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。

Clinical analysis on 45 children with brucellosis in non-pastoral areas

ObjectiveTo investigate the epidemiological, clinical and laboratory characteristics of children with brucellosis, and to provide evidence for its diagnosis in non-pastoral areas. MethodsClinical data of 45 children with brucellosis in non-pastoral areas from Shaanxi Provincial Center for Diseases Control and Prevention, and Xi’an Children’s Hospital from January 2014 to December 2018 were analyzed, retrospectively, and the clinical characteristics and laboratory examinations were summarized and analyzed, respectively. ResultsThe incidence of childhood brucellosis in non-pastoral areas peaked from March to September, and the incidence of childhood brucellosis increased year by year from 2014 to 2018. Among the 45 children, 19 were males and 26 were females. Children aged 0-3 years were the main group with brucellosis in non-pastoral areas (53.3%, 24/45). The main route of transmission was digestive tract transmission (64.4%, 29/45). Children with brucellosis had various clinical manifestations, the main clinical manifestations were fever (82.2%, 37/45), followed by joint swelling and pain (40.0%, 18/45) and hepatomegaly (28.9%, 13/45), while hyperhidrosis (11.1%, 5/45) and fatigue (6.7%, 3/45) were rare. Inflammation indexes were the main abnormal factos in laboratory examination, procalcitonin increased in 30 cases (66.7%), the erythrocyte sedimentation rate (ESR) increased in 10 cases (22.2%), C-reactive protein (CRP) increased in 7 cases (15.6%); no child occurred decreased total number of whole blood cells in routine examination. Among the 45 children, 35 (77.8%) cases were Brucella positive in blood culture and 10 (22.2%) cases were positive in test tube agglutination detection. Symptoms of nervous system involvement were found among 4 cases (8.9%), and Brucella was cultured in cerebrospinal fluid of the above 4 cases. ConclusionsThe clinical manifestations of children with brucellosis are complex . In non-pastoral areas, when children had long-term fever, joint swelling and pain, and liver enlargement, pediatricians should be highly suspicious of brucellosis and make early diagnosis and timely treatment.