The Follow-up Visit And Analysis Of The Clinical Cases Of Brucellosis In Jilin Province

ObjectiveTo understand the current situation of the demographic characteristics, thehistory of epidemics, clinical manifestation and therapeutic process and etc. Explorethe influencing factors in the effect of brucellosis treatment. Provide the basis forimproving the preventive measures and therapeutic regimen.MethodsIn the brucellosis outpatient of the first prevention and control institution ofendemics in Jilin province, we choose the cases confirmed in Jilin province in2013asthe research object. The detection methods used in the laboratory are the plateagglutination test and the tube agglutination test. The therapeutic regimens are“ceftriaxone sodium+azithromycin” and “rifampin+doxycycline”. Using thequestionnaire survey of our own design, inquire and collect material of basicinformation and clinical symptoms and etc in the first diagnosis,90days after twotreatment courses and diagnosis, follow up three times by means of phone call.Curative effect is judged as cure, basic cure, becoming better and no effect. Enter databy the software of Epidata3.0, describe and analyze the data by the statistical softwareof SPSS17.0.Results1.General Demographic CharacteristicsTotally follow up113persons, who distribute in29counties (districts) of9cities(states) in Jilin province,90males,23females, aged between41.84±12.32years old,the married occupy92.04%, the Han nationality occupy93.81%, mostly (57.52%)primary grades and below, mainly peasants (81.42%), and the annual family income ismostly under50thousands (56.64%). 2.The clinic stages and types of patients visitingThe time between the first attack and the first seeing a doctor is14days (6,30.5),the time between the attack and the confirmed diagnosis is28days (11,60), the timebetween the first seeing a doctor and the confirmed diagnosis is1day (1,9.5). Theacute stage in the informants occupies88.05%, and the sub-acute stage11.50%; In theclinic types, the visceral type occupies21.24%and the bone and joint type63.72%.3.Clinical Manifestation and Score Results of Physical Work CapacityIn the first diagnosis,28.32%of the informants manifest shiver,83.19%fever,56.64%sweating much,27.43%muscles ache,73.45%weak,15.93%swirl,35.40%head ache,76.99%bone and joint ache. The score result of physical work capacity isthat1point occupies61.95%,2points occupies31.86%,3points occupies2.65%and4points occupies3.54%.In the follow-up of the first course of treatment,5.31%of the patients fever,12.39%sweat much,8.85%muscle ache,40.71%weak,3.54%swirl,5.31%headache,52.21%bone and joint ache. The score result of physical work capacity is that0point occupies15.93%,1point occupies73.45%,2points occupies8.85%and3points occupies1.77%.In the follow-up of the second course of treatment,0.00%of the patients shiver,0.00%fever,2.65%sweat much,1.77%muscle ache,22.12%weak,1.77%swirl,0.88%head ache,17.07%bone and joint ache. The score result of physical workcapacity is that0point occupies44.25%,1point occupies52.21%,2points occupies2.65%and3points occupies0.88%.In the follow-up after90days of the confirmed diagnosis,5.31%of the patientsare fever,2.65%sweat much,1.77%muscle ache,8.85%weak,1.77%swirl,1.77%head ache,7.08%bone and joint ache. The score result of physical work capacity isthat0point occupies78.76%,1point occupies18.58%,2points occupies1.77%and3points occupies0.88%.Take the score of the physical work capacity of90days after the first diagnosisand the confirmed diagnosis to make rank sum test, the difference of the result hasstatistic significance (P<0.001), as you see, after the treatment, the work capacity ofthe patient has recovered some.4.The Epidemiological ResultWhen first diagnosis,38.05%of the patients often clean the colony house,7.96% often slaughter,36.28%often deliver a lamb,18.58%often vaccinate the livestock,0.88%often treat the livestock as a veterinarian,24.78%often purchase pelage,2.65%often process dairy products,2.65%often process meat products,13.27%oftentransport the livestock,14.16%often feed the young lambs in the interior.In the first course of treatment,11.50%of the patients often clean the colonyhouse,2.65%often slaughter,10.62%often deliver a lamb,2.65%often vaccinate thelivestock,0.00%often treat the livestock as a veterinarian,6.19%often purchasepelage,0.88%often process dairy products,0.88%often process meat products,4.42%often transport the livestock,2.65%often feed the young lambs in the interior.In the second course of treatment,8.85%of the patients often clean the colonyhouse,2.65%often slaughter,8.85%often deliver a lamb,0.88%often vaccinate thelivestock,0.00%often treat the livestock as a veterinarian,4.42%often purchasepelage,0.88%often process dairy products,5.31%often process meat products,0.88%often transport the livestock,1.77%often feed the young lambs in the interior.5.Observation of Curative EffectThe overall treatment effect is as follow:76.99%of the patients are cure,9.73%basic cure,12.39%become better,0.88%no effect.20.35%of the patients appearharmful response.26patients receive the treatment of the first therapeutic regimen(doxycycline+rifampin),76.92%of the patients are cure,11.54%basic cure,11.54%become better,0.00%no effect,38.46%appear harmful response.87patients receivethe treatment of the second therapeutic regimen (ceftriaxone sodium+azithromycin+traditional Chinese medicine),77.01%of the patients are cure,9.20%basic cure,12.64%become better,1.15%no effect, and14.94%appear harmful response.6. Analysis of the Factors Affecting Curative EffectTo make single factor analysis to the20possible factors of4aspects which mayaffect the curative effect like basic situation and clinical manifestation by t test and χ2test, the result is that the30-49years of the patient is the protect factor, the fourthgrade of physical work capacity of the first diagnosis, and engaging in high-riskactivities during the treatment are the risk fators.ConclusionsFollow-up has its own advantage in the supervising of the brucellosis patient’streatment and the area of health education. The cure rate of the therapeutic regimen of ceftriaxone sodium+azithromycin is77.01%,its side effect rate is14.94%.The30-49years of the patients is the protectfactor, the fourth grade of physical work capacity of the first diagnosis, and engagingin high-risk activities during the treatment are the risk fators.