58例恙虫病并发肺部感染的流行病学及临床分析

Clinical and epidemiological analysis on 58 cases with tsutsugamushi disease complicated with pulmonary infection

目的：探讨恙虫病并发肺部感染的流行病学及临床特点。方法回顾性收集2013年1月至2015年12月我院58例恙虫病并发肺部感染患者资料，进行流行病学和临床特点分析。结果恙虫病患者的职业主要为农民，其次为部队官兵和学生，发病无性别差异，发病率较高的年龄组为41～60岁。四季均有病例发现，发病高峰在7月，其次为6、8、9、10月。感染者均有野外草地接触史。主要症状为畏寒、发热（100％），咳嗽、咳痰、气喘、胸痛，体征主要为皮肤焦痂或溃疡（96.6％），局部淋巴结肿大57例（98.3％）。予多西环素治愈56例，治愈率96.6％，2例死亡，死亡率3.4％。死因为恙虫病合并脓毒性休克、急性呼吸窘迫综合征、血小板减少症、多器官功能衰竭等。该病确诊前绝大多数被误诊，误诊率98.3％，分别被误诊为急性上呼吸道感染、急性气管支气管炎、社区获得性肺炎、颅内感染、血液病等，误诊时间最长达21天。结论恙虫病并发肺部感染的临床表现复杂，全身系统并发症多，误诊率高，流行病学史及特异性焦痂溃疡有助于确诊，加强健康教育，避免坐草地，仔细寻找焦痂溃疡可提高确诊率，改善预后。

Objective To understand the epidemiological and clinical feature of tsutsugamushi disease com-plicated with pulmonary infection.Methods The data of 58 cases of tsutsugamushi disease in our hospital were col-lected from Jun 2013 to Dec 2015.The epidemiological and clinical characteristics were analyzed.Results The main occupation of tsutsugamushi disease was farmers.Students and army officers and soldiers were the minor profes-sion.No difference was found about the sexuality.The patients aged 41 ~60 years had the highest incidence.The ca-ses could exist during four seasons.The peak of onset was at July.Then more cases were suffered at June,August, September or October.All the sufferer had field grassland contact history.The main symptoms were chilly and fever （100%）.The main physical sign were eschar and ulcer in skin （96.6%）.57 cases were suffered in regional en-largement of lymph nodes （98.3%）.All the patients with tsutsugamushi disease were treated with doxycycline or az-ithromycin and the cure rate was 96.6%.2 patients with tsutsugamushi disease were died from septic shock,throm-bocytopenia or multiple organ dysfunction syndrome,and the mortality was 3.4%.The majority of patients with tsut-sugamushi disease were misdiagnosed before a definite diagnosis and the the misdiagnosis rate was 98.3%.They were misdiagnosed as acute upper respiratory tract infection,pneumonia,intracranial infection,blood disease,and et al. The length of misdiagnosis added up to 21 days.Conclusion Tsutsugamushi disease complicated with pulmonary in-fection has both sophisticated clinical manifestations,a lot of systematic complications,and higher misdiagnosis rate. The epidemiological history and distinctive ulcer or eschar can both contribute to the definite diagnosis of tsutsuga-mushi disease.Both reinforce of health education and prevention from sitting on the grass will play a role in enhancing the diagnosis rate and improving the prognosis of tsutsugamushi disease.