吉林省松原地区布鲁氏菌病就诊人群流行病学调查与分析
|
摘要
布鲁氏菌病(Brucellosis)是由布鲁氏菌引起的一种人兽共患的慢性细菌性传染病,在全世界各地都有很广泛的分布。近年来我国布鲁氏菌病发病率逐年递增,给畜牧业及其相关产业造成了相当严重的经济损失,同时也给人民的生命健康带来极大的威胁。
本研究采用流行病学现况调查的方法,使用自行设计的《布鲁氏菌病门诊病人个案调查表》调查了吉林省松原市疾病预防控制中心就诊人员,并分析了吉林省松原市布鲁氏菌病的流行病学特征,探索影响布鲁氏菌病发病的相关危险因素及随访患者的临床症状和免疫学指标的转归情况。调查结果显示,就诊人员共计1103人,布鲁氏菌病阳性率为36.6%;就诊人群临床分期构成中,最高为急性期,其次为亚急性期、慢性期和残余期;临床症状及合并症分布中,患者主要的症状为发热,其次为肌肉关节疼痛和乏力,主要合并症为睾丸炎,患者与非患者在发热、多汗、背痛、髋痛、腰间盘突出、骨质增生及颈椎病的分布上经检验差异有统计学意义(P<0.05);就诊时间主要集中在6～8月份;阳性率最高的就诊地区为乾安县,其次为扶余县及前郭县;就诊患者在性别、年龄、职业及文化程度上的分布差异有统计学意义,同时还受到畜别接触史、家庭成员感染史、接触途径及传播媒介等方面因素的影响;26名随访患者进行抗生素治疗,治疗后1个月主要症状为多汗,3个月主要症状为肌肉关节疼痛,6个月主要症状为腰痛,临床症状随时间呈减少趋势;随访患者治疗后3个月和6个月SAT指标均呈现下降趋势,3个月、6个月SAT结果是否达到诊断标准在临床症状分布上差异无统计学意义。
本研究为布鲁氏菌病的预防和临床治疗提供了科学依据,为布鲁氏菌病的病因预防提供了理论支持。建议政府、疾病预防控制部门及高危职业者给予足够的重视,从而有效地控制布鲁氏菌病的疫情。
Background
Brucellosis is a kind of chronic bacterial transmitted diseases caused by Brucella which had a very broad distribution all over the world. According to the WHO survey, human and livestock brucellosis had a wide spread in 170 countries and regions in more than 200 countries around the world.350 million people are threated by brucellosis in China and 5,000 ~ 6,000 people catch Brucellosis each year. As well as the threat to people's lives and health, Brucellosis also leads to great economic losses to the livestock and related industries.
Jilin Province is the hardest hit of brucellosis, the province reported 3,617 new cases in 2009 which increased by 57.53% compared to last year’s.The incidence rate of the nation is in the nation's first three, the number of cases ranks No.4. The cases of Songyuan come to 1636 accounted for 45.2% of the whole province.
At present, in face of rising prevalence, factors of brucellosis is still a lack of systematic research in our country, and few dometic follow-up studies about patients’symptoms and immunological results were repored because a non-clinical treatment is quite popular in China.
The epidemiological status of the investigation were used in the research of Songyuan City CDC in Jilin Province to study brucellosis-positive rate, epidemiological characteristics and risk factors of treatment groups, while follow-up study of their clinical symptoms and immunological changes after antibiotic treatment were also included in the research.The results of the study provide a scientific basis for the brucellosis prevention and clinical treatment.
Methods
In this study, treatment groups in Songyuan City CDC from January 1 to December 31 in 2009 were studied, a total of 1103 people left after excluding repeated, while 26 patients were chosen as follow-up survey. The self-designed questionnaire of brucellosis cases and one-to-one interviews were used in the research.
The questionnaire have been collated and a database were built by EpiData 3.0 software, SPSS 12.0 software were used for statistical analysis.Descriptive analysis andχ2 test were used to analyze the distribution differences of brucellosis in gender, age, nationality, occupation, education, treatment time, the incidence areas, clinical symptoms and complications and follow-up conditions; risk factors of brucellosis were studied by regression analysis.
Results
1. Treatment group countained a total of 1103 people, brucellosis-positive rate was 36.6%. Brucellosis in gender, age, and occupation and education level has a significant difference.
2. Treatment groups in clinical stages of composition, acute phase accounted for 82.4%, sub-acute phase of 8.2%, chronic phase of 5.7%, the residual period of 3.7%. Brucellosis in patients with clinical symptoms and complications of distribution, the main symptoms in patients was fever (68.1%), followed by muscle and joint pain (40.1%) and fatigue (27.2%), the main complication is orchitis (4.4%).
3. Brucellosis in patients with temporal distribution of the patients the positive rate of population up to January (50.0%), followed by February (45.4%) and May (41.8%); In the regional distribution, the difference of positive rate among the areas shows no statistical significance.
4. Through single and multi- factor analysis showed the risk factors of brucellosis: The patient's general situation: gender, age, educational level and occupation; animal exposure history: contact with cattle, sheep, and dogs; family history of infection: spouses and children get infection; transmission channels: contact through the skin and respiratory tract infections; the mass media: the flow of products of infected animals, fur, soil, manure and dust.
5. 26 follow-up of patients after treatment with antibiotics.In the 1 month the main symptoms are excessive sweating (46.2%), 3 months for the muscle and joint pain (34.6%), 6 months for low back pain (23.1%); 3 months SAT indicator 9 lower than the diagnostic criteria (34.6%), 6-month SAT indicator 10 (38.5%) was lower than the diagnostic criteria, while two people (7.7%) to negative; 3 months, 6 months, whether come to the diagnostic criteria for SAT results showed no significant difference in the distribution of clinical symptoms.
