布鲁菌病五例误诊分析

Analysis of 5 Misdiagnosed Patients with Brucellosis Infection

目的分析布鲁菌病误诊原因,并提出防范措施。方法对我科2011年6月—2012年8月误诊的5例布鲁菌病的临床资料进行回顾性分析。结果 5例入院1个月前均有发热,1例伴肘关节红肿疼痛,1例伴双大腿肌肉和右髋部疼痛,1例伴右上肢多发无痛性结节,2例伴腰肩部疼痛。本组均在风湿免疫科就诊,1例误诊为未分化结缔组织病、骨关节炎,1例误诊为干燥综合征,3例误诊为细菌感染。经相应治疗无效,查布鲁杆菌血清凝聚试验阳性,确诊为布鲁菌病,给予利福平和盐酸多西环素联合治疗6周,均痊愈。结论布鲁杆菌的变异及流行病学的改变,使布鲁菌病的临床表现不典型,对慢性发热伴骨关节症状患者,应仔细地询问病史,鉴别诊断中行布鲁杆菌血清凝集试验,以减少误诊。

Objective To analyze misdiagnosis causes of Brucellosis infection and to propose precautionary measures. Methods Clinical data of 5 misdiagnosed patients with Brucellosis infection in our department during June 2011 and August 2012 was retrospectively analyzed. Results All the 5 patients had fever for 1 month hefore admission, one patient with erythrodysesthesia in elbow joint, one with pains in both thighs muscles and right hip, one with multiple unpainful nodes in right upper extremity, and two with pains in waist and shoulder. The 5 patients visited rheumatism and immunology department at first, and one patient was misdiagnosed as having undifferentiated connective tissue disease and osteoarthritis, one as having Sjogreng syndrome, and the other three patients as having bacterial infections. Results of serumal agglutination tests for brucellosis in 5 patients turned to positive, and the diagnosis of brucellosis was confirmed. All the patients were cured after six weeks combination therapy with rifampin and doxycycline hydrochloride. Conclusion The brucellosis variation and epidemiological changes lead to untypical clinical symptoms for brucellosis. Medical history and brucellosis agglutination test should be, performed for patients with chronicity fever and joint symptoms so as to reduce misdiagnosis rate.