2022年湖北省十堰市郧西县57例恙虫病患者临床症状及流行病学特征分析

Clinical symptoms and epidemiological characteristics of 57 patients with tsutsugamushi disease in Yunxi County,Shiyan City,Hubei Province in 2022

目的分析十堰市郧西县恙虫病(tsutsugamushi disease,TD)患者的临床症状及流行病学特点,为TD的科学防控提供参考。方法收集2022年1-12月十堰市郧西县人民医院感染性疾病科收治的57例TD患者信息,包括年龄、性别、职业、临床表现(焦痂或恙螨、高热、皮疹及伴随症)、实验室及影像学检测结果、野外作业及游玩史等。采集患者血液样本及焦痂,应用酶联免疫吸附试验(ELISA)、聚合酶链反应(PCR)分别检测恙虫病东方体抗体(Ot-Ab-IgM)、恙虫病东方体(Ot)。使用TD积分诊断量表计算每例患者积分,积分≥8.5分为临床诊断TD。根据系统损伤数量(0、1、2、≥3个),将57例患者分为A、B、C、D四组,分析TD对其系统功能的损伤情况。结果57例TD患者中,男性26例(45.61%)、女性31例(54.39%),40~79岁患者占比为92.98%(53/57);89.47%(51/57)的患者职业为农民。5月为TD发病最高峰,发病19人,占该年发病患者的33.33%(19/57)。54例患者发病前曾有野外作业或野外游玩史。57例TD患者的高热发生率为100.00%(57/57),焦痂或恙螨发现率为80.70%(46/57),皮疹发生率为98.25%(56/57),恙虫病三联征(同时出现焦痂、高热、皮疹)发生率为80.70%(46/57),嗜酸性粒细胞(EOS)下降发生率为100.00%(57/57),77.19%(44/57)的TD患者出现多系统功能损伤(multi-system functional damage,MSFD)。57例患者TD积分诊断量表积分范围为8.5~10.5分。住院治疗1~5 d后,全部患者体温均降至正常范围,各系统功能逐渐恢复。结论TD已成为湖北省十堰市郧西县多发的自然疫源性传染病之一,患者主要为中老年人,三联征为其典型临床表现,血液系统、肝脏及肾脏无症状性损伤最为常见。

Objective To analyze the clinical symptoms and epidemiological characteristics of patients with tsutsugamushi disease(TD)in Utica County,Shiyan City,providing reference for scientific prevention and control of TD.Methods The information of 57 TD patients admitted to the Department of Infectious Diseases of the People's Hospital of Utica County in Shiyan City from January to December 2022 was collected,including age,gender,occupation,clinical manifestations(tarsus or chigger,high fever,rash and accompanying syndromes),laboratory and imaging test results,and field work and travel history.Blood samples and body crusts were collected,and enzyme-linked immunosorbent assay(ELISA)and polymerase chain reaction(PCR)were used to detect antibodies against Orientia tsugamushi(Ot-Ab-IgM)and Orientia tsutsugamushi(Ot).The scores of each patient were calculated using the TD Diagnostic Scale.A score of≥8.5 was considered a clinical diagnosis of TD.According to the number of system functional damages(0,1,2,≥3),57 patients were divided into 4 groups,A,B,C,and D,TD was analyzed for system functional damages of each system.Results Among the 57 TD patients,26(45.61%)were male and 31(54.39%)were female,and the proportion of patients aged 40-79 years was 92.98%(53/57);farmers accounted for 89.47%(51/57).May was the peak of TD incidence,with 19 cases,which accounted for 33.33%(19/57)of the total number of patients affected that year.Fifty-four patients had a history of fieldwork or field trips before the onset of the disease.The incidence of high fever in 57 TD patients was 100.00%(57/57),the detection rate of body scorch or chiggers was 80.70%(46/57),and the incidence rate of rash was 98.25%(56/57);the incidence rate of tsutsugamushi disease triad(accompanied by scabs,high fever,and rash)was 80.70%(46/57);the incidence of eosinophil decline was 100.00%(57/57),and 77.19%(44/57)of TD patients experienced multiple-system functional damage(MSFD).The TD score diagnostic scale for 57 patients ranged from 8.5 to 10.5 points.After being hospitalized for 1-5 days,all TD patients experienced a decrease in body temperature to the normal range,and the damage to various systems functional gradually recovered.Conclusions TD has become one of the most common natural infectious diseases in Utopia County,Shiyan City,Hubei Province.The patients are mainly middle-aged and elderly people,and the triple syndrome is a typical clinical manifestation.Asymptomatic injuries to the blood system,liver and kidneys are the most common.