5例布鲁氏菌病血清抗体阴性感染病例的鉴定及分析

发布时间：2018-03-13 01:07

本文选题：布氏菌　切入点：临床表现　出处：《现代预防医学》2015年23期 　论文类型：期刊论文

【摘要】：目的通过分析布氏菌病血清抗体阴性的感染病例,降低临床对布氏杆菌感染诊断的误诊率。方法回顾分析2011-2014年我院收治的门诊及住院布氏菌感染病例共51例,其中有5例布氏菌血清抗体阴性,本文结合临床资料对5例疑似感染病例通过血清抗体检测、血细菌培养和16sRNA测序分析加以鉴别确认。结果 5例患者均有明确的流行病学史,临床表现反复发热、多汗、乏力,其中2例患者除上述症状外,主诉关节痛及腰痛来我院就诊。根据临床表现,虽疑似布氏杆菌感染,但因缺乏病原学支持,起初分别误诊为呼吸道感染、肺炎、血液病及风湿免疫性疾病,并给予过对症治疗但疗效不佳,仍然出现反复发热现象。后经血细菌培养及16SrDNA测序分析确认布氏菌病,积极治疗后均治愈。结论对长期不明原因发热者应结合流行病学特点考虑布氏菌病可能,尤其是高度疑似病例,不能完全依靠血培养和血清抗体检测加以鉴别诊断,应多结合临床表现及影像学特征,必要时进行分子生物学鉴定。
[Abstract]:Objective to reduce the misdiagnosis rate of brucellosis by analyzing the cases of brucellosis with negative serum antibody. Methods 51 cases of brucellosis were retrospectively analyzed in our hospital from 2011 to 2014. There were 5 cases of brucellosis with negative serum antibody. 5 cases of suspected infection were identified by serum antibody detection, blood bacterial culture and 16s RNA sequencing analysis. Results all of the 5 patients had a clear epidemiological history. Clinical manifestations included repeated fever, sweating and fatigue. In addition to the above symptoms, two patients complained of joint pain and low back pain. According to the clinical manifestations, although suspected brucellosis infection, but due to lack of etiological support, They were misdiagnosed as respiratory tract infection, pneumonia, hematologic disease and rheumatic immune disease respectively, and had been given symptomatic treatment but the curative effect was not good, and the phenomenon of repeated fever still appeared. After blood bacteria culture and 16s rDNA sequencing analysis, brucellosis was confirmed. Conclusion the possibility of brucellosis, especially the highly suspected cases, should be considered according to the epidemiological characteristics of patients with chronic fever of unknown origin, and the differential diagnosis should not be completely dependent on blood culture and serum antibody detection. Clinical manifestations and imaging features should be combined and molecular biological identification should be carried out when necessary.
【作者单位】：济南市传染病医院中心实验室;济南市传染病医院影像中心;济南市中心医院医学实验诊断中心;
【分类号】：R516.7

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