本文選題：布氏菌　切入點：臨床表現(xiàn)　出處：《現(xiàn)代預防醫(yī)學》2015年23期 　論文類型：期刊論文

【摘要】：目的通過分析布氏菌病血清抗體陰性的感染病例,降低臨床對布氏桿菌感染診斷的誤診率。方法回顧分析2011-2014年我院收治的門診及住院布氏菌感染病例共51例,其中有5例布氏菌血清抗體陰性,本文結合臨床資料對5例疑似感染病例通過血清抗體檢測、血細菌培養(yǎng)和16sRNA測序分析加以鑒別確認。結果 5例患者均有明確的流行病學史,臨床表現(xiàn)反復發(fā)熱、多汗、乏力,其中2例患者除上述癥狀外,主訴關節(jié)痛及腰痛來我院就診。根據臨床表現(xiàn),雖疑似布氏桿菌感染,但因缺乏病原學支持,起初分別誤診為呼吸道感染、肺炎、血液病及風濕免疫性疾病,并給予過對癥治療但療效不佳,仍然出現(xiàn)反復發(fā)熱現(xiàn)象。后經血細菌培養(yǎng)及16SrDNA測序分析確認布氏菌病,積極治療后均治愈。結論對長期不明原因發(fā)熱者應結合流行病學特點考慮布氏菌病可能,尤其是高度疑似病例,不能完全依靠血培養(yǎng)和血清抗體檢測加以鑒別診斷,應多結合臨床表現(xiàn)及影像學特征,必要時進行分子生物學鑒定。
[Abstract]:Objective to reduce the misdiagnosis rate of brucellosis by analyzing the cases of brucellosis with negative serum antibody. Methods 51 cases of brucellosis were retrospectively analyzed in our hospital from 2011 to 2014. There were 5 cases of brucellosis with negative serum antibody. 5 cases of suspected infection were identified by serum antibody detection, blood bacterial culture and 16s RNA sequencing analysis. Results all of the 5 patients had a clear epidemiological history. Clinical manifestations included repeated fever, sweating and fatigue. In addition to the above symptoms, two patients complained of joint pain and low back pain. According to the clinical manifestations, although suspected brucellosis infection, but due to lack of etiological support, They were misdiagnosed as respiratory tract infection, pneumonia, hematologic disease and rheumatic immune disease respectively, and had been given symptomatic treatment but the curative effect was not good, and the phenomenon of repeated fever still appeared. After blood bacteria culture and 16s rDNA sequencing analysis, brucellosis was confirmed. Conclusion the possibility of brucellosis, especially the highly suspected cases, should be considered according to the epidemiological characteristics of patients with chronic fever of unknown origin, and the differential diagnosis should not be completely dependent on blood culture and serum antibody detection. Clinical manifestations and imaging features should be combined and molecular biological identification should be carried out when necessary.
【作者單位】： 濟南市傳染病醫(yī)院中心實驗室;濟南市傳染病醫(yī)院影像中心;濟南市中心醫(yī)院醫(yī)學實驗診斷中心;
【分類號】：R516.7

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