布氏杆菌病9例分析

目的：加强对布氏杆菌病临床特征的认识,以利于及时正确地诊断和治疗。方法：对9例布氏杆菌病患者的临床资料进行分析。结果：临床表现多为长期发热、多汗、畏寒关节疼痛,本组布氏杆菌对四环素、强力霉素、利福平、链霉素等均敏感。用广谱抗生素无效,细胞内抗菌药联合应用效果明显。结论：农牧过渡区临床及防疫医生应高度重视布氏杆菌病,掌握临床及流行病学特征,正确诊断和治疗,加强预防宣传。     

高压氧辅佐药物治疗布鲁杆菌病性脊椎炎的临床疗效

布鲁杆菌病是由布鲁杆菌引起人畜共患具传染性的变态反应性疾病,此病侵袭脊柱引发感染性脊柱炎即布鲁杆菌病性脊椎炎,且发病率逐年增高[1-3].药物治疗是防止本病复发的最主要和最可靠方法,如何更好地提高药物治疗效果且减少用药时间、降低药物毒副作用是我们研究的最终目的.作者自2002年1月至2011年3月对108例患布鲁杆菌病性脊椎炎者进行两种治疗方法的对比,报道如下.     

动态增强磁共振定量成像对布氏杆菌性脊椎炎的鉴别诊断价值

目的探讨动态对比增强磁共振定量成像(dynamic contrast-enhanced MRI,DCE-MRI)技术对布氏杆菌性脊椎炎的鉴别诊断价值。材料与方法 16例脊椎病变患者(经临床或手术病理证实:11例布氏杆菌性脊椎炎、2例脊椎椎体转移瘤、3例结核性脊椎炎)行T1WI、T2WI、STIR及动态对比增强定量检查,分析其形态、信号特点及容积转运参数(Ktrans)与血管外细胞外间隙容积比(Ve)。结果病变累及腰椎最多。布氏杆菌性脊椎炎在MRI上椎体形态多无明显变化,椎体边缘可见小的骨质破坏及骨质增生。病变椎体T1WI呈低信号,T2WI呈低等或等高信号或低等高混杂信号。STIR呈高信号。增强扫描病变椎体明显强化,与周围正常增强的椎体信号类似或更高。各类脊椎病变的Ktrans值与Ve值的差异均有统计学意义(P0.05)。结论布氏杆菌性脊椎炎有特征性的磁共振表现,动态对比增强磁共振定量成像对鉴别诊断有重要价值。     

阿奇霉素联合强力霉素治疗非淋菌性宫颈炎的疗效观察

【目的】探讨阿奇霉素联合强力霉素治疗非淋菌性宫颈炎的临床疗效。【方法】选取2013年1月到2015年12月本院门诊收治的96例非淋茵性宫颈炎患者随机分为阿奇霉素组、强力霉素组、阿奇霉素联合强力霉素联舍组,每组32例,疗程结束后2周观察三组患者的临床疗效及沙眼衣原体（CT）和解脲支原体（UU）转阴率。【结果】联合组的总有效率为96．87％（31／32）,明显高于阿奇霉素组的87．50％（28／32）和强力霉素组的90．63％（29／32）,其差异有统计学意义（P〈0．05）;联合组CT感染、UU感染、两者混合感染转阴率分别达到94．12％（16／17）、90．0％（9／10）和100％,明显高于阿奇霉素组及强力霉素组（P〈0．05）。【结论】阿奇霉素联合强力霉素治疗非淋菌性宫颈炎疗效显著,值得临床推广应用。     

