温州地区48例恙虫病的临床分析

Clinical analysis of 42 tsutsugamushi disease cases in Wenzhou region

目的分析恙虫病的临床特点,为临床诊断与治疗提供依据。方法对48例恙虫病住院患者进行回顾性分析。结果48例患者均有草地等野外活动史。48例均有不同程度发热,44例(91.7%)溃疡或焦痂,30例(62.5%)肝损害,17例(35.4%)肺部损害,14例(29.2%)肾损害,13例(27.1%)脾损害,11例(22.9%)心脏损害,3例(6.3%)淋巴结肿大。经氯霉素或四环素治疗后46例治愈,2例好转。结论恙虫病临床表现多样,误诊率高,详细询问病史、严格体格检查是减少误诊的关键。氯霉素、四环素族、大环内酯类及第三代喹诺酮类均是治疗恙虫病的有效药物,临床医师可根据自己的治疗经验选择使用。

Objective To analyze the clinical characteristics of tsutsugamushi disease and guide to the diagnosis and treatment of the disease. Methods The clinical data of 48 tsutsugamushi disease patients were retrospectively analyzed. Results Forty-eight cases had history of contacting grass and brushwood, and all of them showed the sign of pyrexia. In addition, eschar or ulcer was observed in 44 cases （91.7%）. Liver damage was observed in 30 cases （62.5%）. Pulmonary imaging change was observed in 17 cases（35.4%）. Kidney damage was noticed in 14 cases （29.2%）. Spleen damage was noticed in 13 cases （27. 1%）. Heart harm was noticed in 11 cases （22. 9%）. Lymth tumescence was noticed in 3 cases （6.3%）. After the treatment of chloromycetin or tetracyclines, 46 patients were cured and 2 patients condition were getting better. Conclusion The clinical characteristics of tsutsugamushi disease are complicated. It＇s misdiagnosing rate is high.Detailed inqury of medical history and the strict medical examination were essential to reduce misdiagnosis.Chloromycetin, tetracyclines, macrolides and the 3rd generation quinolones were all effective in the treatment of tsutsugamushi disease. Clinicians according to their own treatment experiences.