布鲁菌病误诊病例4例报告.docVIP

布鲁菌病误诊病例4例报告 　　[摘要] 回顾性分析吉林大学中日联谊医院肾内科（以下简称“我科”）2016年6～11月收治的4 例布鲁菌病患者的病例资料，探讨布鲁菌病的临床特点，减少误诊误治。结果发现，4例患者均有明确的流行病学接触史，2例发热伴腰痛，1例下肢关节疼痛伴尿频，1例以全身浮肿为主要症状。本组均在我科就诊，1例误诊为双肾结石并发感染，1例误诊为骨关节病，1例误诊为泌尿道感染，1例确诊为肾病综合征。前3例经相应治疗无效，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、四环素类及左氧氟沙星抗菌药物1～2种治疗后均痊愈。1例放弃治疗，自动出院。布鲁菌病临床表现复杂多变，对发热伴腰痛、关节疼痛的患者，注意详细询问牛、羊等病畜接触史，疑诊者应及时行布鲁杆菌血清学检查，以减少误诊。 　　[关键词] 布鲁菌病；误诊；泌尿道感染；肾病综合征 　　[中图分类号] R516 [文献标识码] A [文章编号] 1673-7210（2017）05（b）-0160-04 　　[Abstract] Clinical data of 4 cases with Brucellosis infection in Department of Nephrology， China-Japan Union Hospital of Jilin University （for short our department） from June to November 2016 were ret-rospectively analyzed， to investigate the clinical features of brucellosis， less misdiagnosis and mistreatment. The results showed that all the 4 patients had demonstrable epidemiology history， two patients with fever and waist pain， one pain in lower limb joint with frequ-ent urination， one body bloated as the main symptoms. The 4 patients visited at our department at first， and one patient was misdiagnosed as having double kidney stones complicated with infection， one was misdiagnosed as as having osteoarthritis， one was misdiagnosed as as having urinary tract infection， and the last one was diagnosed as nephrotic syndrome. Results of serumal agglutination tests for Brucellosis in 4 patients turned to positive， and the diagnosis of brucellosis was confirmed. The first 3 cases were cured therapy with 1 or 2 kinds of Rifampicin， Tetracyclines and Levofloxacin. One case left hospital without cure. Clinical manifestations of brucellosis are complicated. For fever patients with waist pain， joint pain， clinicians must ask for details of the history of contact with diseased cattle and sheep， and takebrucellosis antibody detection as early as possible to clarify the diagnosis， in order to reduce misdiagnosis rate. [Key words] Brucellosis； Misdiagnosis； Urinary tract infection； Nephrotic syndrome 　　布?菌病又称波状热或地中海弛张热，在全球呈高发态势，对公共卫生安全等领域带来严