肾移植术后布鲁氏菌病1例报道并文献复习

马锡慧; 肖漓; 钱叶勇; 李超; 石炳毅

doi:10.3969/j.issn.1674-7445.2018.03.012

肾移植术后布鲁氏菌病1例报道并文献复习

doi: 10.3969/j.issn.1674-7445.2018.03.012

100091 北京，解放军第 309 医院全军器官移植研究所移植研究室北京市器官移植与免疫调节重点实验室（马锡慧、肖漓、石炳毅），移植外科（钱叶勇、李超）

基金项目:

国家自然科学基金 81571555

解放军第309医院面上课题 2016MS-002

详细信息

作者简介:
马锡慧，女，1985年生，硕士，主管技师，研究方向为移植免疫学，Email：maxihui@sina.com

通讯作者:
石炳毅，男，1953年生，博士，主任医师，研究方向为器官移植，Email: shibingyi@medmail.com.cn

中图分类号: R617, R633
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- 被引次数: 0
出版历程
- 收稿日期: 2018-01-21
- 网络出版日期: 2021-01-19
- 刊出日期: 2018-05-15

Brucellosis after renal transplantation: a report of one case and literature review

Basic Research Laboratory of Organ Transplant Institute, the 309^th Hospital of Chinese People's Liberation Army, Beijing Key Laboratory of Immunology Regulatory and Organ Transplantation, Beijing 100091, China

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Corresponding author: Shi Bingyi, Email: shibingyi@medmail.com.cn

摘要

摘要: 目的分析并总结肾移植术后布鲁氏菌病的临床特点和诊疗经验。方法收集解放军第309医院2016年10月收治的1例肾移植术后布鲁氏菌病患者的临床资料，分析其临床特点和诊疗经过，并结合文献复习总结临床经验。结果患者肾移植术后3个月出现无明显诱因体温升高，以上午发热为主，持续时间3 d，感染途径不明、其他感染症状不明显，经验性抗感染治疗1周效果不佳。经血培养确诊为羊布鲁氏菌感染。及时给予利福平、多西环素、复方磺胺甲抗感染，积极防治并发症，保护肝、肾功能等治疗，疗效良好。随访至该患者出院后1年，移植肾功能稳定，再未出现发热等感染症状。结论肾移植术后感染途径不明的布鲁氏菌病极为罕见，常见症状为波浪热。当经验性抗感染治疗效果不佳时，应及早多次进行血培养等相关检测尽快确诊，治疗方案为利福平与多西环素联合使用。
- 终末期肾病 /
- 肾移植 /
- 机会性感染 /
- 布鲁氏菌病 /
- 人畜共患病 /
- 传染源 /
- 抗生素 /
- 免疫抑制剂
Abstract: Objective To analyze and summarize the clinical features and diagnosis and treatment experience of brucellosis after renal transplantation. Methods Clinical data of one case with brucellosis after renal transplantation admitted to the 309th Hospital of Chinese People's Liberation Army in October 2016 was collected. The clinical features, diagnosis and treatment were retrospectively analyzed. Clinical experience was summarized and literature review was conducted. Results At 3 months after renal transplantation, the patient suffered from temperature rise without known causes and presented with fever in the morning with a duration of 3 d. The route of infection was unknown, and the symptoms of alternative types of infection were not obvious. Empirical anti-infectious therapy was delivered for 1 week and yielded no efficacy. Blood culture test confirmed the diagnosis of brucella melitensis infection. The treatment included anti-infecting by the rifampicin, doxycycline, sulfamethoxazole, preventing the incidence of complications actively and protecting the liver and renal function. High clinical efficacy was achieved. During the 1-year follow up after discharge, the renal graft was stable and no other infectious symptoms, such as fever was found. Conclusions Brucellosis with unknown route of infection after renal transplantation is extremely rare and the common symptom is Malta fever. When the empirical anti-infectious treatment is not effective, blood culture and other related tests should be performed to confirm the diagnosis. The combination of rifampicin and doxycycline is recommended.
- End-stage renal disease /
- Renal transplantation /
- Opportunistic infection /
- Brucellosis /
- Zoonosis /
- Source of infection /
- Antibiotics /
- Immunosuppressive agent

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参考文献(17)

[1]	FERNÁNDEZ-RUIZ M, LÓPEZ-MEDRANO F, ALLENDE LM, et al. Immune risk phenotype in kidney transplant recipients: a reliable surrogate for premature immune senescence and increased susceptibility to infection?[J]. Transpl Infect Dis, 2016, 18(6): 968-970. DOI: 10.1111/tid.12600.
[2]	AUGUSTO JF, GARNIER AS, DEMISELLE J, et al. Hypogammaglobulinemia and risk of severe infection in kidney transplant recipients[J]. Transpl Infect Dis, 2016, 18(5): 741-751. DOI: 10.1111/tid.12593.
[3]	KIR O, ZEYTINOĞLU A, ARDA B, et al. Impact of prophylaxis vs pre-emptive approach for cytomegalovirus infection in kidney transplant recipients[ J]. Transplant Proc, 2017, 49(3): 537-540. DOI: 10.1016/j.transproceed.2017.01.027.
[4]	SIMARD-MEILLEUR MC, BODSON-CLERMONT P, ST-LOUIS G, et al. Stabilization of renal function after the first year of follow-up in kidney transplant recipients treated for significant BK polyomavirus infection or BK polyomavirus-associated nephropathy[J]. Transpl Infect Dis, 2017, 19(3). DOI: 10.1111/tid.12681.
[5]	ARENAS-GAMBOA AM, ROSSETTI CA, CHAKI SP, et al. Human brucellosis and adverse pregnancy outcomes[J]. Curr Trop Med Rep, 2016, 3(4): 164-172. DOI: 10.1007/s40475-016-0092-0.
[6]	MAHAJAN V, BANGA HS, FILIA G, et al. Comparison of diagnostic tests for the detection of bovine brucellosis in the natural cases of abortion[J]. Iran J Vet Res, 2017, 18(3): 183-189. doi: 10.1186/1756-0500-4-525
[7]	CHO JH, YOON YD, JANG HM, et al. Immunologic monitoring of T-lymphocyte subsets and HLA-Drpositive monocytes in kidney transplant recipients: a prospective, observational cohort study[J]. Medicine (Baltimore), 2015, 94(44): e1902. DOI: 10.1097/MD.0000000000001902.
[8]	BUNDLE DR, MCGIVEN J. Brucellosis: improved diagnostics and vaccine insights from synthetic glycans[J]. Acc Chem Res, 2017, 50(12): 2958-2967. DOI: 10.1021/acs.accounts.7b00445.
[9]	GOLSHANI M, BUOZARI S. A review of brucellosis in Iran: epidemiology, risk factors, diagnosis, control, and prevention[J]. Iran Biomed J, 2017, 21(6): 349-359. https://ibj.pasteur.ac.ir/article-1-2141-en.pdf
[10]	刘培, 张凤娟, 牛庆慧, 等.布鲁菌病合并多种泌尿系统表现一例[J].中华传染病杂志, 2017, 35(5): 310. DOI: 10.3760/cma.j.issn.1000-6680.2017.05.015. LIU P, ZHANG FJ, NIU QH, et al. A case of brucellosis combined with multiple urinary systems[J]. Chin J Infect Dis, 2017, 35(5): 310. DOI: 10.3760/cma.j.issn.1000-6680. 2017.05.015.
[11]	曾令佳, 杨雯雯, 帖萍, 等.山西省医疗机构2015年布鲁氏菌病诊断与报告质量调查[J].中华流行病学杂志, 2017, 38(11): 1480-1483. DOI: 10.3760/cma.j.issn.0254-6450.2017.11.008. ZENG LJ, YANG WW, TIE P, et al. Investigation of human brucellosis diagnosis and report quality in medical institutions in key areas of Shanxi Province[J]. Chin J Endemiol, 2017, 38(11): 1480-1483. DOI: 10.3760/cma.j.issn.0254-6450.2017.11.008.j.issn.0254-6450.2017.11.008.
[12]	OLIVARES R, VIDAL P, SOTOMAYOR C, et al. Brucellosis in Chile: description of a series of 13 cases[J]. Rev Chilena Infectol, 2017, 34(3): 243-247. DOI: 10.4067/S0716-10182017000300006.
[13]	CORTINA ME, NOVAK A, MELLI LJ, et al. Development of improved enzyme-based and lateral flow immunoassays for rapid and accurate serodiagnosis of canine brucellosis[J]. Vet Microbiol, 2017, 208: 174-180. DOI: 10.1016/j.vetmic.2017.08.005.
[14]	AFRASIABIAN S, MOHSENPOUR B, GHADERI E, et al. Does helicobacter pylori infection play a role in susceptibility to brucellosis?[J]. Jpn J Infect Dis, 2017, 70(6): 672-674. DOI: 10.7883/yoken.JJID.2017.043.
[15]	江胜利, 白玉兰, 陈佰义.辽宁省82例布鲁菌病患者临床特点[J].中华传染病杂志, 2017, 35(3): 134-137. DOI: 10.3760/cma.j.issn.1000-6680.2017.03.002. JIANG SL, BAI YL, CHEN BY. Clinical features of 82 patients with brucellosis in Liaoning Province[J]. Chin J Infect Dis, 2017, 35(3): 134-137. DOI: 10.3760/cma.j.issn.1000-6680.2017.03.002.j.issn.1000-6680.2017.03.002.
[16]	王振璞, 蒋欣, 苗书斋, 等.甲泼尼龙与醋酸泼尼松治疗肾移植术后肺部感染[J].实用医学杂志, 2017, 33(1): 22-26. DOI: 10.3969/j.issn.1006-5725.2017.01.006. WANG ZP, JIANG X, MIAO SZ, et al. Prospective study of methylprednisolone and prednisone therapy for patients with pulmonary infection after renal transplantation[J]. J Pract Med, 2017, 33(1): 22-26. DOI: 10.3969/j.issn.1006-5725.2017.01.006.
[17]	杨波, 丁翔, 谢晋良, 等.停用免疫抑制药对肾移植肺部感染患者人肾长期存活的影响[J].中南大学学报(医学版), 2015, 40(4): 380-386. DOI: 10.11817/j.issn.1672-7347.2015.04.007. YANG B, DING X, XIE JL, et al. Transient stopping immunosuppressive agents during the post-transplant pulmonary infection does not affect the long-term outcome of renal transplantation[J]. J Cent South Univ (Med Sci), 2015, 40(4): 380-386. DOI: 10.11817/j.issn.1672-7347.2015.04.007.