皖南地区52例恙虫病临床特征分析

Analysis on the clinical pictures of scrub typhus in 52 cases in southernAnhui Province

目的 探讨皖南地区恙虫病的临床特征及误诊情况,为及时、有效地诊治该病提供参考。方法 以2018年1月至2023年10月皖南医学院第一附属医院收治的恙虫病病例为研究对象,收集病例人口学特征、临床表现及相关检查等资料并进行描述性分析。结果 共收治病例52例,男性和女性分别为24例(占46.15%)和28例(占53.85%);平均年龄(56.71±12.36)岁,以30~69岁为主(44例,占84.62%);职业以农民居多(26例,占50.00%)。高发期为6—11月(40例,占76.92%)。有明确昆虫叮咬史17例(占32.69%)。临床特征以发热(52例,占100.00%)、皮疹(51例,占98.08%)、焦痂(50例,占96.15%)和纳差(38例,占73.08%)为主。实验室检测以C反应蛋白、谷草转氨酶、乳酸脱氢酶和D-二聚体升高为主,分别为45例(占86.54%)、33例(占63.46%)、45例(占86.54%)和47例(占90.38%)。心电图多为ST-T改变、房性期前收缩、室性期前收缩,分别有17例、11例和8例;CT显示胸腔积液8例,肺部感染性病变11例;腹部超声发现肝肿大6例,脾肿大10例。病例予以左氧氟沙星或莫西沙星治疗12例,多西环素治疗40例,退热天数分别为(4.52±1.87)d和(2.71±1.08)d;住院时间分别为(6.75±2.26)d和(4.16±2.15)d;所有病例均治愈。病例平均确诊时间为(6.45±2.20)d。误诊38例(占73.08%),分别为细菌感染25例,病毒感染8例,药物性皮炎3例,风湿免疫系统疾病2例。结论 皖南地区的恙虫病患者临床表现仍是以特异性皮疹、焦痂为主,但误诊率较高。临床诊断时,应详细询问流行病学史,仔细体格检查,认真分析辅助检查,从而减少误诊的发生。

Objective To analyze the clinical characteristics and misdiagnosis of scrub typhus in patients from south-ern Anhui area for evidences to make timely and effective diagnosis and treatment for this acute infection.Methods Included in current study were the patients with Orientia tsutsugamushi treated in the First Affiliated Hospital of Wan-nan Medical College between January 2018 and October 2023.The data,including demographic information,clinical manifestations and related examination findings,were collected and descriptively analyzed.Results A total of 52 cas-es were included,in whom 24 were males(46.15%)and 28 females(53.85%).The average age was(56.71±12.36)years,with the majority being 30-69 years(44 cases,84.62%).The infection most occurred in farmers(26 cases,50.00%),and the highest prevalence was seen in the period from June to November(40 cases,76.92%).The patients had definite history of insect bites(17 cases,32.69%),and the clinical pictures primarily consisted of fever(52 cases,100.00%),rash(51 cases,98.08%),scabs(50 cases,96.15%),and poor appetite(38 cases,73.08%).The laboratory tests mainly showed elevated levels of C-reactive protein(45 cases,86.54%),aspartate aminotransferase(33 cases,63.46%),lactate dehydrogenase(45 cases,86.54%),and D-dimer(47 cases,90.38%).The electrocardiogram chiefly exhibited ST-T changes(17 cases),atrial premature contractions(11 cases),and ventricular premature contractions(8 cases).CT scans exposed pleural effusion in 8 cases and pulmonary infectious lesions in 11.Abdominal ultrasonography revealed liver enlargement in 6 cases and splenomegaly in 10 cases.The fever relief was(4.52±1.87)days in the 12 patients treat-ed with levofloxacin or moxifloxacin therapy,and(2.71±1.08)days in another 40 treated with doxycycline.The length of hospital stay was(6.75±2.26)days and(4.16±2.15)days,and all patients were cured.The average time for diagnosis was(6.45±2.20)days.Misdiagnosis occurred in 38 cases(73.08%),which included 25 cases of bacterial infection,8 cas-es of viral infection,3 cases of drug-induced dermatitis and 2 cases of rheumatic and immune system diseases.Conclu-sion The clinical characteristics of tsutsugamushi disease in southern Anhui are still mainly specific rashes and scabs,but the misdiagnosis rate is relatively high.When making a clinical diagnosis,it is necessary to inquire in detail about the epidemiological history,conduct a thorough physical examination,and carefully analyze auxiliary examinations to reduce the occurrence of misdiagnosis.