位于少见部位的无焦痂恙虫病1例

A case of scrub typhus without eschar located in a rare location

目的报道1例由恙虫病东方体(Orientia tsutsugamushi,Ot)感染引起的不典型皮疹病例,以增进临床医师对该致病微生物及相关疾病的认识,为临床诊断和治疗提供参考。方法回顾性分析2023年6月收治于山西医科大学第一医院的1例恙虫病(scrub typhus,ST)病例,并对相关文献进行复习。结果患者,男,77岁,主诉左前臂皮疹持续1周,并伴有4天的发热,初次入院时被诊断为软组织感染,接受经验性抗感染治疗,包括静脉滴注头孢曲松钠和头孢哌酮钠舒巴坦钠,然而治疗后患者体温未见下降,皮疹亦未见改善。通过病原宏基因组学二代测序检测结果显示Ot阳性,随后口服盐酸多西环素肠溶胶囊治疗,5小时后患者体温恢复正常,3天后病情明显好转并获准出院,1个月后复诊未见并发症。结论ST病例相对较为罕见,且临床表现多样、复杂,尤其是在无典型皮疹表现的患者中诊断相对困难。尽管ST的总体死亡率较低,但若未能及时诊断并给予针对性治疗,可能导致严重并发症甚至危及生命。因此,临床医生应加强对该致病微生物及其感染的认识,尽早识别感染并积极治疗,以免发生严重并发症。

Objective This case report aims to present a unique instance of atypical rash resulting from Orientia tsutsugamushi(Ot)infection.The primary objective is to augment the comprehension of the pathogenic microorganism and associated diseases among clinical practitioners,thus offering valuable insights for clinical diagnosis and treatment approaches.Methods A retrospective analysis was performed on a scrub typhus(ST)case admitted to First Hospital of Shanxi Medical University in June 2023,supplemented by a comprehensive review of pertinent literature.Results The patient,a 77-year-old male,presented with a persistent rash on the left forearm lasting one week,concomitant with a four-day febrile episode.Due to the initial diagnosis of soft tissue infection,the patient underwent empirical anti-infection therapy involving intravenous administration of ceftriaxone sodium and cefoperazone sodium sulbactam sodium.Despite treatment,the patient's fever persisted,and the rash failed to ameliorate.Notably,pathogen metagenomic next-generation sequencing(mNGS)testing confirmed Ot positivity.Subsequent management entailed oral administration of doxycycline hydrochloride enteric-coated capsules,resulting in prompt normalization of body temperature in five hours.Substantial clinical improvement was observed after three days,facilitating the patient's discharge.A follow-up examination one month post-discharge revealed an absence of complications.Conclusion Cases of ST are relatively infrequent,characterized by a spectrum of intricate and diverse clinical manifestations,particularly challenging in patients lacking typical rash presentations,thereby complicating diagnostic endeavors.While the overall mortality rate associated with ST is relatively low,delayed diagnosis and inadequate provision of targeted therapies may precipitate severe complications,potentially jeopardizing patient outcomes.Consequently,clinicians are urged to fortify their comprehension of the pathogenic microorganism and its infectious sequelae,emphasizing early detection and proactive intervention to avert grave complications.