对云南省楚雄州存在肾综合征出血热与恙虫病 混合感染病例的调查

Investigation of mixed infection of hemorrhagic fever with renal syndrome and tsutsugamushi disease in Chuxiong prefecture,Yunnan province

目的了解肾综合征出血热与恙虫病混合感染的特点及预后。方法对楚雄州人民医院2013年1月至2019年12月收住院的18例肾综合征出血热与恙虫病混合感染病例进行统计分析。结果18例病例均来自肾综合征出血热及恙虫病疫区,均有发热、焦痂、淋巴结肿大、器官受损等临床表现。胶体金法检查恙虫病2例(11.11%),其中1例IgM阳性,另1例IgG阳性。外斐反应检查11例(61.11%),均为阴性;另7例未查。胶体金法肾综合征出血热抗体阳性率100.00%,其中IgM阳性16例(88.88%),IgG阳性9例(50.0%);IgM及IgG同时阳性者7例(38.88%)。发病时间集中于7~11月。预后:治愈17例,因病危而自动出院1例。结论云南楚雄存在肾综合征出血热与恙虫病混合感染病例,提示既往危重死亡病例存在混合感染的可能。今后应开展“肾综合征出血热+恙虫病”联检,提高混合感染检出率。上述病例预后较好,因病例数太少而不能得出确切结论。焦痂阳性率达100.00%;但外斐氏反应阳性率为0。建议淘汰外斐氏反应,开展更具特异性恙虫病检查方法。

Objective To investigate the characteristics and prognosis of mixed infection of hemorrhagic fever with renal syndrome and tsutsugamushi disease.Methods A statistical analysis of 18 patients of mixed infection of hemorrhagic fever with renal syndrome and tsutsugamushi disease in the People′s Hospital of Chuxiong Yi Autonomous Prefecture from January 2013 to December 2019 was conducted.Results All the 18 patients were from epidemic areas of hemorrhagic fever with renal syndrome and tsutsugamushi disease,and all had clinical manifestations such as fever,eschar,lymphadenopathy,and organ damage.The colloidal gold method was used to examine 2 patients(11.11%)for tsutsugamushi disease,of which 1 patient was positive for IgM and the other was positive for IgG.Weil Felix reaction method was used to examine 11 patients(61.11%),of which all were negative.The other 7 patients were not examined.The antibody positive rate of hemorrhagic fever with renal syndrome by colloidal gold method was 100.00%,of which 16 patients were positive for IgM(88.88%),9 patients were positive for IgG(50.00%)and 7 patients were positive for both IgM and IgG(38.88%).The onset time was concentrated from July to November.In terms of prognosis,17 patients were cured,and 1 patient was discharged automatically due to critical illness.Conclusion There are mixed infections of hemorrhagic fever with renal syndrome and tsutsugamushi disease in Chuxiong prefecture,Yunnan province,suggesting the possibility of mixed infections in previous critical death.In the future,a joint inspection of"hemorrhagic fever with renal syndrome+tsutsugamushi disease"should be carried out to increase the detection rate of mixed infection.The prognosis of the above patients is good,but the number of patients is too small to draw a definite conclusion.The positive rate of eschar was 100.00%,but the positive rate of Weil Felix reaction was zero.It is recommended to eliminate Weil Felix reaction method and develop a more specific examination method for tsutsugamushi disease.