20例布鲁氏菌病的临床分析与治疗

目的了解儿童布鲁氏菌病的临床特征,避免漏诊和误诊。方法回顾性分析在昆明市儿童医院感染性疾病科住院的20例布鲁氏菌病患儿的临床症状、体征、辅助检查及治疗。结果 20例布鲁氏菌病中,男15例、女5例,年龄1.7～12岁,5岁以下为主;常见临床症状为发热、关节疼痛、汗多并伴有淋巴结肿大;14例有羊接触史,血常规中白细胞正常或轻度下降,以淋巴细胞为主,多伴有红细胞沉降率(ESR)轻度升高,合并神经系统损害的比例达40%,主要表现为无菌性脑炎;8岁以下患儿采用利福平联合复方磺胺甲噁唑,8岁及以上患儿则采用多西环素联合利福平治疗,合并脑炎加静脉用头孢曲松,经治疗后已痊愈。结论接诊不明原因反复发热、关节肿痛、汗多的患儿,应注意排除布鲁氏菌病,及时询问有无接触史、是否来自疫区,延长血培养时间以便及时明确疾病,同时积极完善相关脑脊液及肺部影像学检查,了解有无脏器损害;联合、足量、足疗程用药后均能治愈,预后良好。     

新疆布鲁菌病117例临床分析

目的探讨新疆维吾尔自治区(新疆)布鲁菌病的流行情况、临床特征、实验室检查及治疗结果。方法回顾性分析我院2012年7月—2014年4月收治的117例布鲁菌病的临床特征及治疗效果。结果本地区布鲁菌病以4—9月高发,发病人群以畜牧相关人员为主。主要临床表现除发热、多汗、乏力、关节痛等一般症状外,肝脾大和淋巴结肿大也占一定比例,部分患者ALT、AST和GGT升高。治疗以多西环素联合利福平为主,好转率为97.44%。结论布鲁菌病为新疆地区发病率较高的传染病,当地有关部门应普及该病防护知识,临床医师应关注该病的临床特点及其并发症和合并症,并给予规范的抗菌治疗。     

甘肃省儿童布鲁菌病18例临床特征分析

目的 总结18例儿童布鲁菌病的流行病学特征、临床表现及治疗转归,为儿童布病早期诊断和规范治疗提供参考.方法 回顾性总结2012年10月至2019年4月本院收治的18例儿童布鲁菌病临床资料,对其流行病学特征、临床表现、诊治过程等进行分析.结果 61.1％的患儿是男性,66.7％为学龄前期儿童;以农村患儿为主(88.9％)...     

12例布鲁菌病性睾丸炎临床分析

目的总结布鲁菌病性睾丸炎的临床特征及治疗预后情况,为临床诊治提供参考。方法回顾性选取2012—2016年期间明确诊断为布鲁菌病的男性患者73例中并发睾丸炎者12例(16.4%),入院时完善血液学检测及睾丸B超检查,住院期间给予有效的抗菌药物治疗并定期随访复查,治疗结束后复查血液学各项指标。结果 12例布鲁菌病性睾丸炎患者的平均年龄(37.58±10.40)岁,就诊时平均病程为(8.83±6.22)d。抗菌药物治疗后患者的缓解期平均为(15.50±5.92)d。发热、睾丸肿痛是常见的症状,同时合并骨关节系统并发症和肝损害常见。患者丙氨酸转氨酶、红细胞沉降率、C反应蛋白入院时多高于正常水平,治疗结束后均明显下降。结论在布鲁菌病的高发地区,对于睾丸炎患者应考虑布鲁菌感染的可能。布鲁菌病性睾丸炎除了具有睾丸局部红、肿、热、痛的炎症表现外,可伴有明显的全身症状,须给予三药联合的抗菌药物组合方案,小剂量糖皮质激素及局部物理治疗可起到很好的效果,推荐疗程12周。     

