| ObjectiveThe demography,epidemiology,clinical manifestation,laboratory examination and treatment plan of inpatients with brucellosis were analyzed.MethodsThe patients with brucellosis in Jinan Infectious Diseases Hospital from January 2014 to December 2017 were selected and analyzed retrospectively according to their demographic characteristics,clinical manifestations,laboratory examinations,treatment plans and misdiagnosed patients.Four age groups(that is juvenile group,young group,middle-aged group and old group),whether misdiagnosed,and whether there were complications were compared and analyzed.The data is entered by Epidata2,and is analyzed by SPSS 18.0.Results845 cases(69.1%)of brucellosis are male,and 377 cases(30.9%)of brucellosis are female in Jinan Infectious Diseases Hospital,There were 241 cases(19.7%)、279 cases(22.8%)、375 cases(30.7%)、327 cases(26.7%)of brucellosis in the year 2014,2015,2016,2017,respectively.The number of cases in May and September accounted for 58%of the whole year,and the place of residence in rural and urban areas were 966 cases(79.1%)and 256 cases(20.9%).89.7%of them have had with sheep contact history or sheep products,10.3%have contacted with animals such as rabbits,pigs,foxes,minks,dogs,deer placenta,deer blood and others.Most of the patients of brucellosis are famers(75.9%),and the rest are workers,students,veterinarians,cooks,etc.(24.9%).The clinical manifestations are fever(86.61%),joint pain(46.3%),pain in low back(43.2%),sweat(50.3%),fatigue(37.6%),hepatomegaly(13.1%),splenomegaly(15.9%),weight-losing(27.8%),etc.209 cases(17.10%)of the patients have complication such as spondylitis,162 cases of arthritis(13.26%),54 cases of orchitis(5.0%),2 cases of endocarditis,6 cases of encephalomyelitis,and 55 cases of bronchitis(5.0%).560 cases(45.8%)of the patients in brucellosis were misdiagnosed.The median time required to obtain a definitive diagnosis from the first appearance of fever,lumbago,etc.was 32(1-400)days.Those patients are easy to be misdiagnosed as upper respiratory tract infection(20.9%),other diseases like osteoarthritis(7.2%)and tuberculosis(4.7%),.Patients with misdiagnosed fever,excessive sweating,fatigue,liver and spleen enlargement,joint pain,etc.had a higher incidence than patients who had not been misdiagnosed.In 4 groups of patients of different ages,liver enlargement,spleen enlargement,ALT elevation,AST elevation,alkaline phosphatase elevation,neutrophils reduction,and hemoglobin reduction are more common in young patients.Fatigue,lumbago,decreased albumin,decreased platelet,accelerated blood loss,and elevated C-reactive protein are more common in middle-aged and elderly patients.There are no statistical differences in the remaining demographic characteristics,clinical manifestations,and laboratory examination indicators in different age groups.Patients with acute brucellosis had a higher incidence of headache,spleen,weight loss,ALT elevation.AST elevation,and positive blood culture,while non-acute patients had a higher incidence of joint pain and lumbago.Of all the patients,498 cases(40.8%)of them get ALT elevation,407 cases(33.3%)AST elevation,700 cases(57.2%)ALB decreases,and 603 cases(68.5%)C-reactive protein increases.The SAT test was positive in 1195 cases(97.8%)and blood culture positive in 486 cases(41.6%).The treatment is based on doxocycline with lifepin.or doxocycline with streptomycin.According to the severity of the disease,aminoglycoside or quinolone or cephalosporin antimicrobial therapy can be used together.The course of treatment is generally 6 weeks,and some patients with complications such as vertebral side abscesses can be performed surgical treatment.Most of the patients have a good prognosis..ConclusionsMost of the patients had contact with sheep or goat or other animals.The first symptoms were fever,arthralgia,lumbago,sweating and fatigue,with liver damage and joint abscess.and other complications are easily misdiagnosed as upper respiratory tract infection,osteoarthritis,lumbar disc herniation and tuberculosis.Antibiotics should be used reasonably to prevent and cure complications. |
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