Ariza J, Corredoira J, Pallares R, Viladrich P F, Rufi G, Pujol M, Gudiol F
Infectious Disease Service, Hospital de Bellvitge, Universidad de Barcelona, Spain.
Clin Infect Dis. 1995 May;20(5):1241-9. doi: 10.1093/clinids/20.5.1241.
For 16 years we prospectively observed 530 adult patients with brucellosis to analyze the characteristics of and risk factors for relapse. Clinical and laboratory findings from 86 relapsed patients were milder during the relapse episode when compared with those for the same patients during the initial disease. Blood cultures were positive for Brucella melitensis in 65% of cases during relapse and in approximately 80% of cases during the initial disease. Risk factors that were identified as being independently associated with relapse (by logistic regression analysis) were "less-effective" antibiotic therapy (OR, 8.3; 95% CI, 4.6-15.1), positive blood cultures during initial disease (OR, 2.7; 95% CI, 1.2-6.2), < or = 10-day duration of the disease before treatment (OR, 1.9; 95% CI, 1.1-3.6), male sex (OR, 1.8; 95% CI, 1.02-3.8) and a platelet count of < or = 150 x 10(3)/mm3 (OR, 1.7; 95% CI, 1.1-2.8). These data show that relapse of brucellosis is sometimes difficult to diagnose and that it can be an insidious disease. In addition to inappropriate antibiotic therapy, other factors, such as those indicating a more aggressive disease and/or a deficient immunologic response, seem to play an important role in the relapse of brucellosis.
16年来，我们对530例成年布鲁氏菌病患者进行了前瞻性观察，以分析复发的特征和危险因素。与同一患者初次发病时相比，86例复发患者在复发期的临床和实验室检查结果较轻。复发时65%的病例血培养马尔他布鲁氏菌呈阳性，初次发病时约80%的病例血培养呈阳性。经逻辑回归分析确定与复发独立相关的危险因素为“疗效欠佳”的抗生素治疗（比值比[OR]，8.3；95%置信区间[CI]，4.6 - 15.1）、初次发病时血培养阳性（OR，2.7；95% CI，1.2 - 6.2）、治疗前病程≤10天（OR，1.9；95% CI，1.1 - 3.6）、男性（OR，1.8；95% CI，1.02 - 3.8）以及血小板计数≤150×10³/mm³（OR，1.7；95% CI，1.1 - 2.8）。这些数据表明，布鲁氏菌病的复发有时难以诊断，且可能是一种隐匿性疾病。除了不恰当的抗生素治疗外，其他因素，如提示病情更严重和/或免疫反应不足的因素，似乎在布鲁氏菌病的复发中起重要作用。
