Hadda Vijay, Khilnani Gc, Kedia Saurabh
Department of Medicine, All India Institute of Medical Sciences New Delhi, 110029 India.
Cases J. 2009 Sep 1;2:7969. doi: 10.4076/1757-1626-2-7969.
In this era of globalization frequent traveling across the world is common. It has resulted in exchange of knowledge and expertise among medical professionals around the world which has a visible positive impact. However, this predisposes the travelers to the risk of acquiring an 'alien' disease endemic to a particular country. This may be a great challenge for the treating physicians to manage such patients due to lack of facility for diagnosis and experience in handling such disease. We present a similar case scenario and problems we faced in managing that patient.
A 40-year-old man visited to Africa, developed a skin rash over ankle after an insect bite. This was followed by high grade fever. He was investigated in Kenya, however, returned to India pending results. Later he developed sleepiness and coarse tremors. Work up for the cause of fever was inconclusive. He was diagnosed with trypanosomiasis based on reports from Kenya. In absence of alternate diagnosis and clinical setting, we treated him for trypanosomiasis. This therapy resulted no improvement in patient's condition. Finally, at request of the patient's attendants he was referred to Belgium where he was diagnosed as brucellosis and treated successfully.
Our patient was indeed suffering from neurobrucellosis. Brucellosis is a frequently missed cause of pyrexia. Our case highlights that in this era, taking help from our professional colleagues over the globe is easy which can improve patient care greatly.
在这个全球化的时代，频繁的全球旅行很常见。这导致了世界各地医学专业人员之间的知识和专业技能交流，产生了明显的积极影响。然而，这使旅行者面临感染特定国家特有的“外来”疾病的风险。由于缺乏诊断设施和处理此类疾病的经验，对于治疗医生来说，管理这类患者可能是一个巨大的挑战。我们介绍一个类似的病例情况以及我们在管理该患者时所面临的问题。
一名40岁男子前往非洲，在被昆虫叮咬后脚踝处出现皮疹。随后出现高热。他在肯尼亚接受了检查，但在等待结果期间返回了印度。后来他出现嗜睡和粗大震颤。对发热原因的检查没有得出结论。根据肯尼亚的报告，他被诊断为锥虫病。由于没有其他诊断和临床情况，我们对他进行了锥虫病治疗。这种治疗并没有使患者的病情得到改善。最后，应患者家属的要求，他被转诊到比利时，在那里他被诊断为布鲁氏菌病并得到了成功治疗。
我们的患者确实患有神经型布鲁氏菌病。布鲁氏菌病是发热的一个经常被漏诊的原因。我们的病例表明，在这个时代，向全球的专业同事寻求帮助很容易，这可以极大地改善患者护理。
