流行性出血热和地方性斑疹伤寒混合感染131例临床分析

Clinical analysis of 131 cases of co-infection of hemorrhagic fever with renal syndrome and murine typhus

目的探讨肾综合征出血热(HFRS)和地方性斑疹伤寒混合感染的流行特征、临床特点和转归。方法对1997～2007年收入院的131例混合感染患者的临床资料进行回顾性分析。结果 HFRS和地方性斑疹伤寒混合感染以农村居住的男性青壮年为主,发病集中在9月至次年2月,鼠及鼠蚤的接触史并不明显,临床表现缺乏特异性,误漏诊率高。主要表现有持续发热(131,100%)、头痛(131,100%)、醉酒貌(101,77.1%)、蛋白尿(131,100%)和血小板减少(109,83.2%)、肝功能受损(131,100%)等。流行性出血热抗体和OX19阳性有助于诊断。结论在特定流行地区,HFRS和地方性斑疹伤寒能够并发致混合感染,应早期及时诊治,减少误漏诊尤为重要。

【Objective】 To evaluate the epidemiological characteristics,clinical feathers and prognosis of co-infection HFRS and Murine typhus.【Methods】 Clinical data of 131 co-infection HFRS and Murine typhus patients who were admitted in hospital from 1997 to December,2007 were analyzed retrospectively.【Results】 The majority of patients were young male rural settlements;the incidence focused on September to next February,most people had no obvious history of mouse contact and mouse biting.Lack of specific clinical manifestations lead to the high rate of misdiagnosis.The clinical character was a sustained fever（131,100%）,headache（131,100%）,drunkenness face（101,77.1%）,proteinuria（131,100%）,thrombocytopenia（109,83.2%）,liver function impairment（131,100%） and so on.Anti-HFRS IgM antibody,OX19 positive are helpful for diagnosis.【Conclusion】 Co-infection HFRS with Murine typhus can occur in certain epidemic areas.Diagnosis and treatment early and timely,reducing the misdiagnosis is particularly important.