2009－2011年恙虫病流行和临床特征分析

摘要

目的：掌握恙虫病的流行和临床特征，为提出有效的预防控制和诊治措施提供依据。方法收集2009～2011年临床诊断治疗的恙虫病病例，Excel软件建立相关数据库并进行整理分析。结果共收集3年间临床诊治恙虫病病例66例，63例（95.5％）发生于夏秋季7～10月，呈现明显的季节相关性；各年龄段人群普遍易感，农民为高发人群（占57.6％）。临床症状突出表现为高热或超高热（86.4％），多位于身体隐蔽部位的特征性焦痂或溃疡（74.2％），可同时存在多器官功能损害，肝功能损害44例（66.7％），心肌酶谱异常15例（22.7％），肺部感染24例（36.4％）。早期检测外斐氏试验阳性率较低（26.8％）。氯霉素、四环素类、大环内酯类和喹诺酮类抗生素单用或联合使用对恙虫病有效。结论恙虫病发病有明显的季节性，预防重点应是夏秋季的农村地区，争取早期诊断并使用敏感抗生素治疗可有效控制恙虫病病情。%Objective To clarify the characteristic of prevalence and clinical features of scrub typhus in Xiangyun , Yunnan Province , and propose effective measures for prevention , diagnosis and treatment.Methods Scrub typhus cases from 2009 to 2011 in Xiangyun people′s Hospital were collected , relevant databases were established and analyzed by Excel software.Results 66 scrub typhus cases were collected in three years , 63 cases( 95.5%) occurred in the sum-mer and autumn from July to October , showing a clear correlation with the season;all age groups was generally suscepti-ble to scrub typhus , the farmers was high -risk population ( accounting for 57.6%). Prominent clinical symptoms of high fever (86.4%), characteristic eschar or ulcer almost in hidden parts of the body (74.2%), and multiple organ dysfunction including liver dysfunction in 44 cases (66.7%), myocardial enzymes abnormalities in 15 cases (22.7%), pulmonary infection in 24 patients (36.4%) were found.The positive rate of Weil -Felix test was low at the onset of this disease (26.8%).Chloramphenicol , tetracyclines, macrolides and quinolones used alone or in combination with were effective on scrub typhus.Conclusions Obvious seasonal characteristics of scrub typhus were found in Xiangyun , prevention should focus on rural areas in summer and autumn , strive for early diagnosis and sensitive antibiotic treatment can effectively control this disease.