Brucellosis in low-income and middle-income countries.
Brucellosis in low-income and middle-income countries.
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DOI：
10.1097/qco.0b013e3283638104
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发表时间：
2013-10
影响因子：
3.9
通讯作者：
Crump JA
中科院分区：
文献类型：
--
作者：
Rubach MP;Halliday JE;Cleaveland S;Crump JA
人类布鲁氏菌病是一种被忽视、未得到充分认识的传染病，具有广泛的地理分布。它在人类中引起急性发热性疾病和可能使人衰弱的慢性感染，牲畜感染具有重大的社会经济影响。本综述描述了关于发展中国家布鲁氏菌病流行病学的新信息以及诊断和治疗方面的进展。人类布鲁氏菌病的最高发病率发生在中东和中亚。发热病因学研究表明，布鲁氏菌病是发展中国家未分化发热性疾病的一种病因。布鲁氏菌病是返回旅行者中罕见的发热原因，但在从中东和北非返回的旅行者中更为常见。已经验证了适用于资源有限环境的敏感和特定的快速诊断测试。随机对照试验表明，治疗人布鲁氏菌病的最佳方法是强力霉素和氨基糖苷。减少人类布鲁氏菌病负担需要控制动物布鲁氏菌病，但需要有证据为发展中国家控制规划的设计提供信息。布鲁氏菌病在人类和动物群体中引起大量发病率。虽然在资源有限的情况下改进诊断选择和提供更有力的最佳治疗证据应能加强人类布鲁氏菌病的识别和治疗，但通过动物控制预防人类疾病仍然是最重要的。
Human brucellosis is a neglected, underrecognized infection of widespread geographic distribution. It causes acute febrile illness and a potentially debilitating chronic infection in humans, and livestock infection has substantial socioeconomic impact. This review describes new information regarding the epidemiology of brucellosis in the developing world and advances in diagnosis and treatment. The highest recorded incidence of human brucellosis occurs in the Middle East and Central Asia. Fever etiology studies demonstrate brucellosis as a cause of undifferentiated febrile illness in the developing world. Brucellosis is a rare cause of fever among returning travelers, but is more common among travelers returning from the Middle East and North Africa. Sensitive and specific rapid diagnostic tests appropriate for resource-limited settings have been validated. Randomized controlled trials demonstrate that optimal treatment for human brucellosis consists of doxycycline and an aminoglycoside. Decreasing the burden of human brucellosis requires control of animal brucellosis, but evidence to inform the design of control programs in the developing world is needed. Brucellosis causes substantial morbidity in human and animal populations. While improvements in diagnostic options for resource-limited settings and stronger evidence for optimal therapy should enhance identification and treatment of human brucellosis, prevention of human disease through control in animals remains paramount.