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人类布鲁氏菌病的临床及实验室特征综述。

Review of clinical and laboratory features of human brucellosis.

作者信息

Mantur B G, Amarnath S K, Shinde R S

机构信息

Department of Microbiology, Belgaum Institute of Medical Sciences, District Hospital Campus, Belgaum - 590 001, India.

出版信息

Indian J Med Microbiol. 2007 Jul;25(3):188-202. doi: 10.4103/0255-0857.34758.

Abstract

Infection with Brucella spp. continues to pose a human health risk globally despite strides in eradicating the disease from domestic animals. Brucellosis has been an emerging disease since the discovery of Brucella melitensis by Sir David Bruce in 1887. Although many countries have eradicated B. abortus from cattle, in some areas B. melitensis and B. suis have emerged as causes of this infection in cattle, leading to human infections. Currently B. melitensis remains the principal cause of human brucellosis worldwide including India. The recent isolation of distinct strains of Brucella from marine mammals as well as humans is an indicator of an emerging zoonotic disease. Brucellosis in endemic and non-endemic regions remains a diagnostic puzzle due to misleading non-specific manifestations and increasing unusual presentations. Fewer than 10% of human cases of brucellosis may be clinically recognized and treated or reported. Routine serological surveillance is not practiced even in Brucella - endemic countries and we suggest that this should be a part of laboratory testing coupled with a high index of clinical suspicion to improve the level of case detection. The screening of family members of index cases of acute brucellosis in an endemic area should be undertaken to pick up additional unrecognised cases. Rapid and reliable, sensitive and specific, easy to perform and automated detection systems for Brucella spp. are urgently needed to allow early diagnosis and adequate antibiotic therapy in time to decrease morbidity / mortality. The history of travel to endemic countries along with exposure to animals and exotic foods are usually critical to making the clinical diagnosis. Laboratory testing is indispensable for diagnosis. Therefore alertness of clinician and close collaboration with microbiologist are essential even in endemic areas to correctly diagnose and treat this protean human infection. Existing treatment options, largely based on experience gained > 30 years ago, are adequate but not optimal. In our experience, an initial combination therapy with a three drug-regimen followed by a two-drug regimen for at least six weeks and a combination of two drugs with a minimum of six weeks seems warranted to improve outcome in children and adult patients respectively with laboratory monitoring. A safe and effective vaccine in humans is not yet available. Prevention is dependent upon the control of the disease in animal hosts, effective heat treatment of dairy produce and hygienic precautions to prevent occupational exposure. This review compiles the experiences and diagnostic and treatment paradigms currently employed in fighting this disease.

摘要

尽管在家畜中根除布鲁氏菌病已取得进展,但感染布鲁氏菌属仍在全球范围内对人类健康构成风险。自1887年大卫·布鲁斯爵士发现羊布鲁氏菌以来,布鲁氏菌病一直是一种新发疾病。尽管许多国家已从牛群中根除了流产布鲁氏菌,但在一些地区,羊布鲁氏菌和猪布鲁氏菌已成为牛感染的病因,进而导致人类感染。目前,羊布鲁氏菌仍然是包括印度在内的全球人类布鲁氏菌病的主要病因。最近从海洋哺乳动物以及人类中分离出不同的布鲁氏菌菌株,这表明一种新发人畜共患病正在出现。由于存在误导性的非特异性表现以及越来越多不寻常的症状,布鲁氏菌病在流行地区和非流行地区仍然是一个诊断难题。临床上能够被识别、治疗或报告的人类布鲁氏菌病病例不到10%。即使在布鲁氏菌病流行国家,也没有开展常规血清学监测,我们建议这应成为实验室检测的一部分,并结合高度的临床怀疑,以提高病例检测水平。应对流行地区急性布鲁氏菌病首例病例的家庭成员进行筛查,以发现更多未被识别的病例。迫切需要快速、可靠、灵敏、特异、易于操作且自动化的布鲁氏菌属检测系统,以便及时进行早期诊断和给予充分的抗生素治疗,从而降低发病率/死亡率。前往流行国家的旅行史以及接触动物和异国食物的情况通常对做出临床诊断至关重要。实验室检测对诊断不可或缺。因此,即使在流行地区,临床医生的警觉性以及与微生物学家密切合作对于正确诊断和治疗这种多变的人类感染至关重要。现有的治疗方案很大程度上基于30多年前获得的经验,虽足够但并非最佳。根据我们的经验,对于儿童和成人患者,分别采用初始三联药物方案联合治疗,随后采用二联药物方案治疗至少六周以及两种药物联合治疗至少六周,并进行实验室监测,似乎有助于改善治疗效果。目前尚无安全有效的人类疫苗。预防依赖于控制动物宿主中的疾病、对乳制品进行有效的热处理以及采取卫生预防措施以防止职业暴露。本综述总结了目前在抗击这种疾病中所采用的经验以及诊断和治疗模式。

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