布鲁菌病23例临床特点及误诊误治分析

Clinical Features and Misdiagnosed Causes and Mistreatment of 23 Patients with Brucellosis

目的探讨布鲁菌病临床特点及误诊误治原因、防范措施。方法回顾性分析2009—2020年收治的布鲁菌病23例的临床资料。结果本组出现发热22例,多汗14例,乏力12例,腰痛及关节肿痛各8例,头痛6例,睾丸肿痛和皮疹各4例,肌痛3例,外周神经痛2例,葡萄膜炎1例。14例曾误诊为其他疾病,误诊为感染性疾病8例,其中误诊为普通细菌感染7例,病毒感染1例;误诊为风湿性疾病6例,其中误诊为类风湿关节炎和风湿性血管炎各2例,强直性脊柱炎和成人Still病各1例。6例因发热待查入院,病程1~10 d 4例,21和30 d各1例。3例在当地医院已明确诊断为布鲁菌病,但因治疗不及时或不规律,导致病情迁延。本组误诊误治时间(80.2±121.6)d。23例入我院后根据病史、临床表现、血培养布鲁菌阳性和(或)布鲁菌抗体检测阳性等明确诊断布鲁菌病。确诊后20例给予相应治疗6周~3个月,19例治愈,1例因双眼葡萄膜炎导致失明;3例转入当地医院治疗,后失访。结论临床上遇及出现发热、皮疹、关节肿痛、腰背痛及睾丸肿痛等临床表现患者时要考虑到布鲁菌病,一般根据病史、临床表现、血培养及布鲁菌抗体检测等可进行诊断。

Objective To investigate clinical features,the misdiagnosed causes and mistreatment as well as preventive measures of brucellosis.Methods Clinical data of 23 patients with brucellosis admitted between 2009 and 2020 was retrospectively analyzed.Results Among the patients,22 patients had fever,14 patients with hyperhidrosis,12 patients with fatigue,8 patients with lumbago and 8 patients with joint swelling and pain,6 patients with headache,4 patients with testicular swelling and pain,4 patients with skin rash,3 patients with myalgia,2 patients with peripheral neuralgia and 1 patient with uveitis.Among the patients,14 patients were misdiagnosed as having other diseases,and 8 patients were misdiagnosed as having infectious diseases,of whom there were common bacterial infection in 7 patients and virus infection in 1 patient;6 patients were misdiagnosed as having rheumatic diseases,of whom there were 2 patients with rheumatoid arthritis,2 patients with rheumatic vasculitis,1 patient with ankylosing spondylitis and 1 patient with adult onset Still's disease.Six patients hospitalized because of fever,and course of fever was 1-10 d in 4 patient,21 d in 1 patient and 30 d in 1 patient.Three patients had been confirmed as having brucellosis in local hospitals,but courses of the disease were prolonged because of no timely and standard treatment.The duration of misdiagnosis and mistreatment was(80.2±121.6)d.All the 23 patients were confirmed as having brucellosis according to case history,clinical manifestations,positive results of blood culture for brucella and/or positive test for brucella antibody.After confirming,20 patients received corresponding treatment for 6 weeks to 3 months,and 19 patients were cured,while 1 patient was blindness due to uveitis of oculus uterque;3 patients were transferred to local hospitals for treatment but were lost to follow-up.Conclusion Brucellosis should be considered when patients have fever,rash,joint swelling and pain,low back pain and testicular swelling and pain.Brucellosis can be confirmed according to case history,clinical manifestations,results of blood culture for brucella and brucella antibody detection.