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目的分析1例儿童感染布鲁氏菌病(布病)的原因,为布病防控提供依据。方法收集患儿门诊和住院病历,采用描述性流行病学方法对基本情况、发病诊疗经过、密切接触人员、生活习惯和环境、愈后转归等进行调查。采集患儿骨髓进行布鲁氏菌培养、分离和鉴定,采集患儿及其伯父血清进行虎红平板凝集试验(RBPT)和试管凝集试验(SAT)检测布鲁氏菌抗体。结果患儿于2015年2月2日开始出现反复发热、咳嗽、双下肢疼痛等症状,就诊皆以其他疾病诊断治疗;4月2日患儿再次因“发热1天”收治入温州医科大学附属第二医院,实验室检查从患儿骨髓中分离出羊种布鲁氏菌,血清RBPT强阳性,SAT抗体滴度>1∶1 600(++);结合患儿体温升降反复、肝脾肿大、肝损害等临床表现,诊断为布病。患儿伯父于2015年1—2月曾交易、宰杀和食用外地活羊,在此期间患儿与其有密切接触史,但伯父血清RBPT和SAT结果均为阴性。结论该病例为儿童布病病例,可能在与其伯父接触过程中,通过直接接触或气溶胶方式吸入伯父身上污染的布鲁氏菌而感染。温州作为布病控制区,应加强对布病诊治知识的培训,加强对引进牲畜的检疫和职业重点人群监测。
Objective To analyze the causes of brucellosis (brucellosis) in 1 case of children and provide basis for prevention and control of brucellosis. Methods Outpatient and inpatient records of children were collected, and the descriptive epidemiological methods were used to investigate the basic situation, the diagnosis and treatment after the onset of disease, close contact with personnel, living habits and environment, and prognosis after recovery. The bone marrow of children were collected for Brucella culture, isolation and identification. The brucella antibodies were detected by RBPT and SAT in children and their uncle’s serum. Results Children started to have recurrent fever, cough and pain of both lower extremities on February 2, 2015. All the patients were diagnosed and treated with other diseases. On April 2, the children were admitted to Wenzhou Medical Bureau again for 1 day of fever Second Affiliated Hospital of University, laboratory examination Brucella isolated from the bone marrow of children, serum RBPT strong positive, SAT antibody titers> 1: 600 (++); combined with children with repeated temperature rise, liver Splenomegaly, liver damage and other clinical manifestations, diagnosis of brucellosis. The children’s uncle traded, slaughtered and consumed live sheep in January-February 2015, during which time the children had close contact with them, but the uncle’s serum RBPT and SAT results were negative. Conclusion This case is a case of brucellosis in children and may be infected by inhalation of unclean brucellosis by direct contact or aerosol during contact with his uncle. As a brucellosis control area in Wenzhou, training on diagnosis and treatment of brucellosis should be strengthened, and the quarantine and occupational key population monitoring of introduction of livestock should be strengthened.