Demiroğlu Y Ziya, Turunç Tuba, Alişkan Hikmet, Colakoğlu Sule, Arslan Hande
Başkent Universitesi Tip Fakültesi, Enfeksiyon Hastaliklan ve Klinik Mikrobiyoloji Anabilim Dali, Adana ve Ankara.
Mikrobiyol Bul. 2007 Oct;41(4):517-27.
The aim of this study was to retrospectively evaluate the clinical and laboratory characteristics, complications and treatment oucomes of 151 brucellosis cases (age range: 15-79 years; 89 female), who were followed in our clinic between the period of January 2003-July 2005. Of them, 66.2% were diagnosed as acute, 23.8% as subacute and 9.9% as chronic brucellosis. Risk factors were detected as consumption of unpasteurized milk and diary products (80%), stock-breeding (14%) and risky profession such as veterinary, laboratory technician and butcher (3.3%). Most common complaints were arthralgia (87.4%), malaise (86%), fever (79.5%), sweating (78%), and waist pain (71%). In view of laboratory findings, increased erytrocyte sedimentation rate was detected in 61.6%, C-reactive protein positivity in 60%, lymphomonocytosis in 44.4% and anemia in 51.7% of them. Blood cultures were performed from 125 of the patients, and 64 (51.2%) of them yielded Brucella spp. The other specimens in which bacterial growth were detected in one of each, were bone marrow, sternoclavicular joint, psoas abscess, urine and pleural fluid. Standard tube agglutination (STA) test was found negative in 1.3% of patients who were culture positive, while it was positive at 1/160 titer in 20.5%, at 1/320 in 14%, at 1/640 in 14.6% and > or = 1/1280 in 49.7 percent. The most common complication was found as musculo-skeletal system involvement (30 spondylodiscitis, 15 sacroileitis, five peripheric arthritis, one tendinitis) with a rate of 33.7 percent. Other complications were nervous system involvement in 6% (two acute and seven chronic meningitis), genitourinary involvement in 5.3% (five epididymo-orchitis, two prostatitis, one with Brucella positive urine culture), peritonitis in 0.6% and skin involvement in 0.6 percent. Seven different therapy protocols were applied to the patients according to complications and case specialty, however doxycycline+rifampicin combination during six weeks was the most preferred one. Relapse and unresponsiveness to the therapy were detected in 8% and 2% of the cases, respectively. Gastrointestinal intolerance was found as the most common side effect. In conclusion, since brucellosis which is endemic in Turkey, displays diagnostic difficulties due to the various clinical presentations and leads to labor loss due to serious complications, it should be considered in the differential diagnosis of numerous diseases.
本研究旨在回顾性评估2003年1月至2005年7月期间在我院诊治的151例布鲁氏菌病患者（年龄范围：15 - 79岁；女性89例）的临床和实验室特征、并发症及治疗结果。其中，66.2%被诊断为急性布鲁氏菌病，23.8%为亚急性，9.9%为慢性。检测到的危险因素包括食用未经巴氏消毒的牛奶和奶制品（80%）、从事畜牧业（14%）以及兽医、实验室技术员和屠夫等高危职业（3.3%）。最常见的症状为关节痛（87.4%）、不适（86%）、发热（79.5%）、出汗（78%）和腰痛（71%）。根据实验室检查结果，61.6%的患者红细胞沉降率升高，60%的患者C反应蛋白呈阳性，44.4%的患者淋巴细胞增多，51.7%的患者贫血。对125例患者进行了血培养，其中64例（51.2%）培养出布鲁氏菌属。其他检测到细菌生长的标本分别为骨髓、胸锁关节、腰大肌脓肿、尿液和胸腔积液。在培养阳性的患者中，1.3%的患者标准试管凝集试验（STA）呈阴性，20.5%的患者在1/160滴度时呈阳性，14%的患者在1/320滴度时呈阳性，14.6%的患者在1/640滴度时呈阳性，49.7%的患者在≥1/1280滴度时呈阳性。最常见的并发症是肌肉骨骼系统受累（30例脊椎间盘炎、15例骶髂关节炎、5例外周关节炎、1例肌腱炎），发生率为33.7%。其他并发症包括神经系统受累6%（2例急性和7例慢性脑膜炎）、泌尿生殖系统受累5.3%（5例附睾炎或睾丸炎、2例前列腺炎、1例尿液布鲁氏菌培养阳性）、腹膜炎0.6%和皮肤受累0.6%。根据并发症和病例特点，对患者应用了7种不同的治疗方案，然而，六周的多西环素+利福平联合治疗是最常用的方案。分别有8%和2%的病例出现复发和治疗无效情况。胃肠道不耐受是最常见的副作用。总之，由于布鲁氏菌病在土耳其为地方病，因其临床表现多样而诊断困难，且因严重并发症导致劳动力丧失，故在多种疾病的鉴别诊断中应予以考虑。
