云南省儿童恙虫病50例临床特征分析

Clinical characteristics of 50 cases of children with Tsutsugamushi in Yunnan province

目的了解儿童恙虫病的临床特征,避免漏诊和误诊。方法回顾性分析2018年1月—2019年12月,在昆明市儿童医院住院的50例恙虫病患儿的流行病学资料、临床表现及辅助检查结果。结果50例恙虫病患儿中,男29例、女21例,年龄10个月~13岁,平均年龄5.73岁、年龄中位数5岁;发病月份集中在6—11月,78.0%的患儿在7—9月发病;病例来源于云南省14个地(州、市),均有发热症状;96.0%的患儿来自农村,所有患儿均有草地游玩史,94.0%的有焦痂;患儿存在多脏器损害,其中肝功能损伤41例(82.0%)、呼吸系统受累22例(44.0%)、神经系统受累18例(53.0%)和血液系统受累(血细胞下降、低纤维蛋白血症)46例(92.0%)。结论临床上发现儿童持续反复发热、表现多样和多脏器损害症状应警惕恙虫病,及时询问其流行病学史、仔细查体寻找焦痂、完善相关检查,避免漏诊和误诊。

Objective To understand the clinical characteristics of Tsutsugamushi in children,so as to avoid missed diagnosis and misdiagnosis.Methods The epidemiological data,clinical manifestations,signs and auxiliary examinations results of 50 hospitalized cases of children with Tsutsugamushi were retrospectively analyzed in Kunming Children’s Hospital from January 2018 to December 2019.Results Out of the 50 cases of children with Tsutsugamushi,there were 29 cases of the male and 21 cases of the female,aged from 10 months to 13 years,with the average age of 5.73 years and the median age of 5 years.The disease onset time concentrated from June to November,and 78.0%of children cases concentrated from July to September.All cases came from 14 prefectures(cities),with the symptom of fever.There were 96.0%children came from rural area,all of the cases had the history playing on the grassland,and 94.0%of the cases had the eschar.The children cases had multiple organs impairment,including 41 cases(82.0%)with liver function injury,22 cases(44.0%)with respiratory system involvement,18 cases(53.0%)with nervous system involvement,and 46 cases(92.0%)with hematological system involvement(hemocytopenia and hypofibrinogenemia).Conclusions Attention should be paid to Tsutsugamushi in children with persistent and recurrent fever,various clinical manifestations and multiple organ damage.The epidemiological history should be timely inquired,and physical examination be developed to find eschar,and the relevant examination improved to avoid missed diagnosis and misdiagnosis.