肾移植术后布鲁氏菌病1例报道并文献复习

Brucellosis after renal transplantation:a report of one case and literature review

目的分析并总结肾移植术后布鲁氏菌病的临床特点和诊疗经验。方法收集解放军第309医院2016年10月收治的1例肾移植术后布鲁氏菌病患者的临床资料,分析其临床特点和诊疗经过,并结合文献复习总结临床经验。结果患者肾移植术后3个月出现无明显诱因体温升高,以上午发热为主,持续时间3 d,感染途径不明、其他感染症状不明显,经验性抗感染治疗1周效果不佳。经血培养确诊为羊布鲁氏菌感染。及时给予利福平、多西环素、复方磺胺甲恶唑抗感染,积极防治并发症,保护肝、肾功能等治疗,疗效良好。随访至该患者出院后1年,移植肾功能稳定,再未出现发热等感染症状。结论肾移植术后感染途径不明的布鲁氏菌病极为罕见,常见症状为波浪热。当经验性抗感染治疗效果不佳时,应及早多次进行血培养等相关检测尽快确诊,治疗方案为利福平与多西环素联合使用。

Objective To analyze and summarize the clinical features and diagnosis and treatment experience of brucellosis after renal transplantation. Methods Clinical data of one case with brucellosis after renal transplantation admitted to the 309 th Hospital of Chinese People＇s Liberation Army in October 2016 was collected. The clinical features, diagnosis and treatment were retrospectively analyzed. Clinical experience was summarized and literature review was conducted. Results At 3 months after renal transplantation, the patient suffered from temperature rise without known causes and presented with fever in the morning with a duration of 3 d. The route of infection was unknown, and the symptoms of alternative types of infection were not obvious. Empirical anti-infectious therapy was delivered for 1 week and yielded no efficacy. Blood culture test confirmed the diagnosis of brucella melitensis infection. The treatment included anti-infecting by the rifampicin, doxycycline, sulfamethoxazole, preventing the incidence of complications actively and protecting the liver and renal function. High clinical efficacy was achieved. During the 1-year follow up after discharge, the renal graft was stable and no other infectious symptoms, such as fever was found. Conclusions Brucellosis with unknown route of infection after renal transplantation is extremely rare and the common symptom is Malta fever. When the empirical anti-infectious treatment is not effective, blood culture and other related tests should be performed to confirm the diagnosis. The combination of rifampicin and doxycycline is recommended.