Mantur Basappa G, Biradar Mallanagouda S, Bidri Rajendra C, Mulimani Mallanna S, K Veerappa, Kariholu Piaraylal, Patil Siddanagouda B, Mangalgi Smita S
J Med Microbiol. 2006 Jul;55(Pt 7):897-903. doi: 10.1099/jmm.0.46097-0.
A prospective study was carried out to elucidate the clinical, epidemiological and laboratory features of human brucellosis. A total of 26 948 blood samples (from adults aged 15 years and above) were screened for serological evidence of brucellosis over a period of 16 years. The slide agglutination/Rose Bengal plate agglutination test gave positive results in 517 patients, of which 509 had detectable titres by the standard tube agglutination test (SAT). The diagnosis of brucellosis was documented in 495 (1.8 %) patients based on diagnostic titres (> or = 1 : 160, 490 cases) and rising titres from insignificant titres (four cases) by serology and for one case by blood-culture isolation alone. Blood cultures were carried out in 345 cases, of which 191 cases (55.3 %) yielded Brucella melitensis. In 77/79 cases undertaken for follow up, there was a steady fall in 2-mercaptoethanol (2ME) agglutination titres along with clinical improvement (P < 0.01). SAT titres remained detectable in most cases for a longer period in spite of an effective antimicrobial therapy and clinical recovery. A substantial number of patients (84.2 %) presented with fever, this being the only complaint in 51.1 % of the cases. Complications were present in 8.8 % of the patients (arthritis excluded): this included the unusual complications of hydrocele (two cases), Stevens-Johnson syndrome (one case) and urinary tract infection (one case). Brucella agglutinins were demonstrated in synovial, testicular, hydrocele and cerebrospinal fluids. There was no clinical suspicion of brucellosis in 439 cases (88.7 %) and the diagnosis was made only by routine serology. A two-drug regimen for 42-84 days with a follow-up 2ME test resulted in lower levels of relapse. These results suggest that, in endemic areas of the world, it should be mandatory to screen routinely for brucellosis due to protean clinical manifestations.
开展了一项前瞻性研究，以阐明人类布鲁氏菌病的临床、流行病学和实验室特征。在16年的时间里，共筛查了26948份血液样本（来自15岁及以上的成年人），以寻找布鲁氏菌病的血清学证据。玻片凝集试验/虎红平板凝集试验在517例患者中呈阳性结果，其中509例通过标准试管凝集试验（SAT）可检测到滴度。根据诊断滴度（≥1:160，490例）以及血清学检查中滴度从无意义滴度上升（4例）和仅通过血培养分离确诊1例，495例（1.8%）患者被记录为布鲁氏菌病。对345例患者进行了血培养，其中191例（55.3%）培养出羊布鲁氏菌。在79例进行随访的患者中，77例2-巯基乙醇（2ME）凝集滴度随着临床症状改善而稳步下降（P<0.01）。尽管进行了有效的抗菌治疗且临床症状恢复，但在大多数情况下，SAT滴度在较长时间内仍可检测到。大量患者（84.2%）出现发热，其中51.1%的病例仅有发热这一症状。8.8%的患者出现并发症（不包括关节炎）：这包括鞘膜积液（2例）、史蒂文斯-约翰逊综合征（1例）和尿路感染（1例）等罕见并发症。在滑膜液、睾丸液、鞘膜积液和脑脊液中检测到布鲁氏菌凝集素。439例（88.7%）患者临床上未怀疑患有布鲁氏菌病，仅通过常规血清学检查确诊。采用为期42 - 84天的两药联合方案并进行随访2ME检测可降低复发率。这些结果表明，在世界上的流行地区，由于布鲁氏菌病临床表现多样，应强制进行常规筛查。
