Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Int J Antimicrob Agents. 2010 Nov;36 Suppl 1:S12-7. doi: 10.1016/j.ijantimicag.2010.06.014. Epub 2010 Aug 9.
The persistent worldwide prevalence of human brucellosis causes serious public health concerns and economic loss to communities. The multisystem involvement and the protean and unusual clinical presentations of the disease pose significant diagnostic challenges. The clinical features are non-specific and can overlap with a wide spectrum of other infectious and non-infectious diseases, leading to brucellosis being labelled the 'disease of mistakes'. Protracted chronicity and serious complications can result and mislead physicians onto a path of costly laboratory and radiological investigations. To reach a diagnosis clinicians must use a wide range of non-specific routine haematological and biochemical tests in addition to Brucella-specific assays. The latter are microbiological (culture), serological (e.g. slide or tube agglutination, Coombs test, immunocapture agglutination, Brucellacapt, immunochromatographic lateral flow, enzyme-linked immunosorbent assays and the indirect fluorescent antibody test) and molecular (e.g. polymerase chain reaction (PCR) and real-time PCR). Each of these tests has advantages and limitations, and thus requires careful interpretation. Since brucellosis can have several presentations and phases (acute, subacute, chronic, relapsed, active and inactive), the search for reliable, discriminatory diagnostic and prognostic markers, especially for monitoring disease evolution, are ongoing. Although much progress has been made, further challenges remain to the accurate diagnosis of this historic but still common global zoonotic disease.
布鲁氏菌病在全球持续流行，给社区带来了严重的公共卫生问题和经济损失。该病多系统受累，临床表现多样且不典型，给诊断带来了极大的挑战。其临床特征无特异性，与广泛的其他感染性和非感染性疾病相重叠，导致布鲁氏菌病被称为“易误诊的疾病”。可导致疾病迁延慢性化并出现严重并发症，从而误导医生进行昂贵的实验室和影像学检查。为了明确诊断，临床医生除了布鲁氏菌特异性检测外，还必须使用一系列非特异性常规血液学和生化检测。后者包括微生物学（培养）、血清学（例如平板或试管凝集试验、库姆斯试验、免疫捕获凝集试验、Brucellacapt、免疫层析侧向流动试验、酶联免疫吸附试验和间接荧光抗体试验）和分子学（例如聚合酶链反应（PCR）和实时 PCR）。这些检测各有优缺点，因此需要仔细解读。由于布鲁氏菌病可有多种表现和阶段（急性、亚急性、慢性、复发、活动期和静止期），因此正在寻找可靠的、有鉴别能力的诊断和预后标志物，尤其是用于监测疾病进展的标志物。尽管已经取得了很大的进展，但在准确诊断这种具有历史意义但仍然普遍存在的全球人畜共患病方面，仍然存在进一步的挑战。
