5例布鲁氏菌病血清抗体阴性感染病例的鉴定及分析  

Identification of five serologically negative for Brucella infection clinical cases

作　　者：耿大影[1] 熊春梅[2] 纪明宇[3] 

机构地区：[1]济南市传染病医院中心实验室,山东济南250021 [2]济南市传染病医院影像中心,山东济南250021 [3]济南市中心医院医学实验诊断中心,山东济南250013

出　　处：《现代预防医学》2015年第23期4354-4356,共3页Modern Preventive Medicine

摘　　要：目的通过分析布氏菌病血清抗体阴性的感染病例,降低临床对布氏杆菌感染诊断的误诊率。方法回顾分析2011-2014年我院收治的门诊及住院布氏菌感染病例共51例,其中有5例布氏菌血清抗体阴性,本文结合临床资料对5例疑似感染病例通过血清抗体检测、血细菌培养和16sRNA测序分析加以鉴别确认。结果 5例患者均有明确的流行病学史,临床表现反复发热、多汗、乏力,其中2例患者除上述症状外,主诉关节痛及腰痛来我院就诊。根据临床表现,虽疑似布氏杆菌感染,但因缺乏病原学支持,起初分别误诊为呼吸道感染、肺炎、血液病及风湿免疫性疾病,并给予过对症治疗但疗效不佳,仍然出现反复发热现象。后经血细菌培养及16SrDNA测序分析确认布氏菌病,积极治疗后均治愈。结论对长期不明原因发热者应结合流行病学特点考虑布氏菌病可能,尤其是高度疑似病例,不能完全依靠血培养和血清抗体检测加以鉴别诊断,应多结合临床表现及影像学特征,必要时进行分子生物学鉴定。Objective To analyze serologically negative Brucella infection clinical cases, and decrease the misdiagnosis of brucellosis. Methods This was a retrospective review of out or in-patients treated for brucellosis during 2011 to 2014 in our hospital. Five of all fifty-one cinical cases were negative in serological tests, using culture and PCR methods for identification of Brucella. Results All 5 patients had a history of epidemic exposure. The common clinical presentations included fever, hyperhidrosis and weakness. Five patients had been ever misdiagnosed as respiratory tract infection, pneumonia, Hematopathy and Rheumatic disease, respectively. After identification of Brucella, all 5 cases were cured after active medical management. Conclusion The clinical manifestation of brucellosis is various. Epidemiological feature combined with long-term fever of unknowno rigin may suggest the possibility of brucellosis. Blood culture and serum antibody assay are effective diagnostic tools but not enough. It needs the PCR methods for detection if necessary.

关 键 词：布氏菌 临床表现 16SrDNA 鉴定 

分 类 号：R117[医药卫生—公共卫生与预防医学]