30例恙虫病临床特征分析

Clinical characteristics of 30 case of tsutsugamushi disease

目的分析恙虫病的临床特征。方法对我院近5年来收治的30例确诊为恙虫病患者的病例资料进行分析。结果广州地区恙虫病发病季节为5—11月,常见表现为高热、恙螨叮咬处焦痂和溃疡、淋巴结肿大以及皮疹,变形杆菌OXk凝集反应17例(56.67%)阳性。常见并发症依次为肝损害、心脏损害、肾脏损害、继发感染、脑水肿、休克、弥散性血管内凝血。该病首诊误诊率高达80%。氯霉素或多西环素的治疗效果较好,治愈率为87%,病死率达13%。死亡病例均合并多脏器功能障碍综合征,均为2008年病例。结论恙虫病临床表现复杂多样,常伴多器官损害,并发症多,容易误诊。

Objective To investigate clinical characteristics of tsutsugamushi disease in Guangzhou in the past 5 years. Methods Clinical data of 30 patients diagnosed as tsutsugamushi disease in our hospital in the past 5 years were analyzed retrospectively. Results Tsutsugamushi disease occurred between May and Nov. in Guangzhou. Fever, eschar, ulcer, the swelling of lymph nodes and rash were common signs and symptoms. The OXk antigen agglutination reaction of bacillus proteus was positive in 17 cases （ 56.67% ）. The disease was often complicated by liver injure, heart injure, kidney injure, secondary infection, hydrocephalus, shock and disseminated intravascular coagulation （DIC）. The misdiagnosis rate of the initial diagnosis of this disease reached as high as 80%. Chloramphenicol or doxycycline was effective. The curative rate is 87% and the mortality rate 13%. All of the dead cases were complicated by multiple organ dysfunction syndrome （MODS）. Conclusions Clinical characteristics of tsutsugamushi disease are complicated, with multiple organ damage and many complications, so it is likely to be misdiagnosed.