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目的探讨布鲁氏菌病致肺炎并胸腔积液的临床表现、胸部影像学表现及治疗方法。方法对1例诊断为布鲁氏菌病所致肺炎并胸腔积液患者的临床资料进行分析。结果该例患者因处理病猪流产物时吸入含布鲁氏菌的气溶胶,导致肺炎及胸腔积液的发生。临床主要表现为发热、畏寒,轻微咳嗽,咯痰少,伴胸闷、气短。影像学表现为右肺多发斑片、结节影伴右侧胸腔积液。血清虎红平板凝集试验阳性,标准试管凝集试验滴度为1∶200。经口服多西环素和利福平,静脉滴注头孢曲松治疗后,患者临床症状缓解,肺部斑片影及胸腔积液吸收好转。结论布鲁氏菌病肺部受累罕见,临床表现多样,无特异性,易被误诊为普通细菌性肺炎或肺结核;了解流行病学资料及职业史有助于本病的诊断。
Objective To investigate the clinical manifestations of brucellosis-induced pneumonia and pleural effusion, chest radiographic findings and treatment. Methods One patient diagnosed as brucellosis-induced pneumonia and pleural effusion in patients with clinical data were analyzed. Results The patient inhaled brucella-containing aerosol as a result of treatment of swine flow products, resulting in the development of pneumonia and pleural effusion. The main clinical manifestations of fever, chills, mild cough, expectoration less, with chest tightness, shortness of breath. Imaging manifestations of multiple lesions of the right lung, nodular shadow with right pleural effusion. Serum tiger red plate agglutination test positive, standard tube agglutination test titer of 1: 200. After oral administration of doxycycline and rifampicin, intravenous infusion of ceftriaxone treatment, patients with clinical symptoms, pulmonary patch and pleural effusion improved absorption. Conclusions Brucellosis is rare in the lungs. The clinical manifestations are diverse, nonspecific and easily misdiagnosed as common bacterial pneumonia or tuberculosis. Knowledge of epidemiological data and occupational history may help to diagnose the disease.