利福平治疗布鲁菌病

利福平有良好的细胞内弥散作用,动物实验中对布鲁菌具杀菌功效,理论上可治疗布鲁菌病,因此布鲁菌病经四环素或链霉素治疗后复发者亦可应用利福平治疗。作者治疗13例布鲁菌病,其中急性型8例,骨关节性布鲁菌病3例,慢性型2例。急性型和局部性布鲁菌病计11例。利福平剂量为600～1,200mg/d,3例病人后来加用了cyclin。治疗时间急性型为20～60天,其他病例为2～15个月。结果急性型和局部病变11例中,治愈10例,1例失败;另外2例中1例好转,1例无效。利福平总的疗效是满意的。结合文献报道,作者认为利福平治疗的疗程至少30天,最低剂量为600mg/d或10mg/kg,1次投用。复方增效磺胺为利福平拮抗剂,两药不宜     

宁夏儿童布鲁氏菌病47例临床特点及诊治体会

目的 探讨儿童布鲁氏菌病的临床特点,便于及时诊断及治疗。方法 回顾性分析2011—2017年我院收住院的47例儿童布鲁氏菌病资料,对其流行病学、临床表现和疗效进行分析。结果 47例患儿均来自农村,且家中均有人从事羊或牛的养殖业、贩运、屠宰、肉类加工;多数(90%以上)患儿有布鲁氏菌病家庭聚集性,临床表现以发热、下肢肌肉及关节疼痛为主,轻度乏力,男性可伴发睾丸鞘膜积液。利福平联合多西环素或复方磺胺甲噁唑治疗有效。结论 掌握儿童布鲁氏菌病的临床特点及流行病学特征,可提高诊断率,合理、规范的联合抗菌治疗,未见临床耐药病例。     

儿童感染性心内膜炎临床诊断和治疗

目的探讨儿童感染性心内膜炎(IE)的诊断和治疗方法。方法回顾性分析2005—2012年我院收治的IE患儿20例的临床资料,包括诊断方法和治疗方法。结果患儿均有发热症状,血培养阳性12例,其中金黄色葡萄球菌5例、表皮葡萄球菌2例、铜绿假单胞菌2例、链球菌2例、大肠埃希菌1例;15例患儿检出赘生物。患儿中治愈19例,其中药物治愈12例、药物联合手术治疗治愈7例;死亡1例。结论 IE患儿病情危重,早期诊断、及时合理地选择治疗方式是挽救其生命,改善预后的关键。     

布鲁菌感染性心内膜炎外科治疗的临床分析

目的:本研究布鲁菌心内膜炎患者临床特征并探讨内外科治疗的特点及预后分析。方法:回顾性分析2008年10月至2018年12月,在首都医科大学附属北京地坛医院住院诊断布鲁菌感染性心内膜炎患者,并对患者随访。分析患者的流行病学资料、临床特点、内外科治疗方法及预后。结果:811例确诊布鲁菌病患者中,布鲁菌感染性心内膜炎患者共6例,发生率为0. 7%。此6例患者中4例为男性,年龄25~65岁,其中5例接触过牛羊,1例无接触牛羊史,所有患者均发热,4例合并心功能不全表现。6例患者血培养布鲁菌均为阳性。所有患者均累及主动脉瓣。所有患者均接受抗菌药物长程治疗。其中5例接受瓣膜置换术,随访中2例出现瓣周漏,1例重新主动脉瓣膜置换。结论:布鲁菌感染性心内膜炎易引起心功能不全表现,主要累及主动脉瓣,长疗程抗菌治疗联合瓣膜置换手术是有效的治疗措施。     

