布鲁氏菌病是全球最常见的人畜共患病之一。[5]Pappas G, Papadimitriou P, Akritidis N, et al. The new global map of human brucellosis. Lancet Infect Dis. 2006;6:91-99.http://www.ncbi.nlm.nih.gov/pubmed/16439329?tool=bestpractice.com不同的布鲁氏菌种属会影响不同的动物宿主,特定种属在特定的地区更常见。
[Figure caption and citation for the preceding image starts]: 布鲁氏菌:地理分布和宿主由 Nicholas J. Beeching 博士、Sherine Thomas 博士和 Alessandro Gerada 博士编制 [Citation ends].
由于不同国家之间的监测系统不同,也不充分,所以人布氏菌病的全球年发病率不详,但认为某些人群超过 10 例/10 万人。[5]Pappas G, Papadimitriou P, Akritidis N, et al. The new global map of human brucellosis. Lancet Infect Dis. 2006;6:91-99.http://www.ncbi.nlm.nih.gov/pubmed/16439329?tool=bestpractice.com全球主要流行区域包括地中海、阿拉伯湾、中亚以及中南美洲部分地区。[2]Pappas G, Akritidis N, Bosilkovski M, et al. Brucellosis. N Engl J Med. 2005;352:2325-2336.http://www.ncbi.nlm.nih.gov/pubmed/15930423?tool=bestpractice.com[6]Young EJ. An overview of human brucellosis. Clin Infect Dis. 1995;21:283-289.http://www.ncbi.nlm.nih.gov/pubmed/8562733?tool=bestpractice.com[7]Pappas G. The changing Brucella ecology: novel reservoirs, new threats. Int J Antimicrob Agents. 2010;36(suppl 1):S8-S11.http://www.ijaaonline.com/article/PIIS0924857910002542/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/20696557?tool=bestpractice.com有证据表明,在印度,该感染常见,但有漏报。[8]Mantur BG, Amarnath SK, Shinde RS. Review of clinical and laboratory features of human brucellosis. Indian J Med Microbiol. 2007;25:188-202.http://www.ncbi.nlm.nih.gov/pubmed/17901634?tool=bestpractice.com[9]Gwida M, Al Dahouk S, Melzer F, et al. Brucellosis - regionally emerging zoonotic disease? Croat Med J. 2010;51:289-295.http://www.cmj.hr/2010/51/4/20718081.htmhttp://www.ncbi.nlm.nih.gov/pubmed/20718081?tool=bestpractice.com并且,在世界其他地区也有新发病例,例如波利尼西亚和泰国。[10]Guerrier G, Daronat JM, Morisse L, et al. Epidemiological and clinical aspects of human Brucella suis infection in Polynesia. Epidemiol Infect. 2011;139:1621-1625.http://www.ncbi.nlm.nih.gov/pubmed/21733252?tool=bestpractice.com[11]Ekpanyaskul C, Santiwattanakul S, Tantisiriwat W, et al. Factors associated with seropositive antibodies to Brucella melitensis in the Nakhon Nayok, Thailand. J Med Assoc Thai. 2012;95(suppl 12):S40-S46.http://www.ncbi.nlm.nih.gov/pubmed/23513464?tool=bestpractice.com[12]Lewis J, Taegtmeyer M, Murray S, et al. Brucellosis, human, melitensis – UK ex Thailand (Nakom Pathom). ProMED-mail. May 2015. http://promedmail.org/ (last accessed 26 August 2016).http://promedmail.org/post/20150521.3377052在资源贫乏区域,本病更常见于农村贫困人口,他们从事畜牧业,可用医疗资源较少。[13]Godfroid J, Cloeckaert A, Liautard JP, et al. From the discovery of the Malta fever's agent to the discovery of a marine mammal reservoir, brucellosis has continuously been a re-emerging zoonosis. Vet Res. 2005;36:313-326.http://www.vetres.org/articles/vetres/pdf/2005/03/v4056.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/15845228?tool=bestpractice.com[14]Zinsstag J, Schelling S, Wyss K, et al. Potential of cooperation between human and animal health to strengthen health systems. Lancet. 2005;366:2142-2145.http://www.ncbi.nlm.nih.gov/pubmed/16360795?tool=bestpractice.com[15]Kunda J, Fitzpatrick J, Kazwala R, et al. Health-seeking behaviour of human brucellosis cases in rural Tanzania. BMC Public Health. 2007;7:315.http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-315http://www.ncbi.nlm.nih.gov/pubmed/17980046?tool=bestpractice.com[16]Dean AS, Crump L, Greter H, et al. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 2012;6:e1865.http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0001865http://www.ncbi.nlm.nih.gov/pubmed/23145195?tool=bestpractice.com在这些地区,还存在家庭聚集性感染。[8]Mantur BG, Amarnath SK, Shinde RS. Review of clinical and laboratory features of human brucellosis. Indian J Med Microbiol. 2007;25:188-202.http://www.ncbi.nlm.nih.gov/pubmed/17901634?tool=bestpractice.com[10]Guerrier G, Daronat JM, Morisse L, et al. Epidemiological and clinical aspects of human Brucella suis infection in Polynesia. Epidemiol Infect. 