布鲁菌病临床误诊个例复习及预防

目的探讨布鲁菌病误诊、误治的常见疾病,以增加临床对布鲁菌病的认知度。 方法通过对布鲁菌病误诊个例的文献复习,将误诊疾病按系统进行分类分析。 结果布鲁菌病累及呼吸系统可被误诊为重感冒、支气管炎、支气管肺炎、支原体肺炎、结核性胸膜炎或胸膜间皮瘤,累及循环系统可被误诊为病毒性心肌炎或风湿性心脏病,累及消化系统可被误诊为药物性肝炎、肝硬化或胆道蛔虫病,累及血液系统可被误诊为恶性淋巴瘤,累及神经系统可被误诊为脊髓炎,累及运动系统可被误诊为痛风性关节炎、髋关节滑膜炎、腰椎骨折、腰椎间盘突出或腰椎结核,累及生殖系统可被误诊为睾丸炎、附件炎或先兆早产,其他也可被误诊为成人Still病。 结论布鲁菌病可被误诊为多系统、多器官疾病。详细追问患者的流行病学史、常规进行试管凝集试验（SAT）和虎红平板凝集试验（RBPT）检测是减少布鲁菌病误诊误治的有效途径。     

布氏杆菌性附睾睾丸炎11例诊治体会

目的探讨布鲁氏杆菌性附睾睾丸炎的临床表现及诊疗方法,提高诊断及治愈率。方法延安大学附属医院收治的11例布鲁氏杆菌性附睾睾丸炎患者,常规行血、尿常规、超敏C反应蛋白检测和B超检查,行血清虎红平板凝集试验(RBPT)及试管凝集试验(SAT)。确诊后使用多西环素联合利福平的综合治疗。结果 11例患者在接受治疗后,症状均在24~48h内得到有效控制,无手术切除附睾睾丸病例及复发病例。结论布鲁氏杆菌性附睾睾丸炎的诊断需要综合疫畜接触史、临床表现、实验室检查及B超表现,并及时行RBPT和SAT试验确诊布鲁氏杆菌感染,使用多西环素联合利福平的综合治疗疗效确切。     

布氏杆菌致急性附睾睾丸炎5例诊治体会

目的探讨布氏杆菌致急性附睾睾丸炎的临床特点和诊治方法,避免误诊,提高诊治水平。方法 5例患者血清虎平凝集试验（RBPT）、试管凝集试验（SAT）均呈阳性,治疗采取基础对症加以精索封闭、利福平多西环素等为主的综合疗法。结果 5例患者治疗后症状体征全部消失,随访2~12月无复发。结论临床表现及RBPT、SAT试验结果诊断因布氏杆菌引发的附睾睾丸炎简便易行,可有效避免误诊。综合疗法疗效肯定。     

45例非牧区儿童布鲁菌病临床分析

目的探讨非牧区儿童布鲁菌病的流行特点、临床特征及实验室检查,为非牧区儿童布鲁菌病的诊断提供依据。 方法采用回顾性分析方法,收集2014年1月至2018年12月陕西省疾病预防控制中心及西安市儿童医院确诊的45例非牧区布鲁菌病患儿的临床资料,对其临床特征及实验室检查结果进行分析。 结果3～9月份为非牧区儿童布鲁菌病发病高峰期,且2014年至2018年儿童布鲁菌病发病呈逐年增多趋势。45例布鲁菌病患儿中,男19例、女26例,0～3岁儿童为非牧区儿童布鲁菌病主要发病人群（53.3%、24/45）,传播途径以消化道传播（64.4%、29/45）为主;临床表现多样,发热为最主要的临床表现（82.2%、37/45）,其次为关节肿痛（40.0%、18/45）和肝肿大（28.9%、13/45）,但多汗（11.1%、5/45）和乏力（6.7%、3/45）较少见。实验室检查以炎症指标异常为主,降钙素原升高者30例（66.7%）,红细胞沉降率者（ESR）增快者10例（22.2%）,C-反应蛋白（CRP）升高者7例（15.6%）;血常规检查中无全血细胞数下降的患儿;45例患儿血培养布鲁杆菌阳性者35例（77.8%）,另外10例（22.2%）试管凝集试验阳性。45例患儿中4例（8.9%）出现神经系统受累症状,且其脑脊液均培养出布鲁杆菌。 结论儿童布鲁菌病临床表现复杂,非牧区儿童存在长期发热、关节肿痛或肝脏肿大等症状时,儿科医师应高度怀疑布鲁菌病,以尽早诊断和及时治疗。     

