1例布鲁杆菌病误诊为骨肿瘤的病原学调查

Pathogenic investigation of a case of Brucellosis misdiagnosed as bone tumor

目的分析布鲁杆菌病(布病)误诊为骨肿瘤的原因,为疾病的诊断和治疗提供参考。方法对分离到的菌株进行布鲁杆菌属特异性PCR(OMP31-PCR)和布鲁杆菌种型特异性PCR(AMOS-PCR)鉴定。采集患者血液标本,进行虎红平板凝集试验(RBPT)和试管凝集试验(SAT),对患者进行流行病学调查。结果患者被国内4家三甲医院诊断为"右股骨中下段骨肿瘤",手术发现为囊肿。培养后检出布鲁杆菌,经生化、AMR抗原单项特异性抗原血清凝集(A+、M+、R-)、噬菌体裂解[Tb-、Tb(104RTD)-、BK2+、WB-]、OMP31-PCR和AMOS-PCR等试验鉴定为羊种布鲁杆菌生物3型。患者无明显的动物接触史,有偶尔吃牛肉、羊肉史,血清SAT为1∶100(++)。结论该患者经实验室确诊为布鲁杆菌病,建议临床上应加强对布病误诊为骨肿瘤的监测。

Objective To analyze the main reason of Brucellosis （ B. ） misdiagnosis as bone tumors, so as to provide a reference for the diagnosis and treatment of cases. Methods The isolated Brucella was identify for specificity by genus specific PCR （OMP31 -PCR） and type specific PCR（ AMOS -PCR）. Blood samples were taken from the patient for tiger red plate agglutination test （RBPT） and tube agglutination test （SAT）, and epidemiological investigations were carried out on the patient. Results The patient was diagnosed ＂right femoral lower - middle section of bone tumors＂ in domestic four top three hospitals, but was confirmed a cyst through surgery. Brucella was detected after culturing, and by biochemical, AMR single antigen specific antigen serum agglutination were A ＋, M ＋ and R -, Phage cracking test were Tb -, Tb （ 104RTD）, BK2 ＋ and WB -, OMW31 - PCR and AMOS - PCR test identified as sheep bloom Brucella type 3. The patient had no obvious animal exposure history, but had a history of eating beef and mutton, the serum SAT of the patient was 1 ： 100 （ ＋ ＋ ）. Conclusion The patients were diagnosed by laboratory for Brucella, should be clinically recommended to strengthen the detection of Brucella misdiagnosed results as bone tumors.