从血液中分离出羊布氏杆菌一例

布氏杆菌 (Ｂｒｕｃｅｌｌａｓｐｐ)可引起布氏杆菌病 (Ｂｒｕｃｅｌｌｏｓｉｓ) ,又称波浪热 ,它是人畜共患性全身传染病。我院于 1999年 7月从一患者血液中分离出羊布氏杆菌 ,报告如下。患者 ,男 ,35岁 ,因不明原因发热 4个多月后入我院。经询问 ,患者有进食生羊肉串史。布氏杆菌凝集试验阳性 (1∶8)。血培养至第 10ｄ ,血培养仪报警阳性 ,经培养鉴定为羊布氏杆菌。临床用利福平 0 .3ｇ ,强力霉素 0 .1ｇ每天两次联合使用 ,6周为 1个疗程 ,体温逐渐下降 1个多月后痊愈出院。细菌鉴定 :血培养至第 10ｄ ,ＢａｃＴ/Ａｌｅｒｔ血培养仪报警 ,…     

CT联合MRI对布氏杆菌性脊柱炎的诊断价值

<正>布氏杆菌性脊柱炎(BS)是布氏杆菌侵犯脊柱导致感染性脊柱炎的一种传染性疾病，在全部骨关节布氏杆菌病中布氏杆菌性脊柱炎占比约2%～53%^[1]。近年来我国BS发病率明显攀升，局部区域流行严重。BS临床表现及实验室检查无特异性，血培养阳性率较低，容易发生误诊及漏诊，影响患者预后^[2],同时BS与脊柱结核的临床症状及影像学表现较为相似，诊断难度大。     

中西医结合治疗脊柱结核伴布氏杆菌病临床研究

目的：观察中西医结合治疗脊柱结核伴布氏杆菌病的疗效和可行性。方法：自1998年2月—2008年2月共收治脊柱结核204例,其中68例伴有布氏杆菌病,随机设对照组与治疗组,其中对照组34例应用传统西医治疗方法,另34例采用中西医结合疗法,对两组治疗效果进行分析。结果：随访8个月-2年（平均16.5个月）,有59例获得随访,9例中途失访。根据骨结核病灶治愈标准及布氏杆菌病血清免疫学检验指标,对照组治愈时间5-16个月,平均12个月;治疗组治愈时间3-12个月,平均8个月。结论：虽然两种方法都可治疗脊柱结核伴布氏杆菌病,但中西医结合疗法更能进一步缩短疗程,促进愈合,且该方法简单、安全、有效,尤其值得在基层医院应用。     

阿奇霉素治疗慢性阻塞性肺疾病患者肺炎衣原体慢性感染的临床疗效观察

目的:探讨阿奇霉素治疗慢性阻塞性肺疾病患者肺炎衣原体慢性感染的临床效果。方法:选取我院收治的慢性阻塞性肺疾病合并肺炎衣原体慢性感染患者86例,随机分为观察组和对照组各43例。对照组患者给予口服安慰剂治疗,观察组患者给予口服阿奇霉素治疗,连续服用5 d,停用25 d为1个疗程,重复治疗3个疗程。对两组患者临床症状评分、肺功能等指标进行比较。结果:治疗后观察组患者临床症状评分明显低于对照组,差异具有统计学意义,P0.05。观察组患者肺功能明显优于对照组,差异具有统计学意义,P0.05。结论:阿奇霉素治疗慢性阻塞性肺疾病合并肺炎衣原体慢性感染,能够降低患者临床症状评分,改善患者肺功能,使用前景广阔,值得临床推广。     

过氧化氢溶液局部应用联合强力霉素治疗宫颈支原体感染的疗效

[目的]观察过氧化氢溶液联合强力霉素治疗宫颈支原体感染的疗效。[方法]将78例宫颈支原体感染患者随机分为治疗组和对照组。治疗组用过氧化氢溶液联合强力霉素治疗,对照组用强力霉素治疗。两组均以14 d为1疗程。观察临床疗效并检测支原体阴转率。[结果]两组临床总有效率、支原体阴转率分别为91.67%、81.25%和70%、60%。治疗组明显高于对照组（均P〈0.05）。[结论]过氧化氢溶液联合强力霉素用药治疗宫颈支原体感染疗效好,毒副反应少。     

