非牧区67例布鲁氏菌病患者临床分析

Clinical Analysis of 67 Brucellosis Patients in Non-pastoral Areas

目的收集和分析非牧区布鲁氏菌病患者的基本情况、流行病学及临床特征,为非牧区布鲁氏菌病的防治提供参考经验。方法回顾性统计分析福建省泉州市第一医院感染科2013年1月至2021年8月收治的67例布鲁氏菌病患者的临床资料,对流行病学、临床特征、实验室检查结果、并发症以及治疗方案和预后进行统计分析。结果67例布鲁氏菌病患者中,男41例、女26例,男性居多;年龄40~69岁的中老年较多;职业多以餐饮从业人员居多,其次是屠宰人员;传播途径主要是屠宰牛羊、接触生牛羊奶;感染发病时间为7~9月最为集中;临床特征表现多样化,以发热最为见多,其次是乏力、关节疼痛、多汗、淋巴结肿大;经布氏杆菌试管凝集试验提示全部有布鲁氏菌,血培养有38例提示布鲁氏菌。并发症49例中骨关节损害居多,其次是肝损害和神经系统并发症;44例治疗方案选择多西环素+利福平,2例选择利福平+复方磺胺甲噁唑,21例选择多西环素+利福平+头孢曲松;经治疗后61例患者好转出院,1例转心外科手术治疗,5例转骨科手术治疗。结论布鲁氏菌病在非牧区发病率较高,且临床表现呈现多样化,易造成漏诊误诊,需引起感染科临床医师的重视。

Objective To collect and analyze the basic conditions,epidemiology and clinical characteristics of patients with brucellosis in non-pastoral areas,and to provide reference experience for the prevention and treatment of brucellosis in non-pastoral areas.Methods The clinical data of 67 patients with brucellosis admitted to the Department of Infectious Diseases of the First Hospital of Quanzhou City,Fujian Province from January 2013 to August 2021 were retrospectively analyzed.Statistical analyses were performed on epidemiology,clinical features,laboratory findings,complications,and treatment options and prognosis.Results Among the 67 patients with brucellosis,41 were males and 26 were females,with the majority of males.There are more middle-aged and elderly people aged 40-69;Most of the occupations are catering practitioners,followed by slaughterers and unemployed people.The main routes of transmission are slaughtering cattle and sheep,contact with raw cow and goat milk;The onset of infection is most concentrated in July to September.Clinical features are diverse,with fever being the most common,followed by fatigue,joint pain,hyperhidrosis,and lymphadenopathy.Transfuscular brucella test tube agglutination test indicates all Brucella,and blood cultures in 38 cases indicate Brucella.Among the 49 cases of complications,most of them had osteoarticular damage,followed by liver damage and neurological complications;44 patients chose doxycycline+rifampicin,2 patients chose rifampicin+compound sulfamethoxazole,and 21 patients chose doxycycline+rifampicin+ceftriaxone.After treatment,61 patients were discharged from the hospital,one case was treated with cardiac surgery,and 5 cases were treated with orthopedic surgery.Conclusion The incidence of brucellosis in non-pastoral areas is increased,and the clinical manifestations are diversified,which is easy to cause missed diagnosis and misdiagnosis,which requires the attention of clinicians in the department of infectious diseases.