TY - JOUR T1 -图拉菌血症JF -欧洲呼吸杂志JO - Eur Respir J SP - 361 LP - 373 DO - 10.1183/09031936.03.00088903 VL - 21 IS - 2 AU - Tärnvik, a . AU - Berglund, L. Y1 - 2003/02/01 UR - //www.qdcxjkg.com/content/21/2/361.abstract N2 -图拉菌血症是北半球的一种人源性细菌疾病。病原体土拉菌弗朗西斯菌通过直接接触受感染的啮齿动物或鼠形动物、曝气暴露、摄入受污染的食物或水，或通过节肢动物叮咬传播给人类。土拉菌血症的流行表现出很大的地理差异。在一些流行地区，疫情经常发生，而一个国家附近的农村地区可能完全没有疫情。土拉菌是一种兼性细胞内病原体，其主要的哺乳动物靶细胞是单核吞噬细胞。当土拉菌血症经皮肤感染时，通常会发现原发性溃疡，一般情况下，局部淋巴结明显肿大。经吸入感染时，该病可表现为肺炎。然而，几乎同样常见的是没有呼吸道症状和肺部放射学变化的发烧和全身疾病的发展。当出现时，变化很大，有时可能包括与淋巴瘤难以区分的肺门肿大。在疫情暴发期间，土拉菌血症的第一例并不总是容易诊断出来。 A decade may have lapsed since the disease was encountered and its existence may be more or less forgotten. The difficulty refers especially to the respiratory form, in which symptoms are less specific. In cases of atypical pneumonia or acute febrile disease with no local symptoms, a history of exposure to hares or rodents or merely living in an endemic region should be sufficient to include tularaemia among differential diagnoses. The microbiological diagnosis of tularaemia relies mainly on serology, and the treatment on broad-spectrum antibiotics. For decades, a live vaccine has been successfully used in risk groups but is presently not available due to difficulties in standardisation. This work was supported by grants from the Swedish Medical Research Council, Västerbottens läns landsting, and the Medical Faculty, Umeå University. ER -