珠海市88例恙虫病临床特征分析

Clinical features analysis of 88 patients with scrub typhus in Zhuhai

目的分析珠海市恙虫病的临床特点,提高临床诊断及治疗水平。方法回顾性分析珠海市88例恙虫病患者的临床资料,探讨其临床特点。结果 65例患者(73.86%)发病前有草地/树林接触史。临床表现主要有发热(100%)、头痛(63.64%)、乏力(39.33%)、咳嗽(35.23%),淋巴结肿大(47.73%)、肝脾肿大(35.22%)、皮疹(29.55%)及特异性焦痂/溃疡(95.45%)等。外周血白细胞计数多正常(71.59%),可伴有嗜酸性粒细胞减少(78.41%)、血小板减少(38.64%),合并肝损害多见(87.5%)。共有84例患者送检外斐试验98例次,变形杆菌OX K凝集反应阳性效价12例次,阳性率12.24%。氯霉素、米诺环素、多西环素、克拉霉素治疗均有效。结论恙虫病临床表现多样,常累及多个系统,焦痂/溃疡为其最具诊断价值的特异体征,需仔细查体以免误诊。外斐试验阳性率低,不能单独做为诊断依据。氯霉素、四环素类及大环内酯类抗生素治疗效果好。

Objective To analyse the clinical features of patients with scrub typhus in Zhuhai and improve the levels of clinical diagnosis and treatment. Methods The clinical data of 88 patients with scrub typhus in Zhuhai was analysed retrospectively. Results Total of 65 patients （73.86%） had a history of contact with grass or woods before illness onset. The clinical manifestations included fever （100%）, headache （63.64%）, fatigue （39.33%）, cough （35.23%）, lymphadenectasis （47.73%）, hepatosplenomegaly （35.22%）, rashes （29.55%） and specifical eschar or ulcer （95.45%）, etc. The peripheral white blood cell count in the majority of patients （71.59%） was normal. Eosinophil decrease （78.41%） and thrombocytopenia （38.64%） were observed. Hepatitis （87.5%） was the most common complication. A total of 99 cases in 84 patients were tested Weil-Felix, among which 12 cases were positive in Proteus OXK agglutination reaction. The positive rate was only 12.24%. Chloramphenicol, Minocycline, doxycycline and clarithromycin treatment were all effective. Conclusions The clinical manifestations of scrub typhus, involving multisystem, are diverse. Eschar and ulcer are the most specific signs. The positive rate of Weil-Felix test is low. The diagnosis of scrub typhus could not just depend on Weil-Felix test. Chloramphenicol, tetracyclines and macrolides are all the effective drugs for this disease.