Current understanding and management of chronic hepatosplenic suppurative brucellosis
Current understanding and management of chronic hepatosplenic suppurative brucellosis
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DOI：
10.1086/319608
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发表时间：
2001-04-01
影响因子：
11.8
通讯作者：
Pahissa, A
中科院分区：
文献类型：
--
作者：
Ariza, J;Pigrau, C;Pahissa, A
为总结慢性肝脾化脓性布鲁氏菌病(CHSB)的临床特点，探讨合理的治疗方法，对905例CHSB患者的临床资料进行分析。15例患者共发生CHSB 16次，其中肝14次，脾2次。6名患者以前曾患过远端布鲁氏菌病。12例患者出现全身症状，12例出现局部症状。血样培养除1例外，其余均为阴性，脓液标本培养仅2例布氏杆菌阳性。所有患者在计算机断层扫描上均可见钙质沉积，周围有低密度区。患者通常有低滴度的凝集抗体。在接受保守治疗的患者中，早期有效率为50%，晚期有效率为33.3%。在接受手术和同期抗生素治疗的患者中，早期和晚期有效率均为100%。因此，CHSB主要代表先前布鲁氏菌病的局部重新激活。它的诊断可能很难确定，可能需要手术来治愈许多患者。
To outline the characteristics and define appropriate management of chronic hepatosplenic suppurative brucellosis (CHSB), 905 patients with brucellosis were analyzed. Sixteen episodes of CHSB (14 in the liver and 2 in the spleen) were found in 15 patients. Six patients had had previous remote brucellosis. Twelve patients presented with systemic symptoms, and 12 with local symptoms. Cultures of blood samples yielded negative results in all cases except 1, and the results of cultures of pus specimens were positive for Brucella melitensis in only 2 cases. All patients showed calcium deposits surrounded by a hypodense area on computed tomography. Patients often had low titers of agglutinating antibody. In patients who were receiving conservative management, early response was successful in 50% and late response was successful in 33.3%. In the patients who underwent surgery and concomitant antibiotic therapy, early and late response was successful in 100%. Thus, CHSB mainly represents a local reactivation of previous brucellosis. Its diagnosis may be difficult to establish and surgery may be required to cure many patients.