复方丹红联合左氧氟沙星及多西环素治疗慢性布氏杆菌病临床研究

目的 探讨复方丹红联合左氧氟沙星及多西环素治疗慢性布氏杆菌病的临床疗效.方法 选择慢性布氏杆菌病患者168例,随机分为治疗组和对照组,治疗组用复方丹红联合左氧氟沙星及多西环素治疗,对照组只用左氧氟沙星和多西环素治疗,3周为1个疗程,2个疗程后观察其临床疗效.结果 治疗组治愈率为91.7％,对照组治愈率为79.8％,2组比较有统计学意义(x2=4.86,P＜0.05).治疗组不良反应发生率为4.8％.对照组为14.3％,差异有统计学意义(x2=4.42,P＜0.05).结论 复方丹红联合左氧氟沙星及多西环素治疗慢性布氏杆菌病疗效确切,不良反应少,值得临床进一步研究.     

Back pain secondary to Brucella spondylitis in the lumbar region

Brucellosis is a systemic, infectious disease caused by the bacterial genus Brucella and a common zoonosis that still remains a major health problem in certain parts of the world such as the Mediterranean region, the Middle East, and Latin America. It may involve multiple organs and tissues. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylitis is often difficult since the clinical presentation may be obscured by many other conditions. There are only a few reports on brucellar spondylitis in Korea. Here, we report a case of spondylitis due to brucella in an elderly male.     

布氏杆菌性脊柱炎的磁共振研究进展

布氏杆菌病是一种全球性的人畜共患二次传染病,其发病率逐年上升。它是由布氏杆菌引起的全身性感染,腰椎最常受累。磁共振成像的多维参数和良好的组织差异是评估和复查布氏杆菌性脊柱炎的第一选择。本文将从布氏杆菌性脊柱炎的磁共振成像、鉴别诊断、体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion weighted imaging,IVIM-DWI)对该病的研究现状作一综述。     

Brucellar spondylodiscitis: a case report

Brucellosis is a common zoonosis which still remains as a major health problem in certain parts of the world. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylodiscitis is often difficult since the clinical presentation may be obscured by many other conditions. Herein, we reported an uncommon case of spondylodiscitis due to brucella in an elderly male who had diabetes mellitus and degenerative spinal disease as underlying conditions. The diagnosis was established by using magnetic resonance imaging after the brucella-agglutination test was found to be positive. The diagnosis was also confirmed by positive blood culture. A high degree of suspicion in the diagnosis of brucellar spondylitis is essential to reduce the delay for the treatment. Thus, it should be essentially included in the differential diagnosis of longstanding back pain particularly in regions where brucellosis is endemic. Screening serologic tests for brucella should be used more widely in cases with low index of suspicion, especially in endemic areas.     

一期后路手术治疗合并硬膜外脓肿的腰椎布鲁氏菌脊柱炎

目的总结一期后路手术治疗合并硬膜外脓肿的腰椎布鲁氏菌脊柱炎的临床疗效。 方法选择2014年1月至2018年12月应用一期后路手术治疗腰椎布鲁氏菌脊柱炎伴硬膜外脓肿23例,在规范抗布鲁氏菌病基础上,采用后路病灶清除、椎板减压、短节段固定及椎间植骨融合方法进行治疗。观察患者术后腰腿痛减轻及植骨融合情况。 结果术后23例均获随访,随访时间平均（16.28±3.26）个月,术后切口均一期愈合,布鲁氏菌病的症状消失,内固定牢固,植骨融合时间（7.42±1.26）个月。按Nakano等提出的腰背痛手术疗效标准：优,16例;良,5例;可,2例。 结论对合并硬膜外脓肿的腰椎布鲁氏菌脊柱炎在规范抗感染治疗的基础上,行一期后路病灶清除、短节段固定及植骨融合可取得较满意的效果。     

