扬州地区急诊收治38例恙虫病临床特点分析

Clinical analysis of 38 cases of tsutsugamushi disease from emergency department

目的：分析恙虫病的临床特点,为早期诊断及治疗提供依据。方法：对2012~2014年本院急诊科收治的38例恙虫病住院患者的临床特点及诊治过程进行回顾性分析。结果：38例患者发病时间为每年10~11月,临床均有发热、特异性溃疡或焦痂、淋巴结肿大、嗜酸细胞减少等典型表现;其中皮疹22例（57.9%）,肝脾肿大19例（50.0%）;血常规示白细胞正常者29例（76.3%）,白细胞增高者3例（7.9%）,白细胞下降者6例（15.8%）,血小板下降者12例（31.6%）,嗜酸细胞计数为0者27例（71.1%）;尿常规示蛋白尿者12例（31.6%）,尿隐血者16例（42.1%）;血生化示肝功能异常者26例（68.4%）,心肌损伤者22例（57.9%）;X线检查示支气管炎者7例（18.2%）,肺炎者12例（31.6%）;所有病例予阿奇霉素抗感染治疗后24~48h体温均恢复正常。结论：恙虫病临床表现复杂且无特异性,易误诊;详细询问流行病学史、全面体格检查、寻找特异性焦痂是减少误诊关键;及早应用阿奇霉素抗感染可减少出现并发症的机会。

Objective：Analyze the clinical features of tsutsugamushi disease,to provide a basis for early diagnosis and treatment of this disease. Method.. The clinical data of 38 cases of tsutsugamushi disease from 2012--2014 were retrospec- tively analyzed. Result： Morbidity time of 38 tsutsugamushi cases ranged from October to November. All patients had fe- ver, sore ulcer or char, lymphadenopathy, eosinophils reduction. Among them, skin rash in 22 cases （ 57.9 % ）, splenomegaly and hepatomegaly in 19 cases（50.0% ）. Peripheral blood shows leukocytes normal in 29 cases （76.3 % ）, leukocytosis in 3 cases （ 7.9 % ）, leucopenia in 6 cases （ 15.8 % ）, thrombocytopenia in 12 case （ 31.6 % ）, and in 27 cases （ 71.1 % ） eosinophilic count were zero. Urine routine shows proteinuria in 12 cases （31.6 % ）, hematuria in 16 cases （42.1 % ）. Biochemical tests shows hepatic dysfunction in 26 cases （ 68.4 % ）, myocardial injury in 22 cases （57.9 % ）. X ray examination shows bronchi- olitis in 7 cases（18.2 %）, pneumonia in 12 cases（31.6 %）. All patients were treated with azithromycin, the temperature returned to normal in 24-48 h after azithromycin treatment. Conclusion.. Clinical manifestations of tsutsugamushi disease were comlex and not specific, which often leads to misdiagnosis. Detailed illness history, careful physical examination, typi- cal eschar are helpful to diagnosis. Early application of azithromycin may reduce the chance of complications.