Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
GATA Haydarpasa Training Hospital, and Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Chest. 2014 Jan;145(1):87-94. doi: 10.1378/chest.13-0240.
Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis.
This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement.
Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as < 2 months), with an overall mean ± SD duration of symptoms of 33.9 ± 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 ± 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients.
Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.
肺部受累是布鲁氏菌病的罕见并发症。我们描述了迄今为止我们所知的最大系列的患有肺部布鲁氏菌病的患者。
这是一项为期 10 年的回顾性描述性研究，涉及土耳其的 27 个中心，包括所有有明确呼吸系统受累的布鲁氏菌病患者。
在 133 名患者（67 名男性）中，123 名（92.5%）有急性感染（定义为 < 2 个月），总症状平均持续时间为 33.9 ± 8.5 天。肺部疾病的放射学模式为 91 名患者（68.4%）的实变/大叶性肺炎和 41 名患者（30.8%）的胸腔积液，其中 30 名（22.5%）同时存在两者。此外，23 名患者（17.3%）有支气管炎（1 例合并肺炎），10 名患者（7.5%）有结节性肺部病变（1 例合并肺炎和胸腔积液）。119 名患者中有 56 名血培养阳性，所有其他病例均经血清学证实。60 份痰标本和 19 份胸腔积液样本中的 2 份（10.5%）的布鲁氏菌培养结果均为阳性。61 名患者（45.9%）检测到其他布鲁氏菌病特征，如骨关节炎并发症；59 名患者（44.4%）肝转氨酶升高，59 名患者（44.4%）血小板减少。15 名患者（11.3%）因平均 3.8 ± 2.2 天需要在 ICU 进行治疗。所有患者均对布鲁氏菌病的标准联合抗菌治疗有反应，无死亡病例，但 7 名患者需要修改治疗方案。
肺部受累的布鲁氏菌病很少见，但经适当抗生素治疗后预后良好。在暴露史、临床表现和基线血液检查中出现的许多线索都应该提醒临床医生考虑布鲁氏菌病。
