肾移植术后布鲁菌病1例报道并文献复习
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南京医科大学第一附属医院泌尿外科

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国家自然科学基金项目(面上项目,重点项目,重大项目)国家自然科学基金面上项目(82270790,82070769,81770751,82170769,81870512);国家自然科学基金青年基金项目(81900684);江苏省自然科学基金青年基金项目(BK20191063);


Brucellosis after renal transplantation:one case report and literature review
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the National Natural Science Foundation Program,82270790,82070769,81770751,82170769,81870512;the National Natural Science Foundation Program,81900684;Jiangsu Province Natural Science Foundation Program,BK20191063;

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    摘要:

    目的:分析总结肾移植术后布鲁菌病的临床特点和诊疗经验。方法:收集南京医科大学第一附属医院2022年5月收治的1例肾移植术后布鲁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6年余,反复发热1月余,以下午低热为主,有明确羊群接触史,经血培养确诊为羊布鲁氏杆菌感染,给予利福平+多西环素+莫西沙星抗感染治疗,保护肝肾功能等治疗,复查血培养转阴。随访至今,移植肾功能稳定,未再出现发热等感染症状。结论:肾移植术后布鲁菌病少见,常见症状为发热。积极询问流行病学接触史,及早进行血培养等相关检测有助于诊断,治疗方案为利福平、多西环素等药物联合。治疗药物与免疫抑制剂有相互作用,应注意监测免疫抑制剂浓度及肝肾功能。

    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 the First Affiliated Hospital of NJMU in may 2022 was collected. The clinical features, diagnosis and treatment were retrospectively analyzed. Clinical experience was summarized and literature review was conducted. Results: At 6 years after renal transplantation, the patient suffered from temperature rise and presented with fever in the afternoon. Blood culture test confifirmed 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 effificacy was achieved. During the follow up after discharge, the renal graft was stable and no other infectious symptoms, such as fever was found. Conclusions: Brucellosis after renal transplantation is extremely rare and the common symptom is Malta fever. When the empirical anti-infectious treatment is not effective, Actively inquire about epidemiological exposure history,blood culture and other related tests should be performed to confifirm the diagnosis. The combination of rifampicin and doxycycline is recommended.Therapeutic drugs have interaction with immunosuppressive drugs and have hepatic and renal toxicity, attention should be paid to monitor the concentration of immunosuppressive drugs and liver and kidney function.

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  • 收稿日期:2022-11-24
  • 最后修改日期:2022-12-28
  • 录用日期:2023-03-08
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