Human brucellosis in Kuwait: a prospective study of 400 cases

The clinical pattern of 400 cases of brucellosis in Kuwait is presented. The disease was acute in 77 per cent, sub-acute in 12.5 per cent and chronic in 10.5 per cent of cases. Raw milk was the major source of infection. The major features on presentation, irrespective of the course of the disease, were fever, sweating, headache, rigors, arthralgia, myalgia, and low back pain. Hepatosplenomegaly was present in 41 per cent of cases and in 32 per cent neither liver nor spleen were palpable. The haematologic findings were not specific and hepatic dysfunction (shown by liver enzyme abnormalities) was common. Skeletal (26 per cent) and genital (8.5 per cent) changes and neurobrucellosis (7 per cent) were the major complications. The ELISA was the most sensitive and reliable diagnostic test especially in relation to chronic brucellosis and neurobrucellosis. ELISA allowed the determination of brucella-specific immunoglobulins (Ig)G, IgM and IgA in the CSF, and provided profiles of Ig, in sera, which were different in patients with chronic (elevated IgG and IgA) from those with acute (elevated IgM alone or IgG, IgM and IgA) brucellosis. Treatment with tetracycline, doxycycline or rifampicin gave a cure rate of over 91 per cent in acute and subacute brucellosis. Co-trimoxazole was associated with a relapse rate of 50 per cent. Two drug combinations of streptomycin and tetracycline, streptomycin and rifampicin or streptomycin and doxycycline were effective, but one of five patients with chronic brucellosis relapsed. A combination of streptomycin, tetracycline and rifampicin with or without steroids was used successfully in neurobrucellosis, septicaemic shock and subacute bacterial endocarditis.     

甲真菌病临床特点及致病菌谱的研究

目的探讨甲真菌病流行病学特点如发病年龄、临床形态学分型、易感因素,以及致病菌谱状况。方法对2010年12月—2011年12月我院328例甲真菌病的病甲进行拍照和真菌检查（包括直接镜检、真菌培养）,并对所有真菌检查阳性患者进行临床形态学分型,其中113例填写调查问卷调查易感因素。结果 328例甲真菌病统计结果显示,男性发病率高于女性,男女比例为1.45∶1,最主要的发病年龄为20～29岁（35.7%）。370例指甲及趾甲的临床形态学分型中最常见的是远端侧缘甲下型（51.4%）,其次为全甲毁损型（24.3%）,白色浅表型（18.6%）,近端甲下型（5.7%）。196例甲标本培养阳性结果中皮肤癣菌最常见（82.7%）,其次为念珠菌属（11.2%）和非皮肤癣菌的霉菌（6.1%）如曲霉属、青霉属、镰刀菌属等。皮肤癣菌中最常见的是红色毛癣菌,其次须癣毛癣菌。念珠菌属中最常见的是白念珠菌。113例经调查显示易感因素为家族性感染（11.5%）,慢性肾病（4.4%）及肾移植（0.9%）,糖尿病（1.8%）,甲外伤（1.8%）,白血病（0.9%）和特发性血小板较少性紫癜（0.9%）。结论临床通过对甲真菌病患者的流行病学特点及菌种分布等情况进行了解,可指导临床治疗及采取相应的预防措施。     

Human Brucellosis in Kuwait: A Prospective Study of 400 Cases

SUMMARY The clinical pattern of 400 cases of brucellosis in Kuwait ispresented. The disease was acute in 77 per cent, sub-acute in12. 5 per cent and chronic in 10. 5 per cent of cases. Raw milkwas the major source of infection. The major features on presentation,irrespective of the course of the disease, were fever, sweating,headache, rigors, arthralgia, myalgia, and low back pain. Hepato-splenomegalywas present in 41 per cent of cases and in 32 per cent neitherliver nor spleen were palpable. The haematologic findings werenot specific and hepatic dysfunction (shown by liver enzymeabnormalities) was common. Skeletal (26 per cent) and genital(8. 5 per cent) changes and neurobrucellosis (7 per cent) werethe major complications. The ELISA was the most sensitive andreliable diagnostic test especially in relation to chronic brucellosisand neurobrucellosis. ELISA allowed the determination of brucella-specificimmunoglobulins (Ig)G, IgM and IgA in the CSF, and providedprofiles of Ig, in sera, which were different in patients withchronic (elevated IgG and IgA) from those with acute (elevatedIgM alone or IgG, IgM and IgA) brucellosis. Treatment with tetracycline,doxycycline or rifampicin gave a cure rate of over 91 per centin acute and subacute brucellosis. Co-trimoxazole was associatedwith a relapse rate of 50 per cent. Two drug combinations ofstreptomycin and tetracycline, streptomycin and rifampicin orstreptomycin and doxycycline were effective, but one of fivepatients with chronic brucellosis relapsed. A combination ofstreptomycin, tetracycline and rifampicin with or without steroidswas used successfully in neurobrucellosis, septicaemic shockand subacute bacterial endocarditis.     

