人粒细胞无形体病误诊为流行性出血热

Human Granulocytic Anaplasmosis Misdiagnosed as Epidemic Hemorrhagic Fever

目的分析人粒细胞无形体病(human granulocytic anaplasmosis,HGA)的临床特点和误诊原因,加强对本病认识。方法 分析我院2010年7月收治的1例HGA临床资料。患者因发热、头痛、腰痛伴胸闷入院。查查白细胞、血小板减少。诊断为流行性出血热?给予丹参、左氧氟沙星等药物治疗,病情无好转且心、肝功能损害加重。结果患者于入院第5天突然抽搐、口鼻出血,血压90/60 mmHg。急查淋巴细胞0.52(异型淋巴细胞0.34),血小板73×109/L;酶学指标升高,凝血功能检查异常。入院第6天患者突然心搏停止,抢救无效死亡。采集血液标本经血清学检测证实为HGA。结论以发热伴白细胞、血小板减少和多脏器功能损伤为主要表现的病例,应考虑到HGA的可能,及时检测嗜粒细胞包涵体或抗体等,以避免误诊。

Objective To analyze the clinical characteristics and misdiagnosis cause of human granulocytic anaplasmosis（HGA）,and strengthen the cognition of HGA. MethodsThe clinical data of the HGA patient admitted in July 2010 was analyzed.The patient was admitted with complaints of fever,headache,and low back pain complicated with dyspnea.Examination results showed lower level of leukocyte and blood platelets.The patient was diagnosed as epidemic hemorrhagic fever and given salvia miltiorrhiza bunge and levofloxacin with no improvement,however aggravation injury of heart and liver function occurred. ResultsOn the 5th Day after admission,the patient was suddenly convulsive,with bleeding from mouth and nose.Blood pressure was 90/60 mmHg,lymphocytes was 0.52（abnormal lymphocyte 0.34）,blood platelets was 73×109/L;enzyme indicator increased,and blood clotting was abnormal.On the 6 th Day,the patient was asystole and died after unsuccessful salvage.Blood sample was collected for serology and was confirmed as HGA. ConclusionSymptoms of fever,decreasing blood platelets,and multi-organ functional injury are likely to be HGA,granulocytes inclusion bodies and antibody examinations should be taken to avoid misdiagnosis.