恙虫病52例临床分析

Clinical analysis of tsutsugamushi disease in 52 patients

目的进一步了解恙虫病的临床特点,为临床诊断及治疗提供依据。方法对52例恙虫病患者的临床症状、体征、实验室检查及流行病学史进行回顾性分析。结果野外活动史50例(96.2%),全部病例均有高热、乏力、头痛,皮疹41例(78.8%),焦痂或溃疡47例(90.4%),淋巴结肿大45例(86.5%),肝脾肿大30例(57.7%),变形杆菌OXK凝集反应阳性率48例(92.3%),中毒性肝炎45例(86.5%),合并心肌炎4例(7.7%),肺炎4例(7.7%),多器官功能衰竭1例(1.9%),氯霉素或强力霉素治疗有效,死亡1例(1.9%)。结论恙虫病临床表现复杂多样,常致多器官功能损害,合并症多见,提高对该病的认识,注意流行病学史调查及详细体检,是减少误诊、漏诊的关键。

Objective To investigate clinical features of tsutsuganaushi disease for better diagnosis confirming and treatment strategy making. Methods From 1992 to 2005, 52 patients with tsutsugamushi disease were enrolled in our hospital, data from patients＇ records including clinical symptoms, signs, laboratory results and epidemic histories were collected and analyzed retrospectively. Results Out of 52 patients, 50（96.2%）had a history of wild field activity. All of the patients presented with high fever, fatigue and headache, in 41 of 52 （78.8%）appeared macular rashes, 47（90.4%） fiat black eschar or skin ulceration, 45（86.5%） lymph nodes enlargement,and hepatosplenomegaly was presented in 30 （57.7%）. Positive agglutination reactions to proteus OXK were showed by 92.3 %（48/52）. 45（86.5%） cases complicated with toxic hepatitis; and 4（7.7%） with myocarditis and pneumonia respectively, 1 （1.9%） developed multiple organ function failure. Chloromycin or tetracycline showed an excellent effect on dealing with the disease except 1 （1.9%） death. Conclusion Tsutsugamushi disease are of diversified clinical manifestations, and might result in severe complications or multiple system organ damage. Improved recognition, vigilant attention to epidemic history and detailed physical examination are keys to avoid misdiagnosis.