Conclusion
A high brucellosis detection rate was found in outpatients in Songyuan CDC and it had a clear gender differences. The incidence of brucellosis is also affected by age, educational level, occupation, animal exposure history, and family history of infection, time of onset of disease areas, transmission routes and the media and other implications. This study provides theoretical basis for prevention and treatment of brucellosis and affords a theoretical support for the cause of prevention. Government, the disease control departments and high-risk occupational people should pay enough attention to effectively reduction of the brucellosis incidence.
本研究采用流行病学现况调查的方法,使用自行设计的《布鲁氏菌病门诊病人个案调查表》调查了吉林省松原市疾病预防控制中心就诊人员,并分析了吉林省松原市布鲁氏菌病的流行病学特征,探索影响布鲁氏菌病发病的相关危险因素及随访患者的临床症状和免疫学指标的转归情况。调查结果显示,就诊人员共计1103人,布鲁氏菌病阳性率为36.6%;就诊人群临床分期构成中,最高为急性期,其次为亚急性期、慢性期和残余期;临床症状及合并症分布中,患者主要的症状为发热,其次为肌肉关节疼痛和乏力,主要合并症为睾丸炎,患者与非患者在发热、多汗、背痛、髋痛、腰间盘突出、骨质增生及颈椎病的分布上经检验差异有统计学意义(P<0.05);就诊时间主要集中在6～8月份;阳性率最高的就诊地区为乾安县,其次为扶余县及前郭县;就诊患者在性别、年龄、职业及文化程度上的分布差异有统计学意义,同时还受到畜别接触史、家庭成员感染史、接触途径及传播媒介等方面因素的影响;26名随访患者进行抗生素治疗,治疗后1个月主要症状为多汗,3个月主要症状为肌肉关节疼痛,6个月主要症状为腰痛,临床症状随时间呈减少趋势;随访患者治疗后3个月和6个月SAT指标均呈现下降趋势,3个月、6个月SAT结果是否达到诊断标准在临床症状分布上差异无统计学意义。
本研究为布鲁氏菌病的预防和临床治疗提供了科学依据,为布鲁氏菌病的病因预防提供了理论支持。建议政府、疾病预防控制部门及高危职业者给予足够的重视,从而有效地控制布鲁氏菌病的疫情。
Background
Brucellosis is a kind of chronic bacterial transmitted diseases caused by Brucella which had a very broad distribution all over the world. According to the WHO survey, human and livestock brucellosis had a wide spread in 170 countries and regions in more than 200 countries around the world.350 million people are threated by brucellosis in China and 5,000 ~ 6,000 people catch Brucellosis each year. As well as the threat to people's lives and health, Brucellosis also leads to great economic losses to the livestock and related industries.
Jilin Province is the hardest hit of brucellosis, the province reported 3,617 new cases in 2009 which increased by 57.53% compared to last year’s.The incidence rate of the nation is in the nation's first three, the number of cases ranks No.4. The cases of Songyuan come to 1636 accounted for 45.2% of the whole province.
At present, in face of rising prevalence, factors of brucellosis is still a lack of systematic research in our country, and few dometic follow-up studies about patients’symptoms and immunological results were repored because a non-clinical treatment is quite popular in China.
The epidemiological status of the investigation were used in the research of Songyuan City CDC in Jilin Province to study brucellosis-positive rate, epidemiological characteristics and risk factors of treatment groups, while follow-up study of their clinical symptoms and immunological changes after antibiotic treatment were also included in the research.The results of the study provide a scientific basis for the brucellosis prevention and clinical treatment.
Methods
In this study, treatment groups in Songyuan City CDC from January 1 to December 31 in 2009 were studied, a total of 1103 people left after excluding repeated, while 26 patients were chosen as follow-up survey. The self-designed questionnaire of brucellosis cases and one-to-one interviews were used in the research.
The questionnaire have been collated and a database were built by EpiData 3.0 software, SPSS 12.0 software were used for statistical analysis.Descriptive analysis andχ2 test were used to analyze the distribution differences of brucellosis in gender, age, nationality, occupation, education, treatment time, the incidence areas, clinical symptoms and complications and follow-up conditions; risk factors of brucellosis were studied by regression analysis.
Results
1. Treatment group countained a total of 1103 people, brucellosis-positive rate was 36.6%. Brucellosis in gender, age, and occupation and education level has a significant difference.
2. Treatment groups in clinical stages of composition, acute phase accounted for 82.4%, sub-acute phase of 8.2%, chronic phase of 5.7%, the residual period of 3.7%. Brucellosis in patients with clinical symptoms and complications of distribution, the main symptoms in patients was fever (68.1%), followed by muscle and joint pain (40.1%) and fatigue (27.2%), the main complication is orchitis (4.4%).
3. Brucellosis in patients with temporal distribution of the patients the positive rate of population up to January (50.0%), followed by February (45.4%) and May (41.8%); In the regional distribution, the difference of positive rate among the areas shows no statistical significance.
4. Through single and multi- factor analysis showed the risk factors of brucellosis: The patient's general situation: gender, age, educational level and occupation; animal exposure history: contact with cattle, sheep, and dogs; family history of infection: spouses and children get infection; transmission channels: contact through the skin and respiratory tract infections; the mass media: the flow of products of infected animals, fur, soil, manure and dust.
5. 26 follow-up of patients after treatment with antibiotics.In the 1 month the main symptoms are excessive sweating (46.2%), 3 months for the muscle and joint pain (34.6%), 6 months for low back pain (23.1%); 3 months SAT indicator 9 lower than the diagnostic criteria (34.6%), 6-month SAT indicator 10 (38.5%) was lower than the diagnostic criteria, while two people (7.7%) to negative; 3 months, 6 months, whether come to the diagnostic criteria for SAT results showed no significant difference in the distribution of clinical symptoms.
