恙虫病临床特点分析

Analysis on clinical characteristics of patients with scrub typhus

目的研究恙虫病的临床特点。方法分析恙虫病患者的临床和实验室检查资料。结果 17例恙虫病患者中出现皮肤焦痂及溃疡者15例(88.2%),部位分别在腰、胸、下腹、腹股沟、骶尾及肛周、腋下、阴囊等处;数量多为1个,平均直径为1.2cm,表面干燥呈黑色,不伴疼痛及瘙痒,焦痂脱落后形成浅溃疡。伴有焦痂附近浅表淋巴结肿大者12例(70.6%),伴有皮肤出疹者11例(64.7%),首诊时未发现焦痂患者占58.8%(10例)。出现肝功能异常患者9例(52.9%),伴支气管炎和肺部感染患者5例(29.4%),心肌酶谱异常者4例(23.5%),其他表现包括脾肿大、血小板减少、尿潜血阳性、尿蛋白阳性、腹泻、大便潜血阳性等。结论恙虫病患病临床表现多样,常见多系统受损。皮肤焦痂是本病的重要特征,其发生率高、形态独特,但发生部位较散在而隐蔽,体检若不仔细则易漏检和误诊。皮疹和焦痂附近浅表淋巴结肿大是也是本病常见表现。本病临床表现多样、易复杂化。加强认识、认真查体是防止该病误诊的重要手段。

Objective To study the clinical characteristics of scrub typhus. Methods Clinical data from 17 patients with scrub typhus were reviewed, retrospectively. Results The rate of eschar and ulcer in 17 patients was 88.2%, the eschar occurs at the waist, abdomen, chest, groin, crissum, axillary, scrotal, etc. The rate of lymphadenectasis and skin rashes were 70.6% and 64.7% , respectively. Liver damage occured in 9 cases, bronchitis and pneumonia occured in 5 cases, 4 cases appeared myocardial enzymes abnormal. Clinical manifestation also included splenomegaly, thrombocytopenia, hematu, proteinuria, diarrhea, hematochezia, etc. Conclusions Clinical manifestations of scrub typhus were complicated and the multisystem damages were common. The main clinical characteristics including fever, eschar, lymphadenectasis and skin rash. Well qualified expertise and careful examination can avoid misdiagnosis.