儿童布鲁杆菌病六例报告并文献复习

Six cases of Brucella infection in children and review of literatures

目的 报告6例布鲁杆菌感染患儿的临床资料,分析其发病特点及诊断、治疗过程,为临床提供参考.方法 回顾分析2011至2012年临床诊断明确的6例布鲁杆菌感染患儿的临床表现、辅助检查结果及诊断过程,并结合国内外近10年的相关文献,讨论其发病特点.结果 6例患儿均有牛羊接触史或疫区生活或食用牛羊肉感染布鲁杆菌病的病史,经过相关检查,最终确定为布鲁杆菌感染.临床主要表现为均伴有发热,热峰37.5～38.0℃者3例,38.1 ～39.0℃者2例,39.1～41.0℃者1例,除1例患儿热型表现为波状热,其余均为不规则热.3例关节疼痛,1例伴睾丸炎,3例颈部淋巴肿大,2例肝脾肿大,4例肝功能受损,5例布鲁杆菌凝集试验为阳性,全部患儿的血培养均提示布鲁杆菌感染.4例患儿使用复方磺胺甲噁唑＋利福平治疗,1例为利福平＋红霉素治疗,1例患儿家长拒绝用药.以“儿童布鲁杆菌病”“Brucellosis of childhood”为关键词,在万方数据库及Pubmed数据库中检索近10年文献,共检索到13篇文献.文献报道共15例患儿,所有患儿均伴发热,6例关节肿痛,10例肝脾肿大,6例颈部淋巴结肿大,4例合并中枢神经系统感染,9例布鲁杆菌凝集试验为阳性,全部患儿的血培养均为布鲁杆菌感染.结论 儿童布鲁杆菌感染临床表现多样,常伴有全身系统性感染症状,在不明原因的发热筛查中应进行布鲁杆菌的相关检查,诊断时需注意与其他疾病相鉴别.

Objective To present six cases of Brucella infection in children,analyze the characteristics of the disease,diagnostic and therapeutic process.Method The clinical manifestations,laboratory test results and diagnostic process of 6 confirmed cases of brucellosis seen between 2011-2012 were retrospectively analyzed and domestic and foreign literature was reviewed.Result All the 6 children had a history of either exposure to,travelling to endemic area,or consuming infected lamb/beef.After the relevant examinations for these children,either positive etiologic or serologic evidence of brucellosis infection was obtained.The main clinical manifestation was fever in all cases,the peak body temperature was 37.5-38.0 ℃ in 3 cases,38.1-39.0 ℃ in 2 cases,39.1-41 ℃ in 1 case.Except for 1 case whose fever type was undulant fever,all the rest had irregular fever.Joint pain existed in 3 cases,orchitis in 1 case,cervical lymphadenopathy in 3 cases,hepatosplenomegaly in 2 cases,and impaired liver function in 4 cases.The Brucella agglutination test was positive in 5 cases.The blood culture was positive for all cases.In 4 cases the sulfamethoxazle and rifampicin were used for treatment,1 case was treated with rifampicin and erythromycin,parents of 1 case refused to use the drug.The ＆quot;brucellosis in children＆quot; was used to search literature at Wanfang database,Pubmed database for literature of recent 10 years,and a total of 13 articles including 15 cases were retrieved.All the patients had fever,6 cases had joint swelling and pain,10 cases had hepatosplenomegaly,6 cases had cervical lymphadenopathy,4 cases were complicated with central nervous system infection.Brucella agglutination test was positive in 9 cases and blood culture was positive for Brucella infection in all cases.Conclusion Childhood Brucella infections are usually presented with various clinical manifestations,and are often accompanied by symptoms of systemic infection.For fever of unknown origin,one should include tests associated with brucellosis and pay special attention to differential diagnosis against other diseases.