非牧区布鲁菌病12例临床分析

发布时间：2018-08-26 10:14

【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。
[Abstract]:Objective to analyze the clinical characteristics of brucellosis in the emergency ward of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, and to provide clinical basis for early diagnosis and treatment of brucellosis in non-pastoral areas. Methods Epidemiological data of 12 patients with brucellosis in the emergency ward of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from December 2013 to April 2016, were retrospectively analyzed. Results 58% of the patients had a history of contact with cattle and sheep. High fever was the main clinical manifestation (100%), accompanied by chills, general fatigue, sweating, rash, headache, back pain, pharynx, neck and shoulder pain, low back pain, muscle joint pain, cough, hepatosplenomegaly and so on. The percentage of neutrophils was normal (75%), the percentage of most neutrophils was increased (17%) or decreased (8%), the number of platelet count was decreased (17%), and no anemia was found in all patients. Most of the patients (83%) had mild abnormal liver function and no jaundice. In most patients (92%), PCT increased slightly, and C reactive protein (CRP) increased in all patients (100%). All the patients (100%) were positive in blood culture or bone marrow culture for brucellosis agglutination test detected by (CDC) in Guangzhou Centers for Disease Control and Prevention. The treatment included doxycycline rifampicin doxycycline streptomycin doxycycline compound sulfamethoxazole doxycycline moxifloxacin or levofloxacin. Conclusion the clinical manifestations of brucellosis are various, and the patients in non-pastoral areas are prone to misdiagnosis. Especially for patients with fever of unknown origin for a long time, the history of contact should be inquired into in detail, and the possibility of this disease should be warned. Blood culture or brucellae agglutination test were carried out as early as possible.
【作者单位】：中山大学孙逸仙纪念医院急诊科;
【分类号】：R516.7

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