非疫区36例布鲁菌病患者的临床特征及诊疗分析

Clinical features, diagnosis, and treatment of 36 cases of brucellosis in non-epidemic areas

目的探讨布鲁菌病患者的临床特征,提高临床医师对该病的诊治能力。方法临床回顾性研究,收集分析北京大学第一医院2010年1月至2022年12月收治的36例布鲁菌病患者的流行病学特点、临床表现、实验室检查、影像学资料及诊治过程。结果入选者均来自非疫区,男女比例8∶1,中位年龄47.5(36.5,57)岁,32例(88.9%)来自农村,28例(77.8%)有病畜接触史,27例(75.0%)春夏季发病。36例(100%)均有发热,32例(88.9%)以“发热待查”收治,其它主要表现有关节痛(55.6%)、脾大(52.8%)、淋巴结肿大(38.9%)、多汗(38.9%)、肌痛(25.0%)、睾丸肿痛(19.4%)、肝肿大(16.7%)、脊柱炎(11.1%)。3例(8.3%)出现全血细胞减少,2例(5.6%)诊为继发性噬血细胞综合征。入选者起病至确诊的中位时间为45(30.5,78.75)天;26例(72.2%)通过分离鉴定出布鲁杆菌确诊,10例(27.8%)通过试管凝集试验确诊。入选者分别接受四环素类、利福平、阿米卡星、喹诺酮类、头孢曲松或复方新诺明双联或三联抗菌治疗,34例(94.4%)治疗后2~3 d体温降至正常。结论非疫区布鲁菌病易被漏诊或误诊;临床医师若遇到发热患者合并关节痛、多汗、肌痛、睾丸肿痛、肝脾淋巴结肿大、脊柱炎等表现,应询问牛羊接触史并警惕布鲁菌病可能。

ObjectiveTo explore the clinical characteristics of brucellosis patients and improve the diagnosis and treatment of this disease by clinicians.MethodsThis is a retrospective study, in which the epidemiological characteristics, clinical manifestations, laboratory examinations, imaging data, and diagnosis and treatment of 36 cases of brucellosis admitted to Peking University First Hospital from January 2010 to December 2022 were collected and analyzed.ResultsAll the patients were from non-epidemic areas. The male to female ratio was 8∶1, and the median age was 47.5 (36.5, 57) years. Thirty-two cases (88.9%) came from rural areas, 28 (77.8%) had a history of contacting with cattle or sheep, and 27 (75.0%) developed symptoms in spring or summer. All the cases had fever, and 32 (88.9%) were admitted with “fever of unknown origin”. The other manifestations were joint pain (55.6%), splenomegaly (52.8%), lymph node enlargement (38.9%), hyperhidrosis (38.9%), myalgia (25.0%), testicular swelling/pain (19.4%), hepatomegaly (16.7%), and spondylitis (11.1%). Three cases (8.3%) developed pancytopenia, two of which were diagnosed as having secondary hemophagocytic syndrome. The median time from onset to diagnosis was 45 (30.5, 78.75) days. Twenty-six cases (72.2%) were confirmed by culture, and ten (27.8%) were revealed by the serum agglutination test. Participants received double or triple antibiotic therapy, including tetracycline, rifampicin, amikacin, quinolones, ceftriaxone, and cotrimoxazole. In 34 cases (94.4%), the body temperature returned to normal 2-3 days after treatment.ConclusionIn non-epidemic areas, missed diagnosis and misdiagnosis of brucellosis are common. When encountering patients with fever, joint pain, hyperhidrosis, myalgia, testicular swelling, hepatosplenomegaly, enlargement of lymph nodes, and spondylitis, clinicians should inquire about the history of contact with cattle and sheep, and be alert to the possibility of brucellosis.