2011;139:1621-1625.http://www.ncbi.nlm.nih.gov/pubmed/21733252?tool=bestpractice.com[17]Almuneef MA, Memish ZA, Balkhy HH, et al. Importance of screening household members of acute brucellosis cases in endemic areas. Epidemiol Infect. 2004;132:533-540.http://www.ncbi.nlm.nih.gov/pubmed/15188722?tool=bestpractice.com[18]Mendoza-Núñez M, Mulder M, Franco MP, et al. Brucellosis in household members of Brucella patients residing in a large urban setting in Peru. Am J Trop Med Hyg. 2008;78:595-598.http://www.ajtmh.org/content/78/4/595.fullhttp://www.ncbi.nlm.nih.gov/pubmed/18385354?tool=bestpractice.com在欧洲,布鲁氏菌病的发病率与国家的国民生产总值负相关。在已根除动物感染的国家中,人类病例通常与旅游或移民相关。[5]Pappas G, Papadimitriou P, Akritidis N, et al. The new global map of human brucellosis. Lancet Infect Dis. 2006;6:91-99.http://www.ncbi.nlm.nih.gov/pubmed/16439329?tool=bestpractice.com[19]Memish ZA, Balkhy HH. Brucellosis and international travel. J Travel Med. 2004;11:49-55.http://www.ncbi.nlm.nih.gov/pubmed/14769288?tool=bestpractice.com[20]Dahouk SA, Neubauer H, Hensel A, et al. Changing epidemiology of human brucellosis, Germany, 1962-2005. Emerg Infect Dis. 2007;13:1895-1900.http://wwwnc.cdc.gov/eid/article/13/12/07-0527_article.htmhttp://www.ncbi.nlm.nih.gov/pubmed/18258041?tool=bestpractice.com
全球范围内,马耳他布鲁氏菌是感染人类的最常见种属,但有些研究提示,在美国某些区域,多达 73% 的布鲁氏菌病病例可能是由于流产布鲁氏菌。[5]Pappas G, Papadimitriou P, Akritidis N, et al. The new global map of human brucellosis. Lancet Infect Dis. 2006;6:91-99.http://www.ncbi.nlm.nih.gov/pubmed/16439329?tool=bestpractice.com美国在 1979 年至 2002 年期间报告的大多数病例发生在加利福尼亚州和德克萨斯州,尤其是在西班牙裔人群以及前往或来自墨西哥的旅行者中。
布鲁氏菌病一般是一种职业病,主要影响农民、动物管理员、屠宰工人、兽医。本病还见于处理培养物的实验室工作人员。在 1979 年至 1999 年期间,美国大约 8% 的实验室获得性感染是由于布鲁氏菌属。[21]Pike RM. Laboratory-associated infections: summary and analysis of 3921 cases. Health Lab Sci. 1976;13:105-114.http://www.ncbi.nlm.nih.gov/pubmed/946794?tool=bestpractice.com[22]Harding AL, Byers KB. Epidemiology of laboratory-associated infections. In: Fleming DO, Hunt DL, eds. Biological safety: principles and practices. 3rd ed. Washington, DC: ASM Press; 2000:35-36.在流行和非流行国家,布鲁氏菌病都仍然是一种实验室危险。[23]Ergonul O, Celikbas A, Tezeren D, et al. Analysis of risk factors for laboratory-acquired Brucella infections. J Hosp Infect. 2004;56:223-227.http://www.ncbi.nlm.nih.gov/pubmed/15003671?tool=bestpractice.com[24]Yagupsky P, Baron EJ. Laboratory exposures to brucellae and implications for bioterrorism. Emerg Infect Dis. 2005;11:1180-1185.http://www.ncbi.nlm.nih.gov/pubmed/16102304?tool=bestpractice.com[25]Bouza E, Sanchez-Carrillo C, Hernangomez S, et al. Laboratory-acquired brucellosis: a Spanish national survey. J Hosp Infect. 2005;61:80-83.http://www.ncbi.nlm.nih.gov/pubmed/16130212?tool=bestpractice.com[26]Centers for Disease Control and Prevention (CDC). Laboratory-acquired brucellosis - Indiana and Minnesota, 2006. MMWR Morb Mortal Wkly Rep. 2008;57:39-42.http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5702a3.htmhttp://www.ncbi.nlm.nih.gov/pubmed/18199967?tool=bestpractice.com[27]Reddy S, Manuel R, Sheridan E, et al. Brucellosis in the United Kingdom - a risk to laboratory workers? Recommendations for prevention and management of laboratory exposure. J Clin Pathol. 2010;63:90-92.http://www.ncbi.nlm.nih.gov/pubmed/18495792?tool=bestpractice.com[28]Knudsen A, Kronborg G, Dahl Knudsen J, et al. Laboratory exposure to Brucella melitensis in Denmark: a prospective study. J Hosp Infect. 2013;85:237-239.http://www.ncbi.nlm.nih.gov/pubmed/24070633?tool=bestpractice.com[29]Traxler RM, Lehman MW, Bosserman EA, et al. A literature review of laboratory-acquired brucellosis. J Clin Microbiol. 2013;51:3055-3062.http://jcm.asm.org/content/51/9/3055.fullhttp://www.ncbi.nlm.nih.gov/pubmed/23824774?tool=bestpractice.com