Colmenero Juan de Dios, Queipo-Ortuño Maria Isabel, Maria Reguera José, Angel Suarez-Muñoz Miguel, Martín-Carballino Segundo, Morata Pilar
Infectious Diseases Unit, Department of Internal Medicine, Carlos Haya University Hospital, Málaga, Spain.
Diagn Microbiol Infect Dis. 2002 Mar;42(3):159-67. doi: 10.1016/s0732-8893(01)00344-3.
In order to analyze the clinical and therapeutic features of chronic hepatosplenic abscesses, and to define the diagnostic yield of new molecular techniques, we describe seven cases, four hepatic and three splenic, of this uncommon complication of Brucellosis. Onset of symptoms in all cases was insidious and the diagnostic delay considerable. Abdominal CT scan showed large, poorly defined lesions, with heterogeneous attenuation and thick central calcifications surrounded by hypointense areas. Histologically, all cases presented granulomas with central necrosis, a polymorphic infiltrate, few giant cells and peripheral fibrosis. The diagnostic yield with conventional microbiologic techniques was poor, whereas a Brucella PCR-assay of a tissue or pus sample was positive in all six cases in which it was performed. Conservative therapy with antibiotics, either alone or combined with percutaneous drainage, failed in all cases, so that in this type of lesion, the treatment of choice should be medical-surgical, in order to guarantee excision of the central calcium nucleus responsible for the persistence of the infection.
为分析慢性肝脾脓肿的临床及治疗特点，并确定新分子技术的诊断效能，我们描述了布鲁氏菌病这一罕见并发症的7例病例，其中4例为肝脓肿，3例为脾脓肿。所有病例症状起病隐匿，诊断延迟时间较长。腹部CT扫描显示病灶较大，边界不清，密度不均匀，中央有粗大钙化，周围为低密度区。组织学上，所有病例均表现为中央坏死的肉芽肿、多形性浸润、少量巨细胞及外周纤维化。传统微生物学技术的诊断效能较差，而在进行检测的6例病例中，组织或脓液样本的布鲁氏菌PCR检测均呈阳性。单纯使用抗生素或联合经皮引流的保守治疗在所有病例中均失败，因此对于这类病灶，首选治疗方式应为内科-外科联合治疗，以确保切除导致感染持续存在的中央钙化灶。
