恙虫病误诊为肺炎一例

摘要

Tsutsugamushi disease is a common clinical infectious disease with natural foci and high misdiagnosis rate.Herein,this artical reported one case of tsutsugamushi disease with cough and fever as chief complaints.The patient was initially diagnosed with bronchitis and treated with anti-infectious therapy,but the symptoms were not alleviated.Repeated X-ray examination hinted right lung infection.The patient then was di-agnosed with pneumonia and hospitalized in the department of respiration.The signs of fever recurred after in-tensified anti-infectious treatment.Widal and Weil-Felix tests yielded positive results.The patient had a history of lying on grassland.Further physical examination found a medial inguinal scarring in the left leg.The patient was eventually diagnosed with tsutsugamushi disease.This misdiagnosis case hints that clinicians should pay at-tention to tsutsugamushi disease during summer and autumn.To the patient who has recurrent fever and no re-sponse to antibiotics,more explicit inquiry and physical examination is necessary to avert the misdiagnosis of tsutsugamushi disease.%恙虫病是一种临床常见且误诊率高的自然疫源性传染病，该文报道了1例以咳嗽和发热为主诉就诊的患者，在门诊按“支气管炎”常规抗感染治疗无效后，复查 X 线胸片提示右下肺感染，拟诊“社区获得性肺炎”收入呼吸科住院，经加强抗感染治疗，发热仍反复，查外-斐试验、肥达试验均阳性，追问患者有草地坐卧史，仔细体格检查发现患者左大腿内侧近腹股沟处有一处焦痂，最终患者确诊为恙虫病。该例诊治经过提示，临床一线医务工作者在夏秋季节应提高对恙虫病的警惕，对经常规抗感染治疗仍无效的反复发热患者应进行详细的病史追溯和认真的体格检查，避免误诊。