宿迁地区32例恙虫病临床特征分析

Clinical characteristics of 32 cases of tsutsugamushi disease in Suqian Munici-pality

目的分析宿迁地区恙虫病临床特征,为临床诊断与治疗提供参考。方法对宿迁市人民医院急诊中心近2年来诊治的32例恙虫病患者的病例资料进行回顾性分析。结果恙虫病在每年8-11月高发,32例患者均有野外草地等接触史,均有高热及恙螨叮咬处焦痂、溃疡、淋巴结肿大等症状,其中30例出现不同程度肝损害(93.75%),14例有肺部损害(43.75%),9例有心脏损害(28.13%),6例有肾损害(18.75%),1例发生弥散性血管内凝血和多脏器功能障碍综合症(MODS)(3.1%);变形杆菌OX2和OX19均阴性,OXK凝集反应仅6例阳性(18.75%)。32例病例首诊误诊24例,误诊率高达75%。阿奇霉素治疗效果较好,治愈率为96.88%,仅1例死亡,病死率为3.13%。结论恙虫病临床表现比较复杂,且合并肝损害最常见,但是外斐氏试验结果对本地区恙虫病的早期诊断意义不大。临床医生尤其是急诊医生要对该病充分认识,对不明原因发热伴肝损害的患者,应考虑恙虫病的可能,减少误诊。

Objective To understand the clinical characteristics of tsutsugamushi disease in Suqian Municipality,Jiangsu Province so as to guide the diagnosis and treatment of this disease. Methods The clinical data of 32 patients diagnosed as tsutsugamushi disease in our hospital during the past 2 years were analyzed retrospectively. Results Tsutsugamushi disease occurred frequently between August and December. All the 32 patients had the history of contacting grass and brushwood,and all of them showed the signs of pyrexia,eschar,ulcer,swelling of lymph nodes and rash. Liver damages were observed in 30 cases（93.75%）. Pulmonary imaging changes were observed in 14 cases（43.75%）. Heart damages were noticed in 9 cases（28.13%）. Kidney damages were noticed in 6 cases（18.75%）. One case was complicated by multiple organ dysfunction syndromes（MODS） and disseminated intravascular coagulation（DIC）. The OX19 and OX2 antigen agglutination reaction of bacillus proteus were negative in all the cases. The OXK antigen agglutination reaction of bacillus proteus was positive in 6 cases（18.75%）. Among 32 cases,24 cases were misdiagnosed in the first visiting clinic. The misdiagnosis rate of the initial diagnosis of this disease reached as high as 75%. Azithromycin was effective. The curative rate was 96.88% and the mortality was 3.13%（1 case）. Conclusions Clinical characteristics of tsutsugamushi disease are complicated,and it is commonly complicated with liver damages. The Weil-Felix test is not very important to initial diagnosis for tsutsugamushi disease in local. For patients as fever with unknown origin（FUO） and with the liver damage,the diagnosis of tsutsugamushi disease should be reminded.