非牧区布鲁菌病31例临床分析

Clinical analysis of 31 cases of brucellosis in non-pasture area

目的分析布鲁菌病患者的临床特征,为非牧区布鲁菌病的早期诊治提供临床依据和参考。方法收集2016年12月-2018年11月苏州大学附属第一医院收治确诊的布鲁菌病患者31例,就其基本资料、临床特征、实验室检查、影像学资料、治疗及预后等方面进行回顾性分析。结果31例患者男18例,女13例,平均年龄(53.6±17.2)岁,其中13例有明确流行病学史;全年均有患者发病,多数集中于2~7月;临床症状以发热(96.8%)、乏力(77.4%)、多汗(58.1%)、腰痛(35.5%)、关节疼痛(32.3%)多见,部分患者可见肝肿大(16.0%)、脾肿大(60.0%)和淋巴结肿大(16.0%);血常规可见白细胞(25.8%)、血红蛋白(51.6%)和血小板(29.0%)下降,伴有血沉(61.5%)、超敏C反应蛋白(88.5%)、铁蛋白(80.0%)、丙氨酸转氨酶(33.3%)和天冬氨酸转氨酶(44.4%)升高;所有患者布鲁菌试管凝集试验均为阳性,96.8%患者血培养或骨髓培养阳性。治疗方案包括四环素联合利福平(90.3%)、四环素联合左氧氟沙星或莫西沙星(6.5%)、头孢曲松联合左氧氟沙星(3.2%),患者经规范化治疗,预后良好。结论布鲁菌病临床表现多样,无特异性,对于长时间不明原因的发热患者,因警惕该病的可能,重视流行病学史采集,尽早完善血培养和布鲁菌试管凝集试验。

Objective To analyze the clinical characteristics of patients infected with Brucella so as to provide clinical evidence and guidance for earlier diagnosis and treatment of brucellosis in non-pasture area.Methods To retrospectively analyze the demographic data,clinical manifestations,laboratory tests and imaging studies,treatments and outcomes of 31 patients with Brucella infection who were treated at the the First Affiliated Hospital of Suzhou University from December 2016 to November 2018.Results The patients included 18 males and 13 females (mean age of 53.6±17.2 years old).Clear epidemiologic evidence was available for 13 patients.Brucella infection was observed in any season,while most cases occurred between February and July. Main clinical manifestations included fever (96.8%),fatigue (77.4%),excessive sweating (58.1%),low back pain (35.5%),joint pain (32.3%).Hepatomegaly (16.0%),splenomegaly (60.0%) and lymphadenopathy (16.0%) were also found in some patients.Decreased white blood cell count (25.8%),hemoglobin (51.6%),platelet count (29.0%) were documented in some patients,while erythrocyte sedimentation rate (61.5%),high-sensitivity C-reactive protein (88.5%),ferroprotein (80.0%),alanine aminotransferase (33.3%) and aspartate aminotransferase (44.4%) were increased.Serum agglutination test for Brucella was positive in all patients,and blood or bone marrow culture for Brucella was positive in 96.8% of the patients.The treatment outcome was good after standard treatment, including doxycycline combined with rifampicin (90.3%), doxycycline combined with moxifloxacin or levofloxacin (6.5%),ceftriaxone combined with levofloxacin (3.2%). Conclusions The clinical manifestations of brucellosis are diverse and not specific.Brucellosis should be considered for patients with long time fever of unknown origin.Collection of detailed epidemiological data,blood culture,and Brucella tube agglutination test should be performed as early as possible.