骨关节型布鲁杆菌病病灶清除植骨术58例报告

目的评价布鲁杆菌病骨关节型因保守治疗无效而行外科手术清除病灶联合植骨手术的疗效。方法 2016年-2019年本院对58例布什菌病骨关节型经中西医治疗疗效差的病人进行了病灶清除加骨移植术,术后继续抗布什菌治疗6月。结果 58例布什菌病骨关节疼痛全部缓解,3月关节功能恢复,2例出现切口布什菌感染。结论布鲁杆菌骨关节型在有骨质破坏时行病灶清除自体骨拌利福平粉剂移植手术是治疗布鲁杆菌病骨关节型可选的方法之一。     

布鲁菌病血清DNA定量检测的临床意义

目的：分析布鲁菌病血清DNA定量检测与布鲁菌病临床表现的相关性,从而探讨其对布鲁菌病的诊断价值。方法选择2010年5月-2011年6月内蒙古自治区100例布鲁菌血清凝集试验阳性（玻片凝集试验＋~＋＋＋＋）的患者。采用荧光定量PCR法测定血清布鲁菌DNA含量,分析血清布鲁菌DNA检测结果与临床表现的相关性。结果100例布鲁菌血清凝集试验阳性患者中,23例有明显的临床症状,包括发热（91.3%）、全身关节疼痛（78.3%）、乏力（87.0%）、多汗（65.2%）等全身不适症状,其中的20例血清布鲁菌DNA定量值明显升高[范围（1.30～9.27）×106 copies/ml,平均（2.00±7.87）×106 copies/ml],检测时间仅3 h,灵敏度、特异度和准确度分别达到86.96%、97.40%和95.00%。结论血清布鲁菌DNA定量检测可以为布鲁菌病的诊断提供准确、快速和可靠的实验室确诊依据,用以区分布鲁菌现症感染和既往感染,为布鲁菌病的及时治疗提供客观依据。     

Brucellosis: Difficulties in diagnosis and a report on 38 cases

We have reviewed 38 patients with brucellosis who were admitted to the Chaim Sheba Medical Center between 1955 and 1977, i.e. during a 23-year period. The clinical manifestations varied greatly. Diagnosis was easy when brucellosis was suspected, as in cases presenting with fever of unknown origin. In nine of the 38 cases diagnosis was difficult and delayed for several weeks since brucellosis was not suspected. Some of these cases will be described in detail. The diagnosis was established in 16 patients by isolating Brucella melitensis and in the other 22 by serological tests. There were no relapses in the 26 patients treated with a combination of streptomycin and tetracycline; two of the 12 patients treated with tetracycline alone relapsed. Brucellosis should be considered when clinical manifestations are puzzling.     

Brucellosis in children: clinical observations in 115 cases.

OBJECTIVE: Brucellosis is endemic in Saudi Arabia. This report summarizes the epidemiology of brucellosis in children. METHOD: A retrospective review was made of medical records of all patients admitted to King Fahad National Guard Hospital with brucellosis during the period from 1984 to 1995. RESULTS: Children < or =12 years constituted 115/545 (21%) of the total brucellosis admissions. The mean age was 5.8 years and 64% of the patients were males. Consumption of unpasteurized milk (often from camel) was the main source of infection. In 70% the clinical picture was dominated by arthritis, 20% of patients presented with a non-specific febrile illness without localizing signs, and 10% had a febrile illness with uncommon presentations. Brucella serology was most helpful in making an early diagnosis. Initial titers of >1:640 were found in 90% of the cases. Bacteremia was observed in 45% and of the isolates speciated, 96% were Brucella melitensis. No increase in resistance to commonly used antimicrobials was noted during the 12-year study period. A combination of rifampin plus co-trimoxazole with or without streptomycin was used in two thirds of the patients. The overall rate of relapse was 9% and one patient died from neurobrucellosis. CONCLUSION: Brucellosis presents in various ways and should be included in the differential diagnosis of arthritis in endemic countries. Prevention should rely on education including on boiling raw milk.     