The course of Lyme disease in different age groups

Lyme disease is a multisystem infection affecting all age groups. In this study an attempt was made to determine whether the patient's age influences the course of the disease. One hundred and fifty patients with diagnosed Lyme disease were included in the study. Two serological methods were used to detect antibodies to Borrelia burgdorferi and to confirm the diagnosis: an indirect immunofluorescence assay (the Russian strain Ip-21) and Western blot. The course of Lyme disease did not differ from that seen in Europe and North America. However, a few clinical differences between groups were observed. In the first age group (0-15 years) the most common manifestation was flu-like symptoms with fever. Neither radiculoneuritis nor polyneuropathy was observed in this age group. Late manifestations were rare and the outcome of the disease was benign. The course of the disease in the second group (16-40 years) was most similar to that in childhood and the also outcome was similar. Carditis and erythema multiple were significantly more common in the second group (16-40 years) than in the other age groups. No differences were found between the third (41-60 years) and fourth (> than 60 years) group in the frequency of flu-like symptoms, erythema multiple and aseptic meningitis. However, the most important clinical sign in this group was involvement of the nervous system whereas in the third group this was joint damage. This feature deserves attention because, as a rule, the presence of an articular syndrome determines the prognosis of LD.     

原发性肝癌159例的临床特征分析

目的　了解原发性肝癌的临床特征 ,为其防治提供参考资料。方法　 15 9例原发性肝癌、77例慢性乙型肝炎、5 7例乙型肝炎后肝硬化、87例其它恶性肿瘤患者的临床资料进行了调查分析。结果　原发性肝癌患者中乙型肝炎的感染率为 87 4 % (139/ 15 9) ,显著高于其它肿瘤患者和正常人群 ,血清学检查多为“小三阳”(HBsAg、HBeAb、HBcAb) ;AFP、LDH升高率分别为 81 1% (12 9/ 15 9)、4 1 5 % (6 6 / 15 9)显著高于慢性乙型肝炎和乙肝后肝硬化组患者 (P <0 0 1) ;原发性肝癌好发于男性、年龄较大患者。结论　原发性肝癌与乙型肝炎病毒感染密切相关 ,临床应加强检查和防治。     

MRI在布氏杆菌脊柱炎和脊柱结核鉴别诊断中的应用价值

[目的]探讨MRI在布氏杆菌脊柱炎和脊柱结核鉴别诊断中的应用价值.[方法]选择2013年12月至2016年10月本院确诊的布氏杆菌脊柱炎40例、脊柱结核50例,将其分为脊柱炎组与脊柱结核组.对两组患者MRI影像学资料进行分析.[结果]脊柱炎组与脊柱结核组在椎体破坏部位[前侧、后侧、前后侧(25.00%、60.00%、15.00%)vs(68.00%、16.00%、16.00%)]、椎旁软组织内脓肿(7.50%vs 74.00%)、椎间盘破坏[局限、弥漫(45.00%、17.50%)vs(18.00%、40.00%)]、椎间隙狭窄(27.50%vs 50.00%)、椎间盘信号异常(80.00%vs 30.00%)及椎间隙消失(0.00%vs 20.00%)方面比较,差异具有统计学意义(P<0.05);两组发病部位、椎体受累数、后凸畸形发生率比较,差异无统计学意义(P>0.05).[结论]布氏杆菌脊柱炎和脊柱结核发病部位、椎体受累数等MRI表现类似,但在椎体破坏部位、椎间隙狭窄等方面MRI表现差异显著,可作为两者鉴别诊断重要MRI征象.