丹东地区28例恙虫病误诊原因分析

Causes analysis of misdiagnosis of scrub typhus in 28 cases in Dandong

目的:分析恙虫病误诊原因,为临床诊断疾病提供依据,避免误诊。方法:对28例误诊恙虫病住院患者进行回顾性分析。结果:28例患者均有草地等野外活动史,28例(100%)均有不同程度发热;26例(92.8%)有低蛋白;25例(89.3%)有不同程度贫血;24例(85.7%)有溃疡或焦痂;18例(64.3%)有肝损害,17例(60.7%)有肺部损害;16例(57.7%)有血小板减少;14例(50.0%)有肾损害;13例(46.4%)有脾损害;6例(21.4%)有心脏损害;4例(14.3%)有皮疹;3例(10.7%)有淋巴结肿大;3例(10.7%)有白细胞减少,经多西环素治疗全部治愈,无死亡病例。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,多西环素是治疗恙虫病的有效药物。

Objective： To analyze the reasons for misdiagnosis of scrub typhus and thus to provide evidence for future clinical diagnosis of the disease. Methods： Twenty eight cases of nfisdiagnosis of scrub typhus were retrospectively analyzed. Results： All 28 patients had history of activities in grassland and other wilderness, among which 28 patients （100%） had different degree of fever, 26 patients （92.8%） had low-protein, 25 cases （89.3%） had varying degrees of anemia, 24 cases （85.7%） had ulcers or eschar, 18 cases （64.3%） had liver damage, 17 cases had （60.7%） lung damage, 16 cases （57.7%） had thrombocytopeuia, 14 cases （50.0%） had kidney damage, 13 cases （46.4%） had spleen damage, 6 cases （21.4%） had heart damage, 4 cases （14.3%） had rash, 3 cases （10.7%） had lymph nodes and 3 cases （10.7%） had neutropenia. After doxycycline treatment all the patients were cured and no deaths occurred. Conclusion： Scrub typhus is of various clinical manifestations, thus is prone to misdiagnosis. Detailed medical history investigation and physical examination is the key to reduce cases of misdiagnosis. In terms of treatment, doxycycline is an effective drug for scrub typhus.