Successful treatment of brucella melitensis endocarditis

Brucella endocarditis is a rare, but often fatal, complication of brucellosis. A 32 year old man acquired brucellosis while on a visit to his former home in Greece and presented six months later with malaise, fever and aortic regurgitation. Blood cultures grew Brucella melitensis biotype 1. Combined chemotherapy with streptomycin, tetracycline and rifampin sterilized his blood; however, his aortic valve was replaced owing to recurrent emboli and cardiac failure. Over the next 18 months the patient's antibody titer to Brucella fell and his blood remained sterile. Cure was achieved by resection of the infected aortic valve and 10 weeks of bactericidal therapy for B. melitensis.     

Childhood brucellosis:Review of 317 cases

Objective:To describe the main epidemiological,clinical,and laboratory features,treatment options and outcome in children with brucellosis.Methods:Retrospectively evaluated data were obtained from 317 pediatric patients with brucellosis that were treated at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje,during the period from 1989 to 2011.The medical records and follow-up protocols were used for evaluation.Results:Childhood brucellosis composed 317(18.7%) of 1 691 patients with brucellosis.The patients were median 9 years old,ranging from 7 months to 14 years,and 201(63.4%) were males.Family history was present in 197(62.1%),and direct contact with animals occurred in 140(44.2%) of the children.The dominant manifestations were fever in 248(78.2%),joint pain in228(71.9%) and hepatomegaly in 216(68.1%).Organ affection was present in 206(65.0%)of the patients.One hundred and six(33.4%) of the patients were treated with combination composed of two.and 211(66.6%) with three antimicrobial agents.Relapses were registered in 21(6.6%).and therapeutic failures in 3(0.9%) of the children.Conclusions:In endemic regions childhood brucellosis represents a significant part of human cases.Wide spectrum of clinical manifestations,frequent affection of various organ systems and possibility of relapses show that brucellosis could be a serious disease in this age group.The presence of fever,joint pain,sweating,and affection of various systems in children from endemic regions should alert pediatricians for the possibility of brucellosis.     

新疆布鲁氏菌病空间聚集性分析

目的 以2009-2010年新疆布鲁氏菌病疫情数据为例,探索和分析新疆布鲁氏菌病的空间聚集性特征,为新疆布鲁氏菌病的防控提供依据。方法 采用描述性流行病学对新疆布鲁氏菌病的时间与人群分布进行统计分析。利用四分位数分级方法,绘制新疆布鲁氏菌病发病率空间分布地图,计算全局Moran’s I指数,进行空间聚集性分析。结果 新疆布鲁氏菌病发病存在明显的季节差异(多发于5-9月),男性多于女性(男女性别比2.96∶1),职业发病以农、牧民为主(74%),发病人群集中在40~60岁。2010年较2009年,新疆布鲁氏菌病发病范围有明显扩散趋势。2009-2010年新疆布鲁氏菌病发病率的全局Moran’s I指数为0.116 4(P=0.017),表明新疆布病发病率水平存在空间聚集性。发病热点区域集中分布在塔城地区与阿勒泰地区,发病冷点区域集中在喀什地区。结论 新疆各县(区)布病的发病率水平存在明显的空间聚集性,应加强对高危地区的防控。     

Sixteen Chinese pediatric brucellosis patients onset of fever in non-epidemic areas and 8 developed with osteoarticular involvement

The purpose of this study is to summarize the manifestations, diagnosis, differential diagnosis, and treatment of childhood brucellosis in non-epidemic areas of China. A retrospective review of 16 admitted children patients with brucella’s disease who were diagnosed of brucellosis during the period from 2011 to 2016 was performed. Diagnostic criteria, clinical presentations, and outcomes were recorded. The most common symptom was fever. Osteoarticular involvement was found in 50% of the patients. They were infected by contacting with infected animals or consuming of unpasteurized milk or meat of sheep or goats, also. Standard agglutination test was positive in all patients and blood culture in 10 (62.5%) patients as well as medulloculture in 3 (18.8%) patients were positive. A combination of antibiotic treatment with rifampin plus cotrimoxazole showed good response and all clinical manifestations improved. Brucellosis is misdiagnosed frequently and should be considered in the differential diagnosis when patients do not respond to standard treatment. Blood culture, together with brucella serology test, is important and helpful in the diagnosis. MRI is a good method in differentiating those with symptoms of arthritis.     

