布鲁菌病五例误诊分析安娜,白云静,李蓉,周斐作者单位:100700北京,北京军区总医院风湿免疫科通讯作者:白云静,电话:13522372262;E-mail:byjing880629@sina.com[摘要]目的分析布鲁菌病误诊原因,并提出防范措施。方法对我科2011年6月—2012年8月误诊的5例布鲁菌病的临床资料进行回顾性分析。结果5例入院1个月前均有发热,1例伴肘关节红肿疼痛,1例伴双大腿肌肉和右髋部疼痛,1例伴右上肢多发无痛性结节,2例伴腰肩部疼痛。本组均在风湿免疫科就诊,1例误诊为未分化结缔组织病、骨关节炎,1例误诊为干燥综合征,3例误诊为细菌感染。经相应治疗无效,查布鲁杆菌血清凝聚试验阳性,确诊为布鲁菌病,给予利福平和盐酸多西环素联合治疗6周,均痊愈。结论布鲁杆菌的变异及流行病学的改变,使布鲁菌病的临床表现不典型,对慢性发热伴骨关节症状患者,应仔细地询问病史,鉴别诊断中行布鲁杆菌血清凝集试验,以减少误诊。[关键词]布鲁杆菌;感染;误诊;细菌感染[中国图书资料分类号]R516.7[文献标志码]A[文章编号]1002-3429(2013)04-0018-03[DOI]10.3969/j.issn.1002-3429.2013.04.006Analysisof5MisdiagnosedPatientswithBrucellosisInfectionANNa,BAIYun-jing,LIRong,ZHOUFei(DepartmentofRheumatismandImmunology,GeneralHospitalofBeijingMilitaryAreaCommand,Beijing100700,China)[Abstract]ObjectiveToanalyzemisdiagnosiscausesofBrucellosisinfectionandtoproposeprecautionarymeasures.MethodsClinicaldataof5misdiagnosedpatientswithBrucellosisinfectioninourdepartmentduringJune2011andAugust2012wasretrospec-tivelyanalyzed.ResultsAllthe5patientshadfeverfor1monthbeforeadmission,onepatientwitherythrodysesthesiainelbowjoint,onewithpainsinboththighsmusclesandrighthip,onewithmultipleunpainfulnodesinrightupperextremity,andtwowithpainsinwaistandshoulder.The5patientsvisitedrheumatismandimmunologydepartmentatfirst,andonepatientwasmisdiagnosedashavingundifferentiatedconnectivetissuediseaseandosteoarthritis,oneashavingSjogren'ssyndrome,andtheotherthreepatientsashavingbacterialinfections.Resultsofserumalagglutinationtestsforbrucellosisin5patientsturnedtopositive,andthediagnosisofbrucellosiswasconfirmed.Allthepatientswerecuredaftersixweekscombinationtherapywithrifampinanddoxycyclinehydrochloride.ConclusionThebrucellosisvariationandepidemiologicalchangesleadtountypicalclinicalsymptomsforbrucellosis.Medicalhistoryandbrucello-sisagglutinationtestshouldbeperformedforpatientswithchronicityfeverandjointsymptomssoastoreducemisdiagnosisrate.[Keywords]Brucellosis;Infection;Misdiagnosis;Bacterialinfection布鲁菌病是由布鲁杆菌引起的感染家畜为主的人兽共患性传染病[1]。布鲁杆菌侵入机体后引起全身网状内皮系统增生,同时伴随菌血症、毒血症和神经、循环、生殖、免疫等多系统损伤。布鲁菌病临床主要表现为发热、多汗、全身乏力、关节疼痛等症状。由于临床症状与普通感冒、季节性的流行性感冒或风湿免疫性疾病极为相似,因此很容易误诊或漏诊。我科2011年6月—2012年8月收治布鲁菌病9例,误诊5例。为减少该病的误诊误治,现将5例误诊情况总结如下。1临床资料1.1一般资料本组5例,男4例,女1例;年龄39~63岁,平均48岁;春季发病2例,夏季发病1例,秋季发病2例;病程1~3个月4例,5个月1例;职业:建筑工人2例,牧民、警察、农民各1例;2例来自内蒙古牧区,3例来自非牧区。家中饲养牛羊、曾帮助邻居杀牛、发病前进食风干生牛肉干、平素喜食涮羊肉各1例,1例无明确牛羊接触史。1.2临床表现5例入院1个月前均有发热,3例伴畏寒,无寒战,体温37.2~40.0℃;3例高热数日后可降至正常,持续数日后再次高热;1例体温波动于37~38℃,但持续时间较长;1例呈弛张热,伴多汗;1例伴肘关节红肿疼痛,超声检查示滑囊炎;1例伴双大腿肌肉和右髋疼痛,逐渐转为双侧大腿根部...