30例恙虫病特殊临床表现分析及预防建议

The special clinical manifestations of 30 cases of tsutsugamushi disease and its prevention suggestion

目的分析恙虫病典型与特殊临床表现,为准确诊断提供依据。方法回顾性分析30例确诊恙虫病住院患者的临床资料。结果 30例患者除发热、特异性溃疡或焦痂、淋巴结肿大、肝损害等典型表现外,特殊表现包括肺炎16例(53.3%)、心肌炎10例(33.3%)、肾损害9例(30.0%)、脑膜炎2例(6.7%)、胰腺炎1例(3.3%);确诊恙虫病合并流行性出血热感染1例。结论恙虫病临床表现复杂,易误诊。详细询问流行病学史、全面查体、完善检验是减少误诊关键。采取灭鼠、灭恙螨和个体防护等综合防治措施。

Objective To analyze the typical and special features of tsutsugamushi disease for correct diagnosis. Methods Clinical data of 30 hospitalized tsutsugamushi disease patients were analyzed respectively. Results Be- sides fever, specific ulcer or eschar, swollen lymph node and liver injury, special clinical manifestations included pneu- monia（53.3% ） ,myocarditis （ 33.3% ） , kidney injury （ 30. 0% ） , meningitis （ 6. 7% ） , pancreatitis （ 3.3% ）. One patient was diagnosed with tsutsugamushi and epidemic hemorrhagic fever. Conclusion Clinical manifestations of tsutsugamushi disease are diverse. It is likely to be misdiagnosed. Detailed asking of history, physical examination and thorough laboratory tests are the key to reduce misdiagnosis. The enforcement of rodents control, chigger control and human protection should be conducted to prevent tsutsugamushi disease.