非典型布鲁杆菌脊柱炎的诊断与治疗

目的：探讨非典型布鲁杆菌脊柱炎的诊断与治疗,以进一步提高临床医师对该病的认识水平及诊治能力。方法回顾分析19例布鲁杆菌脊柱炎患者,病变节段位于腰椎17例、颈椎2例。14例有羊、牛接触史。19例均行 X 线检查,16例行 CT 检查,11例行 MRI 检查,所有患者标准血清试管凝集试验（SAT）滴度均＞1∶160,虎红平板凝集试验（RBP）均为阳性。均采用规范抗菌治疗,3例患者行手术治疗。结果患者均获随访,时间3～12个月,经规范抗菌治疗后治愈18例,治愈率18／19。3例手术患者术后恢复良好。末次随访时,ESR （10．5±5．1）mm／1h,CRP （4．3±2．5）mg／L,VAS 评分（0．9±0．7）分、JOA 评分（25．0±1．8）分,JOA下腰痛评分治疗改善率78．9％;ESR、VAS 及 JOA 评分与治疗前比较差异均有统计学意义（P ＜0．05）,而 CRP与治疗前比较差异无统计学意义（P ＝0．442）。结论布鲁杆菌脊柱炎易被误诊误治,对可疑患者宜早期行血清学检验,一经确诊应规范、联合、长期、足量抗菌治疗,必要时采用手术治疗,可取得良好效果。     

45例布鲁菌病患者实验室诊断指标特征

目的分析布鲁菌病患者不同病期实验室指标变化特征,为布鲁菌病诊断及预后评估提供参考。 方法对天门市第一人民医院确诊的45例布鲁菌病患者的降钙素原（PCT）、超敏C-反应蛋白（hsCRP）、白细胞（WBC）、血小板（PLT）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、肌酐（Crea）、尿微量白蛋白（mALB）和红细胞沉降率（ESR）等指标以及血培养阳性率和试管凝集试验阳性率进行回顾性分析。根据临床分期分组：急性期患者23例,亚急性期患者8例和慢性期患者14例。 结果急性期与亚急性期布鲁菌病患者感染性指标WBC、PCT、hsCRP、ALT、Crea和mALB水平差异均无统计学意义（t_WBC = 2.04、P = 0.082,t_PCT = 1.98、P = 0.093,t_hsCRP = 2.18、P = 0.081,t_ALT = 0.94、P = 0.18,t_Crea = 2.31、P = 0.088,t_mALB = 2.02、P = 0.085）。急性期布鲁菌病患者AST水平显著低于亚急性期患者（t = 7.59、P = 0.023）,且急性期布鲁菌病患者WBC、PCT、hsCRP、ALT、Crea和mALB水平较慢性期患者差异有统计学意义（t_WBC = 8.43、P = 0.021,t_PCT = 18.36、P = 0.013,t_hsCRP = 12.35、P = 0.020,t_ALT = 5.38、P = 0.024,t_Crea = 4.81、P = 0.036,t_mALB = 10.87、P = 0.020）。亚急性期与慢性期布鲁菌病患者感染性指标WBC、PCT、hsCRP、ALT、Crea和mALB水平差异均无统计学意义（t_WBC = 1.12、P = 0.096,t_PCT = 2.19、P = 0.082,t_hsCRP = 2.03、P = 0.084）。随着病期延长,布鲁菌病患者从急性期进展为慢性期,PLT降低、ESR增快、血培养阳性率逐渐降低,但试管凝集试验阳性率一直较高。急性期、亚急性期和慢性期布鲁菌病患者治疗前后PCT和hsCRP差异均有统计学意义（t_PCT = 7.85、16.31、27.60,P = 0.018、0.0023、0.003;t_hsCRP = 9.98、12.14、7.88,P = 0.021、0.036、0.031）。 结论WBC、PLT、ALT、AST、Crea和ESR等指标变化可反映布鲁菌病患者病情的动态变化,血培养和试管凝集试验阳性为布鲁菌病诊断标准;PCT和hsCRP可作为治疗前后患者病情监测及预后的参考依据。     