Case report: Brucellosis: a re-emerging disease in Thailand

Brucellosis is a zoonotic disease prevalent in many countries, but it has been reported only once in Thailand, 36 years ago. We describe here two consecutive cases of brucellosis in Bangkok, Thailand. Both cases presented with prolonged fever and weight loss. Blood cultures taken from 2 patients yielded Brucella melitensis. The slide agglutination test of blood samples were also positive, with a titer of 1:64 for antibodies to Brucella. The first patient responded to a combination of doxycycline, gentamicin, and ciprofloxacin; the other responded to doxycycline and rifampicin. Brucellosis is a potential public health threat, therefore, preventive measures should be actively implemented. This clinical syndrome should be included in the differential diagnosis of patients presenting with prolonged fever, particularly those with contact to animals which could serve as reservoirs.     

Treatment of human brucellosis with doxycycline plus rifampin or doxycycline plus streptomycin. A randomized, double-blind study.

OBJECTIVE: To compare the effectiveness of doxycycline-rifampin (DR) combination therapy with that of the classic doxycycline-streptomycin (DS) combination in patients with brucellosis. DESIGN: A randomized, double-blind study, with a mean follow-up of 15.7 months. SETTING: A 1000-bed teaching hospital in Barcelona, Spain. PATIENTS: Ninety-five patients (68 men and 27 women; mean age, 39 years) diagnosed with brucellosis on the basis of both clinical and serologic findings; 81 of these patients had blood cultures positive for Brucella melitensis. INTERVENTIONS: Forty-four patients received doxycycline, 100 mg every 12 hours, and rifampin, 15 mg/kg body weight per day in a single morning dose, for 45 days; 51 patients received the same dose of doxycycline for 45 days plus streptomycin, 1 g/d for 15 days. MAIN OUTCOME MEASURES: Therapeutic failure and relapse during the follow-up period. RESULTS: The mean time to defervescence was 4.2 days for the DR group and 3.2 days for the DS group (P greater than 0.2). The actuarial probability of therapeutic failure or relapse at 12 months of follow-up (Kaplan-Meier) was 14.4% in the DR group and 5.9% in the DS group (difference, 8.5%; 95% Cl, -4.8% to 21.6%; P greater than 0.2). All three patients with spondylitis in the DR group failed therapy compared with one of four patients in the DS group. Excluding patients with spondylitis, the actuarial failure rate was 4.9% and 4.3% in the DR and DS groups, respectively, at 12 months of follow-up (difference, 0.6%; Cl, -8.1% to 9.4%; P greater than 0.2). CONCLUSIONS: Doxycycline-rifampin combination therapy for 45 days is as effective as the classic DS combination in most patients with brucellosis; however, DR therapy might be less effective in those patients with spondylitis.     

布鲁杆菌病患者临床特征及发病季节的调查分析

目的分析新疆维吾尔自治区布鲁杆菌病（布病）流行病学特征,探讨预防布病的有效措施。方法选择2008~2013年于我院就诊的249例布病患者,统计并分析以上患者就诊时的临床症状与体征、年龄分布、就诊的时间与接触史情况。结果患者临床症状与体征以发热（92.4%）、肌肉痛（71.5%）和关节疼痛（68.3%）最为常见;年龄31~40岁（28.9%）、41~50岁（25.7%）、≥51岁（16.1%）;发病主要集中于3~7月的春季与夏季（73.9%）;以牛羊饲养员为多（65.9%）。结论布病发病率有逐年上升的趋势,应加强重点人群的监控,加强易感人群的宣传教育,以减少该病的发生。