发热血小板减少综合征误诊一例并文献复习

A Case Report and Literature Review: Severe Fever with Thrombocytopenia Syndrome

目的分析发热血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)的临床特点、误诊原因及其防范措施。方法对我院收治的1例SFTS的临床资料进行回顾性分析,并复习相关文献。结果患者因腹痛、腹泻6 d,发热4 d,尿少、巩膜黄染1 d入院。曾在外院就诊先后诊断为急性肠炎、泌尿系感染,予相应治疗无效。入我院后经综合分析实验室检查结果,高度怀疑SFTS,但患者病情急剧恶化,给予维持血压、抗感染等对症支持治疗无效,入院30 h死亡。死亡后4 h新型布尼亚病毒实时荧光核酸检测结果回报阳性,确诊为SFTS。结论 SFTS临床表现复杂,易误诊。缺乏对SFTS的认识,诊断思维局限,询问病史不详细及未及时行病原学检查是SFTS误诊的主要原因。加强对SFTS的认识,及时认真进行流行病学病史询问及病原学检查可减少SFTS误诊。

Objective To analyze clinical features, misdiagnosis causes and precautionary measures ot severe tever with thrombocytopenia syndrome （SFTS）. Methods Clinical data of one patient with SFTS was retrospectively analyzed, and pertinent literature was also reviewed. Results The patient was admitted for abdominal pain and diarrhea for 6 days, fever for 4 days, oliguria and yellow sclera for 1 day. In other hospitals, the patient was misdiagnosed as having acute enteritis and urinary infection, and corresponding treatments were invalid. SFTS was highly suspected after comprehensive analysis of laboratory examination results in our hospital, but the patientg condition deteriorated rapidly. Blood pressure maintenance and anti infection treatments were not effective, and the patient died after 30 h treatment. The diagnosis of SFTS was defined after laboratory examinations and positivity of real-time reverse transeriptase PCR （RT-PCR） of a novel bunyavirus 4 h after the patient died. Conclusion Clinical manifestations of SFTS are complex and can be easily confused with those of other diseases. Clinicians should pay more attention to patients with SFTS. Epidemiological history and etiology are very important for SFTS diagnosis. The main misdiagnosis causes may be attributive to lack of awareness of SFTS, indistinct medical history and lack of correlative etiology examination.