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目的探讨儿童布氏杆菌病的临床特征及实验室诊断特点。方法对2011年9月至2015年4月首都儿科研究所附属儿童医院收治的10例儿童布氏杆菌病例的临床特征和实验室检查结果进行回顾分析。结果临床主要表现为发热,部分患儿伴有膝、髋关节疼痛,睾丸痛。体征包括肝、脾、淋巴结肿大。实验室检查患儿血培养布氏杆菌阳性率为100%(10/10),报警时间2.3~3.6 d。其中5例患儿同时行骨髓培养,布氏杆菌阳性率为80%(4/5),报警时间1.9~3.7 d。布氏杆菌在血平皿上生长缓慢,形成肉眼可见的菌落需36~48 h。血常规表现为白细胞分类以淋巴细胞为主,部分伴有贫血和血小板减低。CRP升高和肝脏酶学异常较常见。结论儿童布氏杆菌感染临床特征非特异,与多种疾病临床表现相似,易出现漏诊或误诊。血培养和骨髓培养在疾病早期阳性率高,是诊断该病的金标准。
Objective To investigate the clinical features and laboratory diagnostic features of brucellosis in children. Methods The clinical features and laboratory findings of 10 brucellosis children were retrospectively analyzed from September 2011 to April 2015 in Children’s Hospital Affiliated to Capital Institute of Pediatrics. Results The main clinical manifestations of fever, some children with knee, hip pain, testicular pain. Signs include liver, spleen, lymph nodes. The positive rate of brucella in blood culture in laboratory was 100% (10/10), and the alarm time was 2.3 ~ 3.6 days. Five of the children underwent bone marrow culture at the same time. The positive rate of brucellosis was 80% (4/5) and the alarm time was 1.9-3.7 days. Brucella grew slowly on the blood plate and required 36 to 48 hours for visible colonies. Blood manifestations of leucocytes classified as lymphocytes, some accompanied by anemia and thrombocytopenia. Increased CRP and liver enzyme abnormalities are more common. Conclusion The clinical features of brucellosis in children are nonspecific and similar to the clinical manifestations of various diseases. Misdiagnosis and missed diagnosis are easy to occur. Blood culture and bone marrow culture in the early positive rate of the disease is the gold standard in the diagnosis of the disease.