Objective To analyze clinical features and misdiagnosed causes of tsutsugamushi disease in order to avoid misdiagnosis and mistreatment.Methods Clinical data of 98 misdiagnosed patients with tsutsugamushi disease during August 2010 and December 2015 was retrospectively analyzed.Results All patients were misdiagnosed at early period of the disease,and patients visited doctors mainly for fever,cough,epigastric discomfort,lymph node enlargement and eschar or ulcer formation in skin ulceration.Departments of the first diagnosis were infectious diseases,respiratory diseases and emergency departments,and top 3 misdiagnosed diseases were pneumonia,acute hepatitis and upper respiratory tract infection.Medical examinations showed that elevated level of alanine aminotransferase was found in 67 patients,and elevated level of aspartate aminotransferase was found in 63 patients,elevated levels C-reactive protein (CRP) in 76 patients,positive urine occult blood in 23 patients and positive urinary protein in 25 patients.Penicillins and Cephalosporin antibiotics were mainly used in other hospitals,and tsutsugamushi disease was confirmed by combination of clinical manifestations and Felix test after admission in our hospital,and all patients were treated with Azithromycin iv gtt,and then 96 patients (97.96%) were cured,and 2 patients (2.04%) died.Conclusion Misdiagnosed rate of tsutsugamushi disease during early period is high,and it is the key to avoid misdiagnosis and mistreatment by strengthening professional training of medical staff,carefully checking in the popular season for fever patients and use antibiotics rationally.%目的 分析恙虫病的临床特征及误诊原因,减少误诊误治.方法 对我院2010年8月-2015年12月早期误诊的98例恙虫病的临床资料进行回顾性分析.结果 本组病初均误诊,多以发热、咳嗽、上腹部不适、淋巴结增大及皮肤破溃形成焦痂或溃疡就诊,首诊多就诊于感染科、呼吸科、急诊内科,误诊疾病居前3位的分别为肺炎、急性肝炎、上呼吸道感染.查丙氨酸转氨酶升高67例,天冬氨酸转氨酶升高63例,C反应蛋白升高76例;尿隐血阳性23例,尿蛋白阳性25例.在外院就诊过程中多使用青霉素类、头孢菌素类抗生素,入我院后结合临床表现及外斐试验明确诊断为恙虫病,均予阿奇霉素静脉滴注,其中96例(97.96%)治愈,2例死亡(2.04%).结论 恙虫病早期误诊率高,加强医务人员专业培训,在流行季节对发热患者进行仔细查体,合理使用抗生素是减少误诊误治的关键.
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