甲型副伤寒89例临床分析

Clinical analysis of 89 patients with paratyphoid fever A

目的分析总结甲型副伤寒的临床特点、诊断及治疗。方法对我院2000年1月～2006年6月收治的89例甲型副伤寒进行回顾性分析。结果甲型副伤寒临床表现不典型,多数表现为高热、畏寒而无相对特征性的症状和体征,早期诊断困难。外周血白细胞不高及嗜酸粒细胞减少或消失有提示意义,血培养是目前最为实用的确诊措施。氟喹诺酮耐药率有所上升,第三代头孢菌素敏感率高。采用氟喹诺酮或(及)第三代头孢菌素治疗,一般5d内热退,未见严重并发症。结论在甲型副伤寒流行区,无明显可疑病因发热3d以上,外周血白细胞不高及嗜酸粒细胞减少或消失者,应考虑甲型副伤寒,宜及早采血行细菌培养,以便及时确诊和治疗。治疗可首选第三代头孢菌素,及时治疗一般预后良好,但易复发。

Objective To analyze and summarize the clinical characteristics, diagnosis and treatment of paratyphoid fever A. Methods The clinical data of 89 patients with paratyphoid fever A in our hospital from Jan 2001 to Jun 2006 were reviewed retrospectively. Results The clinical manifestations of paratyphoid fever A was atypical. More than half of the patients had fever higher than 39℃ as the only manifestation . It was difficult to diagnose at early stage. Peripheral white blood cell counts within or lower than normal value and eosinophil counts lower than normal value gave a clue of diagnosis in such patients. Blood culture was the most applied diagnosis method at present. Defervescence could be achieved within 5 days with fluoquinolones or（and） the third generation of eephalosporins treatment. No severe complications were observed in these patients. Conclusion In endemic area, patients with high fever longer than three days without suspected etiology whose peripheral white blood cell count are within or lower than normal value and whose eosinophil counts are lower than normal value should be screened for paratyphoid fever A. Blood culture should be performed as soon as possible. The ciprofloxacin resistance rate increases gradually. The prognosis of paratyphoid fever A patients is good under proper treatment, but relapse is still a problem in some of these patients.