海南省恙虫病73例误诊原因分析

Cause Analysis of 73 Misdiagnosed Cases of Tsutsugamushi Disease

目的分析恙虫病的误诊原因,以提高临床恙虫病诊断水平。方法回顾性分析我院2009年1月—2014年12月122例恙虫病的临床资料。结果本组一年四季均有发病,无明显季节性差异;均有发热,大多数有溃疡或焦痂;外斐试验阳性76例(62.30%)。本组误诊73例,误诊率为59.84%,误诊为肺炎20例(27.40%),伤寒11例(15.07%),脓毒症8例(10.96%),急性支气管炎7例(9.59%),上呼吸道感染、脑炎各6例(8.22%),泌尿系感染4例(5.48%),急性胃肠炎、急性肝炎各3例(4.11%),腹股沟淋巴结炎、肾综合征出血热各2例(2.74%),淋巴结结核1例(1.37%)。误诊原因:因患者依从性差误诊37例(50.68%),因查体不仔细误诊21例(28.77%),因实验室检查敏感度低、临床症状体征不典型误诊各16例(21.92%)。结论首诊医师应提高对恙虫病的认识,详细询问流行病学史及仔细查体,并对疑似患者行反复的实验室检查,以降低恙虫病的误诊率。

Objective To analyze the causes of misdiagnosis in tsutsugamushi disease in order to improve diagnostic accuracy. Methods Clinical data of 122 tsutsugamushi cases during 2009 January and 2014 December in our hospital was analyzed retrospectively. Results The disease has been reported in all 4 seasons of the year without much seasonal difference.All the patients ran a fever while most of them also had anabrosis or eschar,and 76 cases（ 62. 30%） were positive for weilfelix test. There were 73 misdiagnosed cases（ 59. 84%） in total. 20 cases（ 27. 40%） were misdiagnosed as pneumonia,11cases（ 15. 07%） as typhus,8 cases（ 10. 96%） as sepsis,7 cases（ 9. 59%） as acute bronchitis,6 cases（ 8. 22%） as infection in upper repository tract and another 6 cases as encephalitis,4 cases（ 5. 48%） as infection in the urinary system,3cases（ 4. 11%） as acute gastroenteritis and another 3 as acute hepatitis,2 cases（ 2. 74%） as panus inguinalis and another 2as hemorrhagic fever with renal syndrome,the last single case was misdiagnosed as lymphatic tuberculosis（ 1. 37%）. The root causes were identified as： 37 cases（ 50. 68%） were caused by non-compliance of the patient,21 cases（ 28. 77%） were caused due to negligent examination,16 cases（ 21. 92%） by low sensitivity level of the laboratory test and another 16 by nontypical clinical symptoms. Conclusion The clinicians need to improve the level of understanding for tsutsugamushi disease,enquire for more details of the epidemiological history of the patient,perform more careful examinations,and give repetitive examinations for the suspected patients in order to prevent misdiagnosis of tsutsugamushi disease.