目的 分析布鲁杆菌病非流行区以不明原因发热为首发症状就诊并确诊的布鲁杆菌病患者的不典型临床表现,提高对非流行区不典型布鲁杆菌病的临床认识.方法 收集2013年1月-2016年1月北京医院以不明原因发热为首发症状就诊后经布鲁杆菌血培养检查阳性确诊的布鲁杆菌病患者10例的临床资料,进行回顾性分析,并结合相关文献复习.结果 10例布鲁杆菌病患者,其中男7例,女3例;诊断时年龄40 ～70岁,平均年龄56.3岁.均来自非牧区.3例有养羊或羊接触史,3例有进食牛羊肉史,1例有在家加工生羊肉史,3例无明确流行病学接触史.10例均以发热伴或不伴其他症状就诊.首诊科室包括急诊科3例,骨科2例,呼吸科2例,风湿科1例,神经内科1例,血液科1例.10例患者布鲁杆菌血培养及凝集试验均为阳性.结论 布鲁杆菌病非流行区对于不明原因发热的患者应重视散发布鲁杆菌病的可能,反复血培养为最终确诊提供依据.%Objective To elaborate the atypical clinical manifestations of confirmed brucellosis patients with the initial symptom of fever of unknown origin in a non-endemic area,in order to expand the clinical recognition of the disease.Methods We did a review of the clinical data of 10 brucellosis patients with the initial symptom of fever of unknown origin,who were admitted to Beijing Hospital between January 2013 and January 2016,and confirmed by blood culture results.And we reviewed the literature related to the disease.Results All the 10 cases (7 males and 3 females aged 40 to 70 years with a mean age of 56.3 years) came from non-pastoral area.Three cases had the history of raising sheep or contact with goats,3 cases had history of eating beef and mutton,1 case had history of processing raw mutton at home,and 3 cases had no clear exposure history.With fever alone or fever accompanying by other symptoms,3 cases initially visited Department of Emergency,2 visited Department of Orthopedics,2 visited Department of Respiratory Medicine,1 visited Department of Rheumatology,1 visited Department of Neurology,and 1 visited Department of Hematology.Results of brucella blood culture and agglutination tests for them were all positive.Conclusion Brucellosis should be kept in mind during the screening of fever of unknown origin in non-endemic areas.Repeated blood culture can provide convincing evidence for a definitive diagnosis.
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