40例儿童布鲁氏菌病临床特征分析

Clinical characteristics of brucellosis in 40 children

目的探讨儿童布鲁氏菌病的临床特征,以提高临床医师对该病的诊疗水平。方法将2012—2023年首都医科大学附属北京佑安医院感染科收治的40例年龄≤14岁的布鲁氏菌病患者纳入研究,收集患者的一般及临床资料并进行分析。结果40例患者中女性(22例,55%)多于男性(18例,45%),年龄最小5月龄,最大14岁,中位年龄是4岁2个月。主要表现为发热(36例,90%)、多汗(25例,62.5%)、腿疼(19例,47.5%)及乏力(18例,45%)。实验室检查数据显示,40例患者中32例(80%)血常规白细胞计数为(4~10)×10^(9)/L;36例(90%)淋巴细胞计数升高;脏器损伤以肝功能异常为主。所有患者均应用至少2种抗菌药物进行治疗,包括利福平、复方磺胺甲噁唑、多西环素(≥8岁以上患者可使用),发生并发症的患者在基础治疗上联合复方磺胺甲噁唑或第三代头孢菌素。结论儿童布鲁氏菌病临床特征多不典型,流行病学史及发热是主要线索,且随着旅游行业、养殖业的发展,此病非流行区的发病率也逐渐上升;临床医生一定要仔细询问病情及是否接触过羊羔、奶制品、牧区,同时还要注意经食源性途径感染所致的发病情况。

Objective Exploring the clinical characteristics of brucellosis inchildrentoimprove the diagnosis and treatment level of clinical physicians.Methods A total of 40 patients aged≤14 years with brucellosis admitted to the Department of Infection,Beijing You’an Hospital,Capital Medical University from 2012 to 2022,including epidemiology,clinical features,laboratory examination and drug therapy,were selected and analyzed.Results Among the 40 patients,there were more females(22 cases,55%)than males(18 cases,45%).The minimum age was 5 months and the maximum age was 14 years.The median age was 4 years and 2 months.The main manifestations were fever(36 cases,90.0%),hyperhidrosis(25 cases,62.5%),leg pain(19 cases,47.5%)and fatigue(18 cases,45%).The white blood cell count of 32 cases(80.0%)was(4~10)×10^(9)/L.Lymphocyte count increased in 36 cases(90.0%).The main organ injury involved abnormal liver function.All cases were treated with at least 2 antimicrobials,including rifampicin,co-sulfamethoxazole,and doxycycline(for children≥8 years old or older).In cases with complications,co-sulfamethoxazole or the third-generation cephalosporin were combined in basic treatment.Conclusions The clinical characteristics of children’s brucellosis are mostly atypical.Epidemiological history and fever are the main clues.With the development of tourism and breeding industry,the incidence rate of this disease in non epidemic areas has gradually increased;Clinicals must carefully inquire about the condition and whether they have come into contact with lambs,dairy products,or pastoral areas,while also paying attention to the incidence of foodborne infections.