神经型布鲁菌病临床特点和实验室诊断分析

目的总结神经型布鲁菌病（NB）的临床及实验室诊断过程,为提高临床和实验室对该病的认识和早期诊疗提供经验。 方法回顾性分析2015年1月至2017年1月于首都医科大学宣武医院确诊的12例神经型布鲁菌病患者的临床表现、流行病学资料及脑脊液（CSF）培养等病原学检查、影像学表现和其他实验室检查结果,并与非神经型布鲁菌病患者比较平均发病年龄,CSF白细胞数、蛋白含量、氯化物、葡萄糖水平等。 结果12例神经型布鲁菌病患者中男性9例,女性3例,平均年龄为（43 ± 14）岁;10例患者来自流行地区,9例有明确的流行病学接触史,其中3例既往诊断布鲁菌病;12例患者均出现不同程度发热,6例有头痛伴脑膜刺激征表现;3例患者表现为复视、视力下降;伴有听力减退伴步态不稳,肢体麻木无力,精神状态改变者各4例。血清布鲁杆菌凝集试验阳性（100%）较CSF凝集阳性率（58.3%）和CSF培养阳性率（46.1%）对临床诊断神经型布鲁菌病价值较大,差异具有统计学意义（χ² = 52.68、P = 0.005,χ² = 73.79、P = 0.005）;12例NB患者CSF白细胞数（单核为主）和蛋白均不同程度升高,葡萄糖、氯化物正常或减低,与非NB感染者相比,CSF葡萄糖检测具有重要价值（P均< 0.05）。给予多西环素或米诺环素+利福平+头孢曲松治疗后12例患者均预后良好。 结论神经型布鲁菌病临床表现多样,易误诊或漏诊,非疫区医务人员应重视CSF血瓶培养及布鲁杆菌凝集,加强多学科协作交流以及早确诊及早治疗。     

宏基因组二代测序技术在布鲁菌脊柱炎诊治中的应用价值

目的 探讨宏基因组二代测序(mNGS)技术在布鲁菌脊柱炎诊治中的价值。方法 手术治疗36例布鲁菌性脊柱炎患者,收集术前血液标本和术中病灶区组织标本(髓核、软骨终板、黄韧带、纤维环),采用Giemsa染色、试管凝集试验(SAT)、血培养、多重聚合酶链式反应技术(PCR)检测和mNGS评估不同组织样本。另选取30例椎间盘突出患者作为阴性对照组。结果 静脉血的mNGS、SAT、多重PCR检测阳性率比较差异均无统计学意义(P>0.05)。髓核的mNGS与多重PCR检测阳性率比较差异无统计学意义(P>0.05)。软骨终板、黄韧带和纤维环的mNGS检测阳性率均大于多重PCR检测阳性率(P<0.05)。髓核中多重PCR和mNGS检测阳性率均高于静脉血、软骨终板、黄韧带和纤维环(P<0.05)。敏感性、阴性预测值：mNGS均高于Giemsa染色、血培养和SAT(P<0.05);mNGS与多重PCR检测比较差异均无统计学意义(P>0.05)。临床诊断一致性mNGS最好,多重PCR和SAT较好,Giemsa染色一般,血培养较差。结论 mNGS可以作为布鲁菌脊柱炎的有效检...     

