical University were retrospectively analyzed.Results All the patients had a history of close contact with sheep.The main clinical manifestations included of moderate to ardent fever,fatigue,anorexia,weight loss,arthralgia and respiratory symptoms,otherwise,sweating and hepatosplenomegaly were not very common.Meanwhile,one case showed relatively rare Parkinsonian-like tremor.T lymphocytes were upregulated and B lymphocytes were downregulated.Blood culture took a long time.Drug sensitivity test showed that Brucella were sensitive to trimethoprim-sulfamethoxazole,levofloxacin,tetracycline and amikacin,but were mostly resistant to cephalosporins.All the patients recovered after combination therapy with levofloxacin and trimethoprim-sulfamethoxazole.Conclusions Brucellosis has showed a trend of spreading to non-endemic areas and it should be taken into account if the patients with fever of unknown origin had a history of close contact with sheep,furthermore,we should pay attention to the uncommon clinical manifestations of respiratory injury and Parkinsonian-like tremor.Levofloxacin combined with trimethoprim-sulfamethoxazole may be suitable for anti-Brucella treatment.