云南省祥云县2015-2019年恙虫病临床与流行病学特征分析

Analysis of clinical and epidemiological characteristics of tsutsugamushi disease from 2015 to 2019 in Xiangyun county,Yunnan province

目的分析云南省祥云县2015-2019年恙虫病临床与流行病学特征,为恙虫病的防治提供科学依据。方法对祥云县人民医院收治的恙虫病病例进行个案调查,应用描述性流行病学和SPSS 26.0软件对资料进行统计分析。结果恙虫病共279例,其中临床诊断病例占94.27%(263/279),实验室诊断病例占5.73%(16/279),男∶女为1∶1.07;发病年龄1~84岁,以30~<75岁为主,占80.29%(224/279);农民发病数最高,占83.87%(234/279)。发病高峰期为8-10月,占79.57%(222/279)。祥云县米甸镇的病例数最多,占36.92%(103/279)。临床表现以发热、寒战和头痛为主,分别占89.63%、84.95%和82.44%;出现特异性焦痂或溃疡占76.00%;并发症以肝损害为主。县、乡(镇)和村3级医疗机构中,村级恙虫病误诊率最低。结论收治的恙虫病病例以临床诊断病例为主,临床表现多样化,为了减少恙虫病的误诊和漏诊,应结合流行病学史和实验室检查进行诊断。为减少恙虫病的发病率,应加强对农民重点人群进行恙虫病的健康教育。

Objective To analyze the clinical and epidemiological characteristics of tsutsugamushi disease(TD)and provide a scientific basis for the prevention and control of TD from 2015 to 2019 in Xiangyun county,Yunnan province.Method Data of TD cases admitted to the Xiangyun County People’s Hospital was collected and statistically analyzed using descriptive epidemiology and SPSS 26.0 software.Results There were 279 cases of TD;of which,94.27%(263/279)were clinically diagnosed and 5.73%(16/279)were laboratory diagnosed,male:female=1:1.07.The onset age was 1 to 84 years old,and the majority was 30 to 74 years old,accounting for 80.29%.The incidence rate of farmers was the highest,accounting for 83.87%.The peak incidence was from August to October accounting for 79.57%.Midian Town of Xiangyun County had the largest number of cases,accounting for 36.92%.The main clinical manifestations were fever,chills and headache accounting for 89.63%,84.95%,82.44%,respectively.TD cases accounted for 76.00%with specific eschar or ulcer.The main complication was liver damage.The village had the lowest misdiagnosis rate of TD in the county,town and village level.Conclusions The cases of TD were mainly diagnosed clinically in Xiangyun county.The diagnosis had to combine with epidemiological history and laboratory examination to reduce the misdiagnosis and missed diagnosis due to the diversity of TD clinical manifestations.Health education should be strengthened among farmers to reduce the incidence of TD.