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基层医疗环境中持续性发热的最佳实践:密切随访还是经验性抗生素治疗?

Best Practice for Prolonged Fever in Primary Care Setting: Close Follow-Up or Empiric Antibiotic Therapy?

作者信息

Sandoughi Mahnaz, Fazeli Seyed Amirhossein, Naseri-Ramroudi Fatemeh, Barzkar Farzaneh

机构信息

Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.

Department of Anatomy, Faculty of Medicine, Gorgan University of Medical Sciences, Gorgan, Iran.

出版信息

Korean J Fam Med. 2018 Sep;39(5):318-321. doi: 10.4082/kjfm.17.0118. Epub 2018 Jul 4.

DOI:10.4082/kjfm.17.0118
PMID:29972895
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6166114/
Abstract

The management of prolonged fever in low-socioeconomic-status areas by primary care providers such as general practitioners is challenging. Given the endemic nature of many infectious diseases, physicians typically start empirical antibiotic therapy following a limited diagnostic workup including serologic examinations. Herein, we report the case of a young male patient with prolonged fever and arthralgia initially diagnosed with and treated for brucellosis but with a confirmed diagnosis of systemic lupus erythematosus on follow-up. This unique case shows that close follow-up is the best practice for managing prolonged fever in cases with non-specific laboratory findings.

摘要

在社会经济地位较低地区,由全科医生等基层医疗服务提供者对长期发热进行管理具有挑战性。鉴于许多传染病的地方性流行特点,医生通常在进行包括血清学检查在内的有限诊断检查后开始经验性抗生素治疗。在此,我们报告一例年轻男性患者,其长期发热伴关节痛,最初诊断为布鲁氏菌病并接受相应治疗,但随访时确诊为系统性红斑狼疮。这一独特病例表明,对于实验室检查结果不明确的长期发热病例,密切随访是最佳管理方法。

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Best Practice for Prolonged Fever in Primary Care Setting: Close Follow-Up or Empiric Antibiotic Therapy?基层医疗环境中持续性发热的最佳实践:密切随访还是经验性抗生素治疗?
Korean J Fam Med. 2018 Sep;39(5):318-321. doi: 10.4082/kjfm.17.0118. Epub 2018 Jul 4.
2
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本文引用的文献

1
Juvenile, adult and late-onset systemic lupus erythematosus: a long term follow-up study from a geographic and ethnically homogeneous population.青少年、成人和迟发性系统性红斑狼疮:来自地理和种族单一人群的长期随访研究。
Clin Exp Rheumatol. 2015 Nov-Dec;33(6):788-94. Epub 2015 Nov 17.
2
Prognostic implications of active discoid lupus erythematosus and malar rash at the time of diagnosis of systemic lupus erythematosus: Results from a prospective cohort study.系统性红斑狼疮诊断时活动性盘状红斑狼疮和颧部皮疹的预后意义:一项前瞻性队列研究的结果
Lupus. 2016 Apr;25(4):376-81. doi: 10.1177/0961203315610645. Epub 2015 Oct 8.
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Systemic lupus erythematosus patient with false positive results of antibody to HIV: A case report and a comprehensive literature review.系统性红斑狼疮患者出现HIV抗体假阳性结果:一例报告及文献综述
Technol Health Care. 2015;23 Suppl 1:S99-S103. doi: 10.3233/thc-150938.
4
Vascular disease in systemic lupus erythematosus.系统性红斑狼疮中的血管疾病
Autoimmune Dis. 2012;2012:876456. doi: 10.1155/2012/876456. Epub 2012 Aug 22.
5
Infectious antibodies in systemic lupus erythematosus patients.系统性红斑狼疮患者中的感染性抗体。
Lupus. 2009 Nov;18(13):1129-35. doi: 10.1177/0961203309345729.
6
Exposure to Epstein-Barr virus infection is associated with mild systemic lupus erythematosus disease.感染爱泼斯坦-巴尔病毒与轻度系统性红斑狼疮疾病有关。
Ann N Y Acad Sci. 2009 Sep;1173:658-63. doi: 10.1111/j.1749-6632.2009.04754.x.
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The sensitivity and specificity of Brucella agglutination tests.布鲁氏菌凝集试验的敏感性和特异性。
Diagn Microbiol Infect Dis. 2003 Aug;46(4):241-3. doi: 10.1016/s0732-8893(03)00081-6.