Conclusion
A high brucellosis detection rate was found in outpatients in Songyuan CDC and it had a clear gender differences. The incidence of brucellosis is also affected by age, educational level, occupation, animal exposure history, and family history of infection, time of onset of disease areas, transmission routes and the media and other implications. This study provides theoretical basis for prevention and treatment of brucellosis and affords a theoretical support for the cause of prevention. Government, the disease control departments and high-risk occupational people should pay enough attention to effectively reduction of the brucellosis incidence.
引文
[1]卫生部疾病预防控制局.布鲁氏菌病防治手册[M].北京:人民卫生出版社,2008.
[2] YaguPsky P, BaronE J.Laboratory exposures to brucellae and Plieations for Bioterrorism[J].Emerg Infect Dis,2005,11(8): 1180-1118.
[3] Sreevat san S, Bookout J B, Ringpis F, et al. A multiplex approach to molecular detection of Brucella abortus and/or Mycobacterium bovis infection in cattle [J].ClinMicrobiol,2000,38(7): 2602-2610.
[4]白文彬,于康震.动物传染病诊断学[M].北京:中国农业出版社,2002: 621～627.
[5]张卓然,倪语星.临床微生物学及微生物检验[M].北京:人民卫生出版社, 2003:184-186.
[6]田野,徐晶晶.奶牛布鲁氏杆菌病的实验室诊断[J].河南畜牧兽医,2007, 28 (9):627.
[7]邢进,王金锋,赵宝华,等.布鲁菌病及其诊断方法研究进展[M].动物医学进展,2009,30(3):69-73.
[8] Fetete A, Bantle JA, Halling SM, et al. Preliminary development of a diagnosistic test for brucella using polymerase chain reaction[J].Applied Bacteriology, 1990, 69(2): 216-227.
[9]尚德秋.布鲁氏菌病流行病学及分子生物学研究进展[J].中国地方病防治杂志,1996,11(6):339.
[10] Franco MP, Mulder M, Gilman RH, et al. Human brucellosis[J]. Lancet Infect Dis,2007,7(12):775-786.
[11]王大力,张士义.急性期布氏病治疗研究进展[J].中国地方病防治,2001, 16(2):94-95.
[12]刘磊,刘晶芝,赵宝华,等.布氏杆菌病的检测与防治[J].安徽农业科学, 2007,35(20):6139-6141.
[13] Gopaul K K, Koylass M S, Whatmore A M. Rapid identificationof Brucella isolates to the species level by real time PCR based single nucleotide polymorphism (SNP) analysis [J]. BMC Microbiol, 2008, 8: 86.
[14]江森林,崔步云,苏增华,等.全国布鲁氏菌病防治工作调研报告[J].中国地方病防治杂志,2006,21(6):3-5.
[15]尚德秋.布氏菌病研究进展[J].中国地方病防治杂志, 2004,19(4): 204-212.
[16] GB15988-1995,布鲁氏菌病诊断标准及处理原则[S].北京:中华人民共和国卫生部,1995.
[17]王大力,李铁锋,江森林,等.2007年全国布氏菌病监测结果分析[J].中国地方病防治杂志,2008,23(6):443-445.
[18]江森林,王季秋,王大力,等.近年我国布氏菌病疫情及其分析[J].中国地方病防治杂志,2005,20(5):297-300.
[19]郭卫东,池海谊.内蒙古自治区2002～2006年人间布鲁氏菌病流行特征[J].中国热带医学,2008,8(4):604-606.
[20]杨海,李一航,王戬,等.陕西省1406份布鲁杆菌病高危职业人群血清学检测报告分析[J].流行病学与预防保健,2009,25(4):403-405.
[21]杨海,姬淑,李一航,等.布病职业人群感染现况调查[J].中国人兽共患病杂志,2002,18(2):126-127.
[22]王恺,姜秋梅,马玉芝,等.白城市布鲁氏菌病疫情动态分析[J].医学动物防制,2009,25(3):189-190.
[23]杨海,冯福军,蔡正华,等.西安市清真屠宰从业人员布病调查报告[J].疾病监测,2005,20(4): 208-209.
[24] F. Tabak, E. Hakko, B. Mete, et al. Is Family Screening Necessary in Brucellosis? [J].Infection,2008,36(6):575-577.
[25]常殊杰,金福芝,靳玉珠,等.齐齐哈尔市1995～2007年布鲁氏菌病疫情动态分析[J].中国地方病防治杂志,2009,24(1):2872.
[26]马炳杰,单秀红,田秀兰,等.抚宁县人间布氏菌病疫情分析[J].医学动物防制,2006,8(22):559-560.
[27]高玉宝,索凌燕,牛卫东,等.肃南县182例布鲁氏菌病患者临床流行病学特点分析[J].地方病通报, 2002, 17(2): 270-272.
[28]郭茜,殷茂荣,王延东,等.淄博市布氏菌病14年监测结果分析[J].中国卫生检验杂志, 2009, 19(10): 2361-2363.
[29] Tsolia M, Drakonaki S, Messaritaki A, et al. Clinical features, complications and treatment outcome of childhood brucellosis in central Greece[J]. Infect, 2002, 44:257-262.
[30] Miranda RT, Gimeno AE, Rodriguez TF, et al. Acute cholecystitis caused by Brucella melitensis: case report and review [J]. Infect, 2001, 42(1): 77-78.
[31] Almuneef MA, Memish ZA, Balkhy HH, et al. Importance of screening household members of acute brucellosis cases in endemic areas[J]. Epidemiol Infect, 2004, 132(3):533-540.
[32]金城日,曲彬,孙景芳,等. 2002～2004年吉林市布鲁杆菌病疫情调查分析[J].中国地方病学杂志, 2006, 25(2): 218.
[33]张兴国.河北省丰宁县2008年布鲁氏菌病流行情况分析[J].中国地方病防治杂志, 2009, 24(5): 373.
[34]崔步云.中国布鲁氏菌病疫情监测与控制[J].疾病监测,2007,22(10): 649.
[35] Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, et al. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol Northern Iran[J]. Epidemiol Infect, 2004, 132(6): 1109-1114.
[36] Bouza E, Sanchez-Carrillo C, Hernangomez S, et al. Laboratory-acquired brucellosis: a Spanish national survey[J]. Hosp Infect, 2005, 61(1): 80-83.
[37] Noviello S, Gallo R, Kelly M, et al. Laboratoryacquired brucellosis[J].Emerg Infect Dis, 2004, 10(10): 1848-1850.
[38]卿燕,高如常,木合塔尔,等. 1999年新疆布尔津县人间布鲁氏菌病监测报告[J].地方病通报, 2001,16(4): 54-55.
[39]许小利,王军,吴保红,等. 2000～2005年河南省焦作市人间布鲁氏菌病监测分析[J].地方病通报, 21(5): 77-78.
[40]柳晓琳,周艳彬,刘孝刚,等.辽西地区职业人群布鲁菌病认知状况调查[J].中国公共卫生, 2009, 25(12): 1475-1476.
[41]陈秀英.菏泽市布鲁杆菌病干预效果评价[J].现代预防学,2008, 35(16): 3168-3170.
[42] Al-Shamahy HA, Wright SG. A study of 235 cases of humanbrucellosis in Sana’a, Republic of Yemen[J]. East Mediterr Health, 2001, 7(1-2): 238-246.
[43] Kozukeev TB, Ajeilat S, Maes E, et al. Risk factors for brucellosis-Leylek and Kadamjay districts, Batken Oblast, Kyrgyzstan, January-November, 2003[J]. Morb Mortal Wkly Rep, 2006, 55(1): 31-34.
[44] Ahmad M, Al-Majali, Mahmoud Shorman. Childhood brucellosis in Jordan:prevalence and analysis of risk factors [J]. International Journal of Infectious Diseases, 2009, 13(2):196-200.
[45] Sinuff T, Patel RV, Adhikari NK, et al. Quality of professional society guidelines and consensusconference statements in critical care[J]. Critical Care Medicine, 2008, 36(4): 1360-1361.
[46] Jorge PP, Schwartz DN, Schiff GD, et al. Effects of type and level of training on variation in physician knowledge in the use and acquisition of blood cultures: a cross sectional survey[J]. BMC Infect Dis, 2005, 5:71.
[47] Ali Gur, Mehmet Geyik, Bunyamin Dikici, et al. Complications of Brucellosis in different age groups: A study of 283 cases in southeastern Anatolia of Turkey[J]. Yonsei Medical Journal, 2003, 44(1): 33-44.
[48] Kenneth Earhart, Sadulla Vafakolov, Nargiza Yarmohamedova, et al. Risk factors for brucellosis in Samarqand Oblast,Uzbekistan[J]. International Journal of Infectious Diseases, 2009, 13(6): 749-753.
[49]刘永为,江秀文,李秀忠,等.涉县1995至2008年布鲁氏菌病流行状况分析报告[J].河北医药, 2009, 31(15): 1995-1996.
[50]姜云丽,崔步云,刘权恕,等.辽宁省盖州市布鲁氏菌病流行病学调查[J].疾病监测, 2009, 24(20): 755-756.
[51]马炳杰,单秀红,田秀兰,等.抚宁县人间布氏菌病疫情分析[J].医学动物防制, 2006, 22(8): 559-560.
[52]徐延霞.乌兰察布市2000～2008年布氏杆菌病流行特征分析[J].疾病监测与控制, 2009, 3(12): 722-723.
[53] Husseini AS, Ramlawi AM. Brucellosis in the West Bank, Palestine [J]. Saudi Med J, 2004, 25(11):1640-1643.
[54]乔孝.松原市年2007年人间布氏菌病调查分析[J].中国地方病防治杂志, 2008, 23(2): 145.
[55] Young EJ, Tarry A, Genta RM, et al. Thrombocytopenic purpura associated with brucellosis: report of 2 cases and literature review[J]. Clin Infect Dis, 2000, 31(4): 904-909.
[56] Vajramani GV, Nagmoti MB, Patil CS. Neurobrucellosispresenting as an intra-medullary spinal cord abscess[J]. Ann Clin Microbiol Antimicrob, 2005, 4: 14-18.
[57] Coskun E, Suzer T, Yalcin N, et al. Spinal extradural compression caused by granuloma of brucellosis[J]. ScandJ Infect Dis, 1998, 30(3):311-313.
[58] Yetkin MA,Erdinc FS,Bulut C,et al.Epididymoorchitis due to brucellosis in central Anatolia,Turkey[J].Urol Int, 2005,75(3): 235-238.
[59] Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, et al. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran [J]. Epidemiol Infect, 2004, 132(6): 1109-1114.
[60] Akinci E, Bodur H, Cevik MA, et al. A complication of brucellosis: epididymoorchitis[J]. Int Infect Dis, 2006, 10(2): 171-177.
[61] Sari R, Buyukberber N, Sevinc A, et al. Buyukberber S: Brucellosis in the etiology of febrile neutropenia: case report [J]. Chemother, 2002, 14(1): 88-91.
[62] Memish ZA, Venkatesh S. Brucellar epididymo-orchitis in Saudi Arabia: a retrospective study of 26 cases and review of the literature[J]. BJU Int, 2001, 88(1): 72-76.
[63] Yagupsky P. Detection of brucellae in blood cultures[J]. ClinMicrobiol, 1999, 37(11): 3437-3442.
[64] Colmenero JD, Reguera JM, Ferna′ndez-Nebro A, et al. Osteoarticular complications of brucellosis[J]. Ann Rheum Dis, 1991,50(1):23-26.
[65] Duyur B, Erdem HR, Ozgocmen S. Paravertebral abscess formation and knee arthritis due to brucellosis in a patient with rheumatoid arthritis[J]. Spinal Cord, 2001, 39(10):554–556.
[66] Bingol A, Yucemen N, Meco O. et al. Medically treated intraspinal Brucella granuloma[J]. Surg Neurol, 1999, 52(6):570-576.
[67] Cooper CW. Risk factors in transmission of brucellosis from animals to humans in Saudi Arabia[J]. Trans R Soc Trop Med Hyg, 1992, 86(2):206-209.
[68] Muma JB, Samui KL, Siamudaala VM, et al. Prevalence of antibodies to Brucella spp and individual risk factors of infection in traditional cattle, goats and sheep reared in livestock-wildlife interface areas of Zambia[J]. Trop Anim Health Prod, 2006, 38(3):195-206.
[69] Sofian M, Aghakhani A, Velayati AA, et al. Risk factors for human brucellosis in Iran: a case-control study [J].Int J Infect Dis, 2008, 12(2):157-161.
[70] Husseini AS, Ramlawi AM. Brucellosis in the West Bank, Palestine[J]. SaudiMed, 2004, 25(11):1640-1643.
[71] Karabay O, Serin E, Tamer A, et al. Hepatitis B carriage and Brucella seroprevalence in urbanand rural areas of Bolu province of Turkey: a prospective epidemiologic study[J]. Turk Gastroenterol, 2004, 15(1):11-13.
[72] Almuneef MA, Memish ZA, Balkhy HH, et al. Importance of screening household members of acute brucellosis cases in endemic areas[J]. Epidemiol Infect, 2004, 132(3):533-540.
[73] Cetinkaya F, Nacar M, Aydin T. Prevalence of brucellosis in the rural area of Kayseri, Central Anatolia, Turkey[J]. Int Infect Dis, 2006, 10(2):179-181.
[74] Mantur BG, Mangalgi SS, Mulimani B. Brucella melitensis-a sexually transmissible agent[J]. Lancet, 1996, 34(7): 1763.
[75] Corbell JM.Brucellosis: an overview[J]. Emerg Infect Dis, 1997, 3(2):213-221.
[76] Abo-Shehada MN, Odeh JS, Abu-Essud M,et al. Seroprevalence of brucellosis among high-risk people in northern Jordan[J]. Int Epidemiol, 1996, 25(2): 450-454.
[77] De Massis F, Di Girolamo A, Petrini A, et al. Correlation between animal and human brucellosis in Italy during the period 1997-2002[J]. Clin Microbiol Infect, 2005,11(8):632-636.
[78] Orti A, Roig P, Alcala R, et al. Brucellar prosthetic arthritis in a total knee replacement[J]. Eur Clin Microbiol Infect Dis, 1997, 16(11):843-845.
[79] Vassallo DJ. The saga of brucellosis: controversy over credit for linking Malta fever with goat’s milk[J]. Lancet, 1996, 348(9030): 804-808.
[80] Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, et al. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran[J]. Epidemiol Infect, 2004, 132(6): 1109-1114.
[81] Young EJ. Brucellosis: current epidemiology, diagnosis, and management[J]. Curr Clin Top Infect Dis, 1995, 15:115-128.
[82] Pappas G, Akritidis, Bosilkovski, et al.Brucellosis[J].N Engl Med,2005,35(2): 2325-2336.
[83]徐卫民,金行一,杨洋,等.浙江省布鲁菌病控制达标后疫情回升分析[J].中国预防医学杂志, 2007, 6(8): 223-225.
[84] E Daglioglu, N Bayazit, O Okay, et al. Lumbar epidural abscess caused by brucella species: report of two cases[J]. Neurocirugía, 2009, 20(2):159-162.
[85]尚德秋.布鲁氏菌病发病研究[J].地方病通报,1991,6(2): 22-29.
[86] Glynn MK, Lynn TV. Brucellosis [J]. Am Vet Med Assoc, 2008, 233(6): 900-908.
[87] Stoffregen WC, Olsen SC, Wheeler CJ, et al. Diagnostic characterization of a feral swine herd enzootically infected with Brucella [J]. Vet Diagn Invest 2007, 19(3): 227-237.
[88] Stella Mitka, Constantine Anetakis, Efimia Souliou, et al. Evaluation of different PCR assays for early detection of acute and relapsing brucellosis in humans in comparison with conventional methods[J].Journal of Clinical Microbiology, 2007, 45(4):1211-1218.
[89] Giulietti A, L Overbergh, D Valckx, et al. An overview of real time quantitative PCR: applications to quantify cytokine gene expression[J]. Methods, 2009, 25(4):386-401.
[90] Solera J, E Lozano, E Mart?′nez-Alfaro, et al. Brucellar spondylitis: review of 35 cases and literature survey[J]. Clin Infect Dis, 1996, 29(6): 1440-1449.
[91] Clavareau C, Wellemans V, Walravens K, et al.PhenotyPie and molecular Characterization of a Brucella strain isolated from a minke whale [J]. Microbiology, 1998, 144(12): 3267-3273.
[92] Zygmunt MS, Debbarh HS, Cloeekaert A, et al. Antibody response to Brucella Melitensis outer membrane antigens in naturally infected and Revl vaccinated Sheep [J]. Veterinary microbiology, 1994, 39(1-2): 33-46.
[93]邢济春,梁琦.建立完善黑龙江省农村布病防治体系[J].中国公共卫生管理, 2006, 22(5): 379-380.
[2] YaguPsky P, BaronE J.Laboratory exposures to brucellae and Plieations for Bioterrorism[J].Emerg Infect Dis,2005,11(8): 1180-1118.
[3] Sreevat san S, Bookout J B, Ringpis F, et al. A multiplex approach to molecular detection of Brucella abortus and/or Mycobacterium bovis infection in cattle [J].ClinMicrobiol,2000,38(7): 2602-2610.
[4]白文彬,于康震.动物传染病诊断学[M].北京:中国农业出版社,2002: 621～627.
[5]张卓然,倪语星.临床微生物学及微生物检验[M].北京:人民卫生出版社, 2003:184-186.
[6]田野,徐晶晶.奶牛布鲁氏杆菌病的实验室诊断[J].河南畜牧兽医,2007, 28 (9):627.
[7]邢进,王金锋,赵宝华,等.布鲁菌病及其诊断方法研究进展[M].动物医学进展,2009,30(3):69-73.
[8] Fetete A, Bantle JA, Halling SM, et al. Preliminary development of a diagnosistic test for brucella using polymerase chain reaction[J].Applied Bacteriology, 1990, 69(2): 216-227.
[9]尚德秋.布鲁氏菌病流行病学及分子生物学研究进展[J].中国地方病防治杂志,1996,11(6):339.
[10] Franco MP, Mulder M, Gilman RH, et al. Human brucellosis[J]. Lancet Infect Dis,2007,7(12):775-786.
[11]王大力,张士义.急性期布氏病治疗研究进展[J].中国地方病防治,2001, 16(2):94-95.
[12]刘磊,刘晶芝,赵宝华,等.布氏杆菌病的检测与防治[J].安徽农业科学, 2007,35(20):6139-6141.
[13] Gopaul K K, Koylass M S, Whatmore A M. Rapid identificationof Brucella isolates to the species level by real time PCR based single nucleotide polymorphism (SNP) analysis [J]. BMC Microbiol, 2008, 8: 86.
[14]江森林,崔步云,苏增华,等.全国布鲁氏菌病防治工作调研报告[J].中国地方病防治杂志,2006,21(6):3-5.
[15]尚德秋.布氏菌病研究进展[J].中国地方病防治杂志, 2004,19(4): 204-212.
[16] GB15988-1995,布鲁氏菌病诊断标准及处理原则[S].北京:中华人民共和国卫生部,1995.
[17]王大力,李铁锋,江森林,等.2007年全国布氏菌病监测结果分析[J].中国地方病防治杂志,2008,23(6):443-445.
[18]江森林,王季秋,王大力,等.近年我国布氏菌病疫情及其分析[J].中国地方病防治杂志,2005,20(5):297-300.
[19]郭卫东,池海谊.内蒙古自治区2002～2006年人间布鲁氏菌病流行特征[J].中国热带医学,2008,8(4):604-606.
[20]杨海,李一航,王戬,等.陕西省1406份布鲁杆菌病高危职业人群血清学检测报告分析[J].流行病学与预防保健,2009,25(4):403-405.
[21]杨海,姬淑,李一航,等.布病职业人群感染现况调查[J].中国人兽共患病杂志,2002,18(2):126-127.
[22]王恺,姜秋梅,马玉芝,等.白城市布鲁氏菌病疫情动态分析[J].医学动物防制,2009,25(3):189-190.
[23]杨海,冯福军,蔡正华,等.西安市清真屠宰从业人员布病调查报告[J].疾病监测,2005,20(4): 208-209.
[24] F. Tabak, E. Hakko, B. Mete, et al. Is Family Screening Necessary in Brucellosis? [J].Infection,2008,36(6):575-577.
[25]常殊杰,金福芝,靳玉珠,等.齐齐哈尔市1995～2007年布鲁氏菌病疫情动态分析[J].中国地方病防治杂志,2009,24(1):2872.
[26]马炳杰,单秀红,田秀兰,等.抚宁县人间布氏菌病疫情分析[J].医学动物防制,2006,8(22):559-560.
[27]高玉宝,索凌燕,牛卫东,等.肃南县182例布鲁氏菌病患者临床流行病学特点分析[J].地方病通报, 2002, 17(2): 270-272.
[28]郭茜,殷茂荣,王延东,等.淄博市布氏菌病14年监测结果分析[J].中国卫生检验杂志, 2009, 19(10): 2361-2363.
[29] Tsolia M, Drakonaki S, Messaritaki A, et al. Clinical features, complications and treatment outcome of childhood brucellosis in central Greece[J]. Infect, 2002, 44:257-262.
[30] Miranda RT, Gimeno AE, Rodriguez TF, et al. Acute cholecystitis caused by Brucella melitensis: case report and review [J]. Infect, 2001, 42(1): 77-78.
[31] Almuneef MA, Memish ZA, Balkhy HH, et al. Importance of screening household members of acute brucellosis cases in endemic areas[J]. Epidemiol Infect, 2004, 132(3):533-540.
[32]金城日,曲彬,孙景芳,等. 2002～2004年吉林市布鲁杆菌病疫情调查分析[J].中国地方病学杂志, 2006, 25(2): 218.
[33]张兴国.河北省丰宁县2008年布鲁氏菌病流行情况分析[J].中国地方病防治杂志, 2009, 24(5): 373.
[34]崔步云.中国布鲁氏菌病疫情监测与控制[J].疾病监测,2007,22(10): 649.
[35] Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, et al. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol Northern Iran[J]. Epidemiol Infect, 2004, 132(6): 1109-1114.
[36] Bouza E, Sanchez-Carrillo C, Hernangomez S, et al. Laboratory-acquired brucellosis: a Spanish national survey[J]. Hosp Infect, 2005, 61(1): 80-83.
[37] Noviello S, Gallo R, Kelly M, et al. Laboratoryacquired brucellosis[J].Emerg Infect Dis, 2004, 10(10): 1848-1850.
[38]卿燕,高如常,木合塔尔,等. 1999年新疆布尔津县人间布鲁氏菌病监测报告[J].地方病通报, 2001,16(4): 54-55.
[39]许小利,王军,吴保红,等. 2000～2005年河南省焦作市人间布鲁氏菌病监测分析[J].地方病通报, 21(5): 77-78.
[40]柳晓琳,周艳彬,刘孝刚,等.辽西地区职业人群布鲁菌病认知状况调查[J].中国公共卫生, 2009, 25(12): 1475-1476.
[41]陈秀英.菏泽市布鲁杆菌病干预效果评价[J].现代预防学,2008, 35(16): 3168-3170.
[42] Al-Shamahy HA, Wright SG. A study of 235 cases of humanbrucellosis in Sana’a, Republic of Yemen[J]. East Mediterr Health, 2001, 7(1-2): 238-246.
[43] Kozukeev TB, Ajeilat S, Maes E, et al. Risk factors for brucellosis-Leylek and Kadamjay districts, Batken Oblast, Kyrgyzstan, January-November, 2003[J]. Morb Mortal Wkly Rep, 2006, 55(1): 31-34.
[44] Ahmad M, Al-Majali, Mahmoud Shorman. Childhood brucellosis in Jordan:prevalence and analysis of risk factors [J]. International Journal of Infectious Diseases, 2009, 13(2):196-200.
[45] Sinuff T, Patel RV, Adhikari NK, et al. Quality of professional society guidelines and consensusconference statements in critical care[J]. Critical Care Medicine, 2008, 36(4): 1360-1361.
[46] Jorge PP, Schwartz DN, Schiff GD, et al. Effects of type and level of training on variation in physician knowledge in the use and acquisition of blood cultures: a cross sectional survey[J]. BMC Infect Dis, 2005, 5:71.
[47] Ali Gur, Mehmet Geyik, Bunyamin Dikici, et al. Complications of Brucellosis in different age groups: A study of 283 cases in southeastern Anatolia of Turkey[J]. Yonsei Medical Journal, 2003, 44(1): 33-44.
[48] Kenneth Earhart, Sadulla Vafakolov, Nargiza Yarmohamedova, et al. Risk factors for brucellosis in Samarqand Oblast,Uzbekistan[J]. International Journal of Infectious Diseases, 2009, 13(6): 749-753.
[49]刘永为,江秀文,李秀忠,等.涉县1995至2008年布鲁氏菌病流行状况分析报告[J].河北医药, 2009, 31(15): 1995-1996.
[50]姜云丽,崔步云,刘权恕,等.辽宁省盖州市布鲁氏菌病流行病学调查[J].疾病监测, 2009, 24(20): 755-756.
[51]马炳杰,单秀红,田秀兰,等.抚宁县人间布氏菌病疫情分析[J].医学动物防制, 2006, 22(8): 559-560.
[52]徐延霞.乌兰察布市2000～2008年布氏杆菌病流行特征分析[J].疾病监测与控制, 2009, 3(12): 722-723.
[53] Husseini AS, Ramlawi AM. Brucellosis in the West Bank, Palestine [J]. Saudi Med J, 2004, 25(11):1640-1643.
[54]乔孝.松原市年2007年人间布氏菌病调查分析[J].中国地方病防治杂志, 2008, 23(2): 145.
[55] Young EJ, Tarry A, Genta RM, et al. Thrombocytopenic purpura associated with brucellosis: report of 2 cases and literature review[J]. Clin Infect Dis, 2000, 31(4): 904-909.
[56] Vajramani GV, Nagmoti MB, Patil CS. Neurobrucellosispresenting as an intra-medullary spinal cord abscess[J]. Ann Clin Microbiol Antimicrob, 2005, 4: 14-18.
[57] Coskun E, Suzer T, Yalcin N, et al. Spinal extradural compression caused by granuloma of brucellosis[J]. ScandJ Infect Dis, 1998, 30(3):311-313.
[58] Yetkin MA,Erdinc FS,Bulut C,et al.Epididymoorchitis due to brucellosis in central Anatolia,Turkey[J].Urol Int, 2005,75(3): 235-238.
[59] Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, et al. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran [J]. Epidemiol Infect, 2004, 132(6): 1109-1114.
[60] Akinci E, Bodur H, Cevik MA, et al. A complication of brucellosis: epididymoorchitis[J]. Int Infect Dis, 2006, 10(2): 171-177.
[61] Sari R, Buyukberber N, Sevinc A, et al. Buyukberber S: Brucellosis in the etiology of febrile neutropenia: case report [J]. Chemother, 2002, 14(1): 88-91.
[62] Memish ZA, Venkatesh S. Brucellar epididymo-orchitis in Saudi Arabia: a retrospective study of 26 cases and review of the literature[J]. BJU Int, 2001, 88(1): 72-76.
[63] Yagupsky P. Detection of brucellae in blood cultures[J]. ClinMicrobiol, 1999, 37(11): 3437-3442.
