非布鲁杆菌病流行区7例布鲁杆菌病患者临床分析

Clinical features of seven patients with brucellosis from a non-endemic area： results of a retrospectiveanalysis

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／磺胺甲嗯唑。

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 levofloxaein 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.