甲型副伤寒68例临床分析

Clinical analysis of 68 paratyphoid A cases

目的了解威海市一起因使用被甲型副伤寒杆菌污染的井水加工食物引起的甲型副伤寒爆发流行的临床特征。方法回顾分析威海地区68例甲型副伤寒的临床特征、药敏试验及治疗。结果合计确诊68例患者，均为城镇居民。患者均有2～3周的持续高热，热型为弛张热，95．6％有晨寒。全身中毒症状及消化道症状较轻，仅2例有皮疹。肥达反应阳性率低。治疗以喹诺酮类、第三代头孢菌素为首选药物。结论氟喹诺酮类是治疗伤寒、甲型副伤寒的首选用药，不宜用氟喹诺酮类者可改用头孢曲松。

Objective To describe the clinical feature of a paratyphoid A outbreak in Weihai city. This outbreak was caused by processing food with well water contaminated by Salmonella paratyphoid A. Methods The clinical feature, susceptibility testing and treatment of paratyphoid fever A cases were reviewed and analyzed. Results Sixty-eight patients were reliably diagnosed as paratyphoid fever A. All these patients were urban residents. Patient had lasting high fever for two to three weeks. The fever was remittent type. About 95.6% of the patients had chilliness. Systemic toxicity and gastrointestinal symptoms were relatively mild. Rashes were reported in only 2 patients. Positive rate of Widal reaction was low. Blood culture should be done as early as possible for diagnosis. Quinolones and the third generation cephalosporins were the first choice for treatment. Aminoglycosides were only used in combination therapy. The time to defervescence was 7 ± 3 days when two antimicrobial agents were combined. Conclusions The outcomes are good after treatment with combination therapy of two antimicrobial agents.