[64] Colmenero JD, Reguera JM, Ferna′ndez-Nebro A, et al. Osteoarticular complications of brucellosis[J]. Ann Rheum Dis, 1991,50(1):23-26.
[65] Duyur B, Erdem HR, Ozgocmen S. Paravertebral abscess formation and knee arthritis due to brucellosis in a patient with rheumatoid arthritis[J]. Spinal Cord, 2001, 39(10):554–556.
[66] Bingol A, Yucemen N, Meco O. et al. Medically treated intraspinal Brucella granuloma[J]. Surg Neurol, 1999, 52(6):570-576.
[67] Cooper CW. Risk factors in transmission of brucellosis from animals to humans in Saudi Arabia[J]. Trans R Soc Trop Med Hyg, 1992, 86(2):206-209.
[68] Muma JB, Samui KL, Siamudaala VM, et al. Prevalence of antibodies to Brucella spp and individual risk factors of infection in traditional cattle, goats and sheep reared in livestock-wildlife interface areas of Zambia[J]. Trop Anim Health Prod, 2006, 38(3):195-206.
[69] Sofian M, Aghakhani A, Velayati AA, et al. Risk factors for human brucellosis in Iran: a case-control study [J].Int J Infect Dis, 2008, 12(2):157-161.
[70] Husseini AS, Ramlawi AM. Brucellosis in the West Bank, Palestine[J]. SaudiMed, 2004, 25(11):1640-1643.
[71] Karabay O, Serin E, Tamer A, et al. Hepatitis B carriage and Brucella seroprevalence in urbanand rural areas of Bolu province of Turkey: a prospective epidemiologic study[J]. Turk Gastroenterol, 2004, 15(1):11-13.
[72] Almuneef MA, Memish ZA, Balkhy HH, et al. Importance of screening household members of acute brucellosis cases in endemic areas[J]. Epidemiol Infect, 2004, 132(3):533-540.
[73] Cetinkaya F, Nacar M, Aydin T. Prevalence of brucellosis in the rural area of Kayseri, Central Anatolia, Turkey[J]. Int Infect Dis, 2006, 10(2):179-181.
[74] Mantur BG, Mangalgi SS, Mulimani B. Brucella melitensis-a sexually transmissible agent[J]. Lancet, 1996, 34(7): 1763.
[75] Corbell JM.Brucellosis: an overview[J]. Emerg Infect Dis, 1997, 3(2):213-221.
[76] Abo-Shehada MN, Odeh JS, Abu-Essud M,et al. Seroprevalence of brucellosis among high-risk people in northern Jordan[J]. Int Epidemiol, 1996, 25(2): 450-454.
[77] De Massis F, Di Girolamo A, Petrini A, et al. Correlation between animal and human brucellosis in Italy during the period 1997-2002[J]. Clin Microbiol Infect, 2005,11(8):632-636.
[78] Orti A, Roig P, Alcala R, et al. Brucellar prosthetic arthritis in a total knee replacement[J]. Eur Clin Microbiol Infect Dis, 1997, 16(11):843-845.
[79] Vassallo DJ. The saga of brucellosis: controversy over credit for linking Malta fever with goat’s milk[J]. Lancet, 1996, 348(9030): 804-808.
[80] Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, et al. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran[J]. Epidemiol Infect, 2004, 132(6): 1109-1114.
[81] Young EJ. Brucellosis: current epidemiology, diagnosis, and management[J]. Curr Clin Top Infect Dis, 1995, 15:115-128.
[82] Pappas G, Akritidis, Bosilkovski, et al.Brucellosis[J].N Engl Med,2005,35(2): 2325-2336.
[83]徐卫民,金行一,杨洋,等.浙江省布鲁菌病控制达标后疫情回升分析[J].中国预防医学杂志, 2007, 6(8): 223-225.
[84] E Daglioglu, N Bayazit, O Okay, et al. Lumbar epidural abscess caused by brucella species: report of two cases[J]. Neurocirugía, 2009, 20(2):159-162.
[85]尚德秋.布鲁氏菌病发病研究[J].地方病通报,1991,6(2): 22-29.
[86] Glynn MK, Lynn TV. Brucellosis [J]. Am Vet Med Assoc, 2008, 233(6): 900-908.
[87] Stoffregen WC, Olsen SC, Wheeler CJ, et al. Diagnostic characterization of a feral swine herd enzootically infected with Brucella [J]. Vet Diagn Invest 2007, 19(3): 227-237.
[88] Stella Mitka, Constantine Anetakis, Efimia Souliou, et al. Evaluation of different PCR assays for early detection of acute and relapsing brucellosis in humans in comparison with conventional methods[J].Journal of Clinical Microbiology, 2007, 45(4):1211-1218.
[89] Giulietti A, L Overbergh, D Valckx, et al. An overview of real time quantitative PCR: applications to quantify cytokine gene expression[J]. Methods, 2009, 25(4):386-401.
[90] Solera J, E Lozano, E Mart?′nez-Alfaro, et al. Brucellar spondylitis: review of 35 cases and literature survey[J]. Clin Infect Dis, 1996, 29(6): 1440-1449.
[91] Clavareau C, Wellemans V, Walravens K, et al.PhenotyPie and molecular Characterization of a Brucella strain isolated from a minke whale [J]. Microbiology, 1998, 144(12): 3267-3273.
[92] Zygmunt MS, Debbarh HS, Cloeekaert A, et al. Antibody response to Brucella Melitensis outer membrane antigens in naturally infected and Revl vaccinated Sheep [J]. Veterinary microbiology, 1994, 39(1-2): 33-46.
[93]邢济春,梁琦.建立完善黑龙江省农村布病防治体系[J].中国公共卫生管理, 2006, 22(5): 379-380.