20例以发热为首发症状的恙虫病的临床分析

摘要

Objective:To provide clinical evidence for early diagnosis and treatment of tsutsugamushi disease by analyzing the clinical characteristics of patient with tsutsugamushi disease admitted in the Emergency Department of Sun Yat-sun Memorial Hospital of Sun Yat-sen University from December 2013 to December 2016. Methods:Epidemiological, clinical, laboratory, complications, misdiagnosis rate, and treatment data, as well as outcomes, of 20 patients diagnosed as tsutsugamushi disease from December 2013 to December 2016 were retrospectively analyzed. Results: Tsutsugamushi disease was tended to occur between summer and autumn. The majority of patients were peasant and the middle-aged people, all(100%) patients had a history of contacting grass and brushwood. Hyperpyrexia was the predominant symptom (100% ), and accompanied with headache, arthralgia, cough, expectoration, running nose, stuffy nose, myalgia, diarrhea. Eschar or ulcer appeared to be the most specific sign, followed by rash, lymphadenectasis, hepatomegaly, and splenomegaly.The descent of eosinophilic granulocyte ratio was the most important characteristics of routine blood test. The elevation of PCT level (80% ) was the significant diagnostic indicator. Positive OXk antigen agglutination reaction of bacillus (65% ) was the specific immunologic diagnostic indicator. Hepatic dysfunction was the most common complication (85%), followed by pneumonia, pleural effusion, kidney injury, heart injury, coagulation disorders. The misdiagnosis rate of the initial diagnosis of this disease reached as high as 75%. Chloramphenicol or doxycycline were effective, the curative rate is 100%. Conclusion:Due to the diversity of clinical manifestation and complication, tsutsugamushi diseasealways was misdiagnosed. Detailed history of exposure to infectious agents, as well as physical examination, should be performed as early as possible for patients with long-term fever of unknown origin so as to avoid misdiagnosis and delayed treatment.%目的：分析中山大学孙逸仙纪念医院急诊病区2013年9月至2016年9月收治的恙虫病病例的临床特征，为恙虫病的早期诊治和提高疗效提供临床依据。方法：对2013年9月至2016年9月收治的20例恙虫病患者的流行病学资料、临床表现、实验室检查、并发症、误诊率、治疗和转归情况进行回顾性分析。结果：高发于夏秋季，以中壮年、农民发病居多，发病前均有草木丛林接触史。发热是恙虫病最常见的症状（100％），同时伴有头痛、关节酸痛，咳嗽、咳痰，流涕、鼻塞、咽痛，肌肉疼痛，腹泻等。焦痂或溃疡为其最特异的体征（70％），同时伴有皮疹，肝、脾、淋巴结肿大。嗜酸性粒细胞百分比降低为其最重要血常规特征（95％）；降钙素原（PCT）升高（80％）为其重要的诊断指标；外斐试验 OXk 凝集效价阳性（65％）为其特异的免疫学诊断指标。肝功能损害为其最常见并发症（85％），以及肺炎、胸腔积液、肾脏损害、心脏损害、凝血功能障碍等。该病首诊误诊率为高达75％。氯霉素或多西环素治疗效果良好，治愈率为100％。结论：恙虫病的临床表现复杂多样，并发症多，易误诊。对于长时间不明原因发热的患者，要详细询问病史和体格检查，警惕本病的可能，做到早诊断、早治疗。