恙虫病合并急性呼吸窘迫综合征研究进展

Research progress of scrub typhus complicated with acute respiratory distress syndrome

恙虫病为恙螨幼虫叮咬后感染的地方疫源疾病,是东方立克次氏体感染所致的一种胞内菌,最初表现无明显特异性,与流感症状类似,如发热、头痛、咳嗽、肌肉酸痛、听力短暂丧失等,部分患者查体可见特异性焦痂、淋巴结肿大。该病可累及全身多个器官,重症患者常有急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、急性肾衰竭、心肌炎、脑膜炎、DIC等并发症。目前人们对该病的认知参差不齐,大部分医师尤其是基层首诊医生对恙虫病的认知不足,造成恙虫病误诊、漏诊率仍较高。恙虫病不同地区的毒株类型、疾病检测时间、群体遗传学均存在差异,导致常见的检测方法例如外斐试验阳性率较低。目前对恙虫病合并急性呼吸窘迫综合征的研究较少,本文对恙虫病合并急性呼吸窘迫综合征的诊断以及临床治疗的最新研究进展进行综述,旨在为恙虫病合并ARDS的临床诊疗提供参考。

Scrub typhus is a local epidemic disease infected by the bite of chigger larvae.It is an intracellular disease caused by rickettsia orientalis infection.It usually shows no obvious specificity at first,similar to the symptoms of influenza,such as fever,headache,cough,muscle aches,temporary hearing loss,etc.Some patients can find specific eschar and lymph node enlargement on physical examination,and the disease can involve multiple organs in the body.Severe patients often have acute respiratory dis-tress syndrