RESUMEN
Objective To analyze the prevalence of brucellosis with the initial symptom of fever in non-pasture area and to investigate the method of early diagnosis.Method Clinical features including symptoms,blood routine tests,blood cultures,rose-bengal plate agglutination tests,treatment and follow-up were analyzed in 18 patients with brucellosis admitted to the Department of Infectious Diseases,Tianjin First Centre Hospital from January 2010 to June 2013.Results Middle-aged men with history of smoking and drinking accounted for the majority of patients with initial symptom of fever.Twelve were not complicated with any underlying diseases.Twelve had no contact history.Four had history of farm animal contact,one had history of consuming raw meat products,and one had history of dog raising.All of them had fever,15 of which had hyperpyrexia and 13 had irregular fever.White cells in blood routine test were normal in 12 cases,decreased in 6 cases.And the proportion of rhabditiform nucleus neutrophil increased.Six showed neutrophil left shift.Blood platelet decreased in 3 cases.Thirteen cases showed increased alanine aminotransferase and aspartate aminotransferase.C-reactive protein was elevated in 14 cases.Twelve cases had positive culture of Brucella melitensis in blood or bone marrow culture.Eighteen cases had positive results of rose-bengal plate agglutination test.The proportions of neutrophil and lymphocyte were normal.The treatment included moxifloxacin,levofloxacin,isepamicin,etimicin,amikacin,rifampicin,minocycline.The regimens were usually two or three drugs in combination.The duration of follow-up ranged from 4 to 11 months with good prognosis.Conclusions Patients from nonpasture area with initial symptom of fever could be brucellosis.Clinician should be alert to the disease and inquiry contact history in detail.Brucella serology test should be performed.Early diagnose and prompt treatment could avoid serious complications.