2009-2011年恙虫病流行和临床特征分析

Analysis of 2009～2011 Tsutsugamushi Xiangyun County of Yunnan Province Disease Prevalence and Clinical Features

目的掌握恙虫病的流行和临床特征,为提出有效的预防控制和诊治措施提供依据。方法收集2009～2011年临床诊断治疗的恙虫病病例,Excel软件建立相关数据库并进行整理分析。结果共收集3年间临床诊治恙虫病病例66例,63例（95.5%）发生于夏秋季7～10月,呈现明显的季节相关性;各年龄段人群普遍易感,农民为高发人群（占57.6%）。临床症状突出表现为高热或超高热（86.4%）,多位于身体隐蔽部位的特征性焦痂或溃疡（74.2%）,可同时存在多器官功能损害,肝功能损害44例（66.7%）,心肌酶谱异常15例（22.7%）,肺部感染24例（36.4%）。早期检测外斐氏试验阳性率较低（26.8%）。氯霉素、四环素类、大环内酯类和喹诺酮类抗生素单用或联合使用对恙虫病有效。结论恙虫病发病有明显的季节性,预防重点应是夏秋季的农村地区,争取早期诊断并使用敏感抗生素治疗可有效控制恙虫病病情。

Objective To clarify the characteristic of prevalence and clinical features of scrub typhus in Xiangyun,Yunnan Province,and propose effective measures for prevention,diagnosis and treatment. Methods Scrub typhus cases from 2009 to 2011 in Xiangyun people＇ s Hospital were collected,relevant databases were established and analyzed by Excel software. Results 66 scrub typhus cases were collected in three years,63 cases（ 95. 5%） occurred in the summer and autumn from July to October,showing a clear correlation with the season; all age groups was generally susceptible to scrub typhus,the farmers was high- risk population（ accounting for 57. 6%）. Prominent clinical symptoms of high fever（ 86. 4%）,characteristic eschar or ulcer almost in hidden parts of the body（ 74. 2%）,and multiple organ dysfunction including liver dysfunction in 44 cases（ 66. 7%）,myocardial enzymes abnormalities in 15 cases（ 22. 7%）,pulmonary infection in 24 patients（ 36. 4%） were found. The positive rate of Weil- Felix test was low at the onset of this disease（ 26. 8%）. Chloramphenicol,tetracyclines,macrolides and quinolones used alone or in combination with were effective on scrub typhus. Conclusions Obvious seasonal characteristics of scrub typhus were found in Xiangyun,prevention should focus on rural areas in summer and autumn,strive for early diagnosis and sensitive antibiotic treatment can effectively control this disease.