中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2014年
4期
229-232
,共4页
布鲁菌病%非牧区%发热%诊断
佈魯菌病%非牧區%髮熱%診斷
포로균병%비목구%발열%진단
Brucellosis%Non-pasture area%Fever%Diagnosis
目的 回顾性分析非牧区以发热为首发症状布鲁菌病的临床特征,探讨早期诊断方法.方法 天津市第一中心医院感染科2010年1月至2013年6月收治的布鲁菌病住院患者18例,分析患者临床症状、血常规、血培养、布鲁菌虎红玻片凝集试验等指标,结合治疗和随访,分析其临床特征.结果 以发热为首发症状布鲁菌病患者中年男性有烟酒史的多见,12例无基础疾病.12例无明确接触史,4例有牛羊接触史,1例进食过未煮熟牛羊肉,1例饲养犬.18例患者均有发热,其中高热15例,不规则热13例.血常规白细胞计数正常12例,白细胞计数减少6例;杆状细胞比例升高,细胞核左移6例;血小板计数减少3例;ALT、AST增高13例;C反应蛋白升高14例;血液或骨髓细菌培养为马耳他布鲁菌12例;布鲁菌虎红玻片凝集试验阳性18例.中性粒细胞比例和淋巴细胞比例均正常.治疗药物为莫西沙星、左氧氟沙星、异帕米星、依替米星、阿米卡星、利福平、米诺环素,选两种或三种药物联合治疗,随访4～11个月,预后好.结论 非牧区以发热待查为首诊的患者要警惕布鲁菌病可能,接诊医师应对本病保持警惕性,详细问诊接触史,行实验室检查,明确诊断并给予及时治疗可避免严重并发症的发生.
目的 迴顧性分析非牧區以髮熱為首髮癥狀佈魯菌病的臨床特徵,探討早期診斷方法.方法 天津市第一中心醫院感染科2010年1月至2013年6月收治的佈魯菌病住院患者18例,分析患者臨床癥狀、血常規、血培養、佈魯菌虎紅玻片凝集試驗等指標,結閤治療和隨訪,分析其臨床特徵.結果 以髮熱為首髮癥狀佈魯菌病患者中年男性有煙酒史的多見,12例無基礎疾病.12例無明確接觸史,4例有牛羊接觸史,1例進食過未煮熟牛羊肉,1例飼養犬.18例患者均有髮熱,其中高熱15例,不規則熱13例.血常規白細胞計數正常12例,白細胞計數減少6例;桿狀細胞比例升高,細胞覈左移6例;血小闆計數減少3例;ALT、AST增高13例;C反應蛋白升高14例;血液或骨髓細菌培養為馬耳他佈魯菌12例;佈魯菌虎紅玻片凝集試驗暘性18例.中性粒細胞比例和淋巴細胞比例均正常.治療藥物為莫西沙星、左氧氟沙星、異帕米星、依替米星、阿米卡星、利福平、米諾環素,選兩種或三種藥物聯閤治療,隨訪4～11箇月,預後好.結論 非牧區以髮熱待查為首診的患者要警惕佈魯菌病可能,接診醫師應對本病保持警惕性,詳細問診接觸史,行實驗室檢查,明確診斷併給予及時治療可避免嚴重併髮癥的髮生.
목적 회고성분석비목구이발열위수발증상포로균병적림상특정,탐토조기진단방법.방법 천진시제일중심의원감염과2010년1월지2013년6월수치적포로균병주원환자18례,분석환자림상증상、혈상규、혈배양、포로균호홍파편응집시험등지표,결합치료화수방,분석기림상특정.결과 이발열위수발증상포로균병환자중년남성유연주사적다견,12례무기출질병.12례무명학접촉사,4례유우양접촉사,1례진식과미자숙우양육,1례사양견.18례환자균유발열,기중고열15례,불규칙열13례.혈상규백세포계수정상12례,백세포계수감소6례;간상세포비례승고,세포핵좌이6례;혈소판계수감소3례;ALT、AST증고13례;C반응단백승고14례;혈액혹골수세균배양위마이타포로균12례;포로균호홍파편응집시험양성18례.중성립세포비례화림파세포비례균정상.치료약물위막서사성、좌양불사성、이파미성、의체미성、아미잡성、리복평、미낙배소,선량충혹삼충약물연합치료,수방4～11개월,예후호.결론 비목구이발열대사위수진적환자요경척포로균병가능,접진의사응대본병보지경척성,상세문진접촉사,행실험실검사,명학진단병급여급시치료가피면엄중병발증적발생.
Objective To analyze the prevalence of brucellosis with the initial symptom of fever in non-pasture area and to investigate the method of early diagnosis.Method Clinical features including symptoms,blood routine tests,blood cultures,rose-bengal plate agglutination tests,treatment and follow-up were analyzed in 18 patients with brucellosis admitted to the Department of Infectious Diseases,Tianjin First Centre Hospital from January 2010 to June 2013.Results Middle-aged men with history of smoking and drinking accounted for the majority of patients with initial symptom of fever.Twelve were not complicated with any underlying diseases.Twelve had no contact history.Four had history of farm animal contact,one had history of consuming raw meat products,and one had history of dog raising.All of them had fever,15 of which had hyperpyrexia and 13 had irregular fever.White cells in blood routine test were normal in 12 cases,decreased in 6 cases.And the proportion of rhabditiform nucleus neutrophil increased.Six showed neutrophil left shift.Blood platelet decreased in 3 cases.Thirteen cases showed increased alanine aminotransferase and aspartate aminotransferase.C-reactive protein was elevated in 14 cases.Twelve cases had positive culture of Brucella melitensis in blood or bone marrow culture.Eighteen cases had positive results of rose-bengal plate agglutination test.The proportions of neutrophil and lymphocyte were normal.The treatment included moxifloxacin,levofloxacin,isepamicin,etimicin,amikacin,rifampicin,minocycline.The regimens were usually two or three drugs in combination.The duration of follow-up ranged from 4 to 11 months with good prognosis.Conclusions Patients from nonpasture area with initial symptom of fever could be brucellosis.Clinician should be alert to the disease and inquiry contact history in detail.Brucella serology test should be performed.Early diagnose and prompt treatment could avoid serious complications.
