恙虫病32例误诊分析

Analysis of 32 Misdiagnosis Cases of Tsutsugamushi Disease

目的探讨恙虫病的误诊原因,以提高早期诊断率。方法对32例恙虫病患者的临床资料、辅助检查进行回顾性分析。结果发热32例(100.00%),焦痂或溃疡27例(84.38%),分别位于肩胛部、腹部、颈部、腋窝、腘窝、会阴部、臀部、小腿,淋巴结肿大12例(37.50%),主要在颈部、腹股沟淋巴结,皮疹18例(56.25%),头痛、头晕11例(34.38%)。血常规异常17例(53.13%),包括白细胞减少10例、白细胞增高1例、血小板减少6例,肝功能异常30例(93.75%),尿常规异常2例(6.25%),15例(46.88%)胸片出现肺间质病变或肺纹理增粗。腹部B超17例(53.13%)脾脏轻度肿大、3例(9.38%)肝脏肿大。误诊病种:上呼吸道感染、支气管-肺感染、伤寒、肾综合征出血热、急性胃肠炎、急性肝炎、淋巴结炎、麻疹。结论误诊原因主要是临床医师对该病临床表现认识不足,因此提高对本病认识,细致体检,注重流行病学资料是减少误诊的关键。

Objective To discuss the reason for misdiagnosis of tsutsugamushi disease,and improve the early diagnosis.Methods Retrospectively analyzed the clinical data and laboratory examinations of 32 cases of tsutsugamushi disease.Results All 32 cases had fever（100%）.27 cases（84.38%） had eschar or ulcer in scapular,abdomen,neck,axilla,popliteal fossa,perineum,buttocks or legs.Swollen lymph nodes appeared in 12 cases（37.5%）,mainly in the neck or groin lymph nodes.18 cases had skin rash（56.25%）.11 cases had a headache and dizziness（34.38%）.The results of blood routines tests in 17 cases were abnormal（53.13%）.Among them,the total of white blood cell（WBC） were lower than normal in 10 cases and higher than normal in 1 case,and the platelet count were lower than normal in 6 cases.The liver function was abnormal in 30 cases（93.75%）.The urine routine was abnormal in 2 cases（6.25%）.The chest radiograph of 15 cases（46.88%） had pathological changes of pulmonary interstitial or increased lung markings.And the abdominal type-B ultrasonic of 17 cases（53.13%） presented that the spleen was mild enlargement and 3 cases（9.38%） had appeared liver enlargement.Misdiagnosed diseases： upper respiratory tract infections,bronchial-pulmonary infections,typhoid fever,hemorrhagic fever with renal syndrome,acute gastroenteritis,acute hepatitis,lymphadenitis and measles.Conclusion The main cause for misdiagnosis of the disease is that the clinicians were lack of knowledge for the specific clinical manifestations of the disease.Therefore,improving the knowledge of the disease,doing the physical examination carefully and focusing on epidemiological data is the key to reduce the misdiagnosis.