Objective To investigate the causes of misdiagnosis of brucellosis spondylitis(BS)as spinal tuberculo-sis,so as to improve the early diagnosis rate of BS in general hospitals in non-pastoral areas.Methods The clinical data of 7 patients with BS misdiagnosed with spinal tuberculosis in early stage admitted to hospital from June 2019 to June 2021 were retrospectively analyzed.Results All the 7 patients had recent travel history and contact history of cattle and sheep in pasto-ral areas,including 1 patient with a history of pulmonary tuberculosis.Lesion sites included lumbar spine(5 cases)and tho-racic spine(2 cases).All patients had self-administered antipyretic and analgesic drugs before treatment.All of the 7 patients had persistent chest,waist and back pain with limited movement,intermittent fever and weakness,and there was systemic joint wandering pain in 6 patients,loss of appetite in 5 patients,local spinal tenderness and tapping pain in 3 patients,hepa-tosplenomegaly in 3 patients,cervical lymph node enlargement in 2 patients,and testicular pain in 1 patient.All the 7 cases were diagnosed as spinal tuberculosis.Detailed follow-up of medical history revealed that all patients had a recent history of travel or business trips in pastoral areas,and three tests for tuberculosis were negative to rule out tuberculosis.Brucella sero-logical test,tiger red plate agglutination test and serum agglutination test were positive,and BS was confirmed.The duration of misdiagnosis was 10-12 days.After diagnosis,the symptoms of patients treated with Rifampicin combined with Doxycycline and(or)Ceftriaxone disappeared,and the prognosis was favorable after six months of follow-up.Conclusion The diagnosis rate of BS in general hospitals in non-pastoral areas is very low,the vigilance of attending physicians is low,the history of tu-berculosis is not detailed,and the use of antipyretic and analgesic drugs interferes with the diagnosis,which makes it more likely to be misdiagnosed as spinal tuberculosis.The attending doctors of general hospitals in non-pastoral areas should strengthen their understanding of rare diseases in those areas,raise their vigilance,inquire about the relevant medical history in detail,perform the relevant medical examination as soon as possible,comprehensively analyze the condition,and carefully differentiate the diagnosis,so as to reduce the misdiagnosis rate of the disease in early stage.
关键词
脊柱炎/布鲁菌病/误诊/脊柱结核/流行病史/发热/腰痛/鉴别诊断
Key words
Spondylitis/Brucellosis/Misdiagnosis/Tuberculosis of the spine/Epidemiological history/Heat/Lower back pain/Differential diagnosis
维普
万方数据