42例布鲁菌病临床误诊个例的综合分析

目的探讨布鲁菌病常见的误诊及其误诊的主要原因。 方法搜索布鲁菌病误诊个例文献。收集共42篇42例布鲁菌病的误诊文献,进行一般情况、误诊疾病、感染途径、确诊方式、地区分布以及预后及不良事件等进行统计分析。 结果42例布鲁菌病患者,男女之比3.2︰1,平均年龄42.3岁,误诊时间最短1周,最长7年。误诊疾病涉及8个系统或组织的29种疾病。感染途径：有明确接触史38例（90.5%）、无任何接触史2例（4.8%）、未描述接触史2例（4.8%）。确诊方式：血清学确诊34例（80.9%）、生物学培养确诊8例（19.1%）。地区分布：42例分布于15个省市自治区,涉及专业科室11个。临床转归：总有效率97.6%。误诊期间出现不良事件4例（9.5%）。 结论布鲁菌病危害之广、误诊疾病之多为其他疾病所罕见。病史采集欠详细、对布鲁菌病认识不足和过度依赖设备检测是该病误诊的主要原因。     

神经型布鲁菌病的临床特点及诊治分析

目的探讨神经型布鲁菌病的临床特点、诊断标准及抗菌药物联合治疗方案。 方法回顾性分析首都医科大学附属北京地坛医院2008年9月至2014年7月收治的10例神经型布鲁菌病患者的临床资料。 结果神经型布鲁菌病以青壮年男性为主,均有明确的流行病学史,临床多表现为脑膜炎和脑膜脑炎等。所有患者血清布鲁杆菌凝集试验阳性,6例患者行脑脊液布鲁杆菌凝集试验,其中4例阳性。所有患者均行腰椎穿刺检查,7例患者脑脊液压力升高,9例白细胞数升高（以单核细胞升高为主）,9例患者蛋白升高,5例糖减低。全部病例给予多西环素和利福平基础上联合三代头孢、氨基糖苷类、复方新诺明、喹诺酮类中的一种或两种组成三联或四联初始抗病原治疗,序贯长疗程口服抗菌药物,平均疗程> 6个月。 结论神经型布鲁氏菌病的临床表现复杂多样,大部分患者预后良好,少数患者可留有后遗症。治疗上不同药理学机制的抗菌药物联合、足量、长疗程治疗有效。     

Serological Evidence of Brucella abortus Prevalence in Punjab Province,Pakistan – A Cross‐Sectional Study

Twenty‐one villages in Punjab Province, seven from each region (North, Central & South) were randomly selected to determine the prevalence of B. abortus infection by two age categories (Group A: 0–2 years; Group B: >2 years) in cattle and buffalo populations. In each village, eight blood samples were collected from each age group of cattle and buffaloes. Sera from a total of 672 blood samples (336 each from cattle and buffaloes) were analysed for the presence of antibodies to B. abortus using rose bengal plate agglutination test (RBPT). Further confirmation of the RBPT‐positive samples was carried out using competitive ELISA. Overall, 43 of 672 (6.4%) sera were found positive for the presence of antibodies to B. abortus using RBPT. In cattle, the prevalence of B. abortus antibody was 5.06%, and in buffaloes, it was 7.74%. From the RBPT‐positive sera, 30 (70%) sera were confirmed for B. abortus antibodies using competitive ELISA. Results indicated that the prevalence of infection increased with the age of animals i.e. 3.27% and 9.52% in groups A and B, respectively. In cattle, incidence of these antibodies was 3.57% and 6.54% while in buffaloes, it was 2.98% and 12.50% in groups A and B, respectively. The region‐wise prevalence of B. abortus infection in buffaloes was 3.13%, 4.46% and 4.02% and in cattle, it was 3.13%, 1.79% and 2.68% in Northern, Central and Southern regions, respectively. This study provided baseline data on the occurrence of brucellosis infection in cattle and buffaloes at village level. This is the first study in Punjab province on the prevalence of brucellosis at village level.     

应用试管-玻片凝集试验和酶联免疫吸附试验检测不育患者抗精子抗体

应用试管-玻片凝集试验测定96例不育男性血清和/或精浆抗精子抗体,阳性率为33.3％,其中血清阳性率31.2％、精浆阳性率为16.3％。血清和精浆两者间的阴性、阳性符合率为75.9％。抗精子抗体对精液量、精子密度和精子的活率等指标无明显影响。并对58例患者血清和精浆标本采用酶联免疫吸附测定法对比测定,结果显示血清和精浆的阴、阳性符合率分别为67.2和74.1％。对56对夫妇分析显示,男方阳性率33.0％,女方阳性率25.0％,其中男女双方均为阳性的发生率为16.1％。夫妇双方有一方阳性者占42.9％。     

Presence of Sperm Agglutinating Antibodies in Infertile Men and Inhibition of in vitro Sperm Penetration into Cervical Mucus

The relation between presence of antispermatozoal antibodies in infertile men and the inhibition of the in vitro sperm penetration into cervical mucus (CM) was studied with the sperm cervical mucus contact (SCMC) test. The tests were performed with semen from infertile men and from semen donors. The CM used permitted good penetration of normal spermatozoa. The so called "shaking phenomenon", the result of a specific interaction of spermatozoa and CM, was expressed in the shaking percentage (S%).
The S% did not change beyond the experimental error within 30 min after mixing semen and CM. The S% was 30 at the most in 194 out of 198 SCMC tests with normal donor semen and normal pre-ovulatory CM. Significant negative correlations ( P < 0.005) were found between the readings of the sperm penetration meter (SPM) test on one hand and the S%, the sperm agglutination titer in the serum and the sperm agglutination titer in the seminal plasma (SP) on the other hand. Significant positive correlations ( P < 0.005) were found between the S% and the sperm agglutination titer in the SP. The sperm agglutination titer in serum and in SP correlated significantly better ( P < 0.02) with the S% in the SCMC test than with the readings of the SPM test.
It was concluded that: 1. A high S% is highly specific for the presence of antispermatozoal antibodies in infertile men, 2. The SCMC test is more suited than the SPM test for studying the effect of antispermatozoal antibodies on the penetration and migration of spermatozoa into CM,     

Significance of sperm antibodies detected by the mixed antiglobulin reaction and the tray agglutination test

Summary. The most widely used tests to detect seminal and serum sperm antibodies are the mixed antiglobulin reaction (MAR as recommended by WHO) and the tray agglutination test (TAT). It has been suggested that the prognostic significance of sperm antibody tests might be influenced by a concomitant reduction of sperm numbers and/or sperm motility. Furthermore, the relative sensitivity of these sperm antibody tests to detect sperm antibodies is not known. We therefore compared TAT, performed with serum and MAR results retrospectively for 565 infertile patients and MAR IgA and MAR IgG results for 1189 infertile patients. The association of TAT and MAR results with changes in sperm number, morphology and motility was assessed for 565 and 1185 patients, respectively. The influence of MAR and TAT results on sperm cervical mucus penetration test (SCMPT) results was investigated for 349 and 434 patients, respectively. Whereas only 23% of all MAR IgG positive patients were also MAR IgA positive, 82% of all MAR IgA positive patients were also MAR IgG positive. There was a significant ( P < 0.0001) correlation between serum TAT, and MAR results. Positive MAR and TAT results were not associated with reductions in sperm number, motility and morphology. There was a significant correlation between MAR IgG and MAR IgA results and the sperm cervical mucus penetration test (SCMPT) results. According to these results, the MAR IgG would be sufficient as an initial screening for seminal sperm antibodies. MAR IgG negative patients with strong indication for immunologic infertility should also be investigated with the MAR IgA and the serum TAT. Serum and seminal sperm antibodies do not seem to influence male fertility via reductions of sperm number, motility and morphology. However because of their significant influence on SCMPT results, MAR IgG and MAR IgA results seem to be of prognostic significance.     

Sensitivity,specificity and predictive probability values of serum agglutination test titres for the diagnosis of Salmonella Dublin culture‐positive bovine abortion and stillbirth

The objective of this study was to determine the diagnostic value of maternal serology for the diagnosis of Salmonella Dublin bovine abortion and stillbirth. A retrospective, unmatched, case–control study was carried out using twenty year's data (1989–2009) from bovine foetal submissions to an Irish government veterinary laboratory. Cases (n  = 214) were defined as submissions with a S . Dublin culture‐positive foetus from a S . Dublin unvaccinated dam where results of maternal S . Dublin serology were available. Controls (n  = 415) were defined as submissions where an alternative diagnosis other than S . Dublin was made in a foetus from an S . Dublin unvaccinated dam where the results of maternal S . Dublin serology were available. A logistic regression model was fitted to the data: the dichotomous dependent variable was the S . Dublin foetal culture result, and the independent variables were the maternal serum agglutination test (SAT ) titre results. Salmonella serology correctly classified 87% of S . Dublin culture‐positive foetuses at a predicted probability threshold of 0.44 (cut‐off at which sensitivity and specificity are at a maximum, J  = 0.67). The sensitivity of the SAT at the same threshold was 73.8% (95% CI : 67.4%–79.5%), and the specificity was 93.2% (95% CI : 90.3%–95.4%). The positive and negative predictive values were 84.9% (95% CI : 79.3%–88.6%) and 87.3% (95% CI : 83.5%–91.3%), respectively. This study illustrates that the use of predicted probability values, rather than the traditional arbitrary breakpoints of negative, inconclusive and positive, increases the diagnostic value of the maternal SAT . Veterinary laboratory diagnosticians and veterinary practitioners can recover from the test results, information previously categorized, particularly from those results declared to be inconclusive.     

The Prevalence of Brucellosis in Cattle,Goats and Humans in Rural Uganda: A Comparative Study

A cross‐sectional study was conducted to determine the presence of brucellosis in cattle, goats and humans in farms from south‐western Uganda and identify risk factors associated with brucellosis in these three host groups. Data and serum samples were collected from 768 cattle, 315 goats and 236 humans, with 635 samples of bovine milk, from 70 farms in two different study areas in south‐western Uganda. Sera from livestock were tested with the Rose Bengal Plate test, using B. abortus and B. melitensis antigens, and human sera were tested with a commercial IgG/IgM lateral flow assay. Milk samples were tested using the OIE‐approved milk ring test. Screening tests for brucellosis were positive in 14% of cattle serum, 29% of bovine milk, 17% of goat serum and 11% of human serum samples. There were significant differences in the test prevalence of brucellosis by study site, with levels higher in the study area near Lake Mburo National Park than in the study area near Queen Elizabeth National Park. Multivariable regression models identified risk factors associated with increasing test positivity at the individual and farm levels for cattle, goats and humans. Positive associations were seen between increasing seropositivity of brucellosis in goats, cattle and humans. Results of multivariable analyses suggest that improvements in farm biosecurity and hygiene may reduce the risk of brucellosis on the farm and suggest a role for ticks in bovine brucellosis. Although cattle are the focus of brucellosis control in Uganda, the significant associations between seropositivity in humans and seropositivity in goats suggest that brucellosis in goats may be an important contributor to the epidemiology of the disease on the farm.     

A new assay method that detects only intact osteocalcin. Two-step non-invasive diagnosis to predict adynamic bone disease in haemodialysed patients.

BACKGROUND: We studied the usefulness of a new assay method that detects only the intact human osteocalcin molecule in haemodialysed patients. METHODS: Iliac bone biopsy specimens obtained from 62 haemodialysed patients were analysed. RESULTS: Bone formation rates (BFR/BS) correlated positively with serum intact osteocalcin concentrations (n=62), osteocalcin concentrations assayed by a conventional method (n=31), parathyroid hormone (PTH) concentrations (n=62), and total alkaline phosphatase concentrations (r=0.602, 0. 588, 0.650, and 0.401 respectively). Based on ROC curve and Youden index analysis, the optimal cut-off value to distinguish adynamic bone disease from a mild lesion was 195 pg/ml of serum PTH concentration (Youden index=0.233) or 30 ng/ml of serum intact osteocalcin concentration (Youden index=0.628). The optimal cut-off value to distinguish between hyperparathyroid bone and a mild lesion was 455 pg/ml of serum PTH level (Youden index=0.63) or 50 ng=ml of serum intact osteocalcin concentration (Youden index=0.634). Since both ROC curve and Youden index suggested that the serum PTH concentration was not a good marker to distinguish adynamic bone from a mild lesion or hyperparathyroid bone, we designed a two-step procedure. The first step was the diagnosis of adynamic bone (cut-off: 65 pg/ml) or hyperparathyroid bone (cut-off: 455 pg/ml) according to serum PTH concentration. In a second step, we assessed serum intact osteocalcin concentration in patients with serum PTH concentrations between 65 and 455 pg/ml. The cut-off values for adynamic and hyperparathyroid bone in this diagnostic approach were 30 and 70 ng/ml respectively. As a result, 49 out of 62 patients were diagnosed properly. The Youden index of this two-step diagnosis was 0.527 and 0.661 for adynamic bone and hyperparathyroid bone respectively. Sensitivity markedly improved to 94.4% and 96.2% for adynamic bone and hyperparathyroid bone respectively, without sacrificing specificity (84.0 and 88.8% respectively). CONCLUSION: Measurement of serum intact osteocalcin concentration is useful for the diagnosis of adynamic bone in haemodialysed patients. A two-step procedure involving also simultaneous measurement of serum PTH concentration further improved the sensitivity of each individual marker while maintaining specificity.     

TRUST、TP-ELISA和TPPA 3种方法在16375例梅毒血清学诊断中的应用

目的:了解甲苯胺红血清不需加热试验(TRUST)、梅毒螺旋体抗体酶联免疫吸附试验(TP-ELISA)、梅毒螺旋体颗粒凝集试验(TPPA)3种方法在梅毒血清学诊断中的应用价值。方法:使用TRUST与TP-ELISA法同时对住院患者12 622例、体检中心1 500例、门诊患者2 253例进行筛查,TRUST和TPPA分别作定量试验。结果:16 375例患者中筛查出384例临床确诊的梅毒,TRUST(1∶2～1∶16)、TPPA(1∶80～1∶2 560)阳性检出率分别为100%,而TP-ELISA阳性检出率为92.2%。结论:TP-ELISA不能作为梅毒筛查的首选,应用TRUST和TP-ELISA法同时筛查,TP-ELISA和TRUST测定结果为阳性的均需用TPPA确认。3种检测方法配合检测对减少梅毒漏诊或误诊,及早、准确地诊断梅毒有重要意义。     

Risk factors for occupational Brucella infection in veterinary personnel in India

Brucellosis is an important animal and human health issue in developing countries. This study aimed to identify risk factors associated with occupational Brucella infection in veterinary personnel in India. Blood samples were collected from 279 veterinary personnel working in the public sector. Sera were tested with rose bengal plate test (RBPT ), standard tube agglutination test (STAT ), and IgG and IgM ELISA s. Information about participant demographics, risk of exposure and infection control practices was collected using a self‐completed questionnaire. The outcome measure of Brucella infection was created based on a positive RBPT or STAT test and a positive IgG ELISA test. Binomial logistic regression analyses were conducted to evaluate associations between explanatory variables and the outcome variable. Of the 279 participants, 61 (21.9%), 67 (24.0%), 55 (19.7%) and 150 (53.8%) were positive in RBPT , STAT , IgM and IgG ELISA , respectively. Compared to a trained veterinarian, veterinary pharmacists and animal handlers had greater odds of being test positive, suggesting that they were at greater risk of Brucella infection. Number of years spent working with animals was associated with greater odds of a person being positive for Brucella infection (p  = .015). Counter‐intuitively, those using personal protective equipment (PPE ) for handling sick animals were found to be at greater risk, suggesting that either the use of PPE is inappropriate—making it ineffective—or that it is reverse association whereby those experiencing brucellosis symptoms start using PPE . Brucellosis is a common occupational zoonosis among veterinary personnel in India with the risk being higher in paraveterinary staff than veterinarians and in those who have been practicing for a longer period of time. Further investigations are required to clarify the effectiveness of PPE to reduce Brucella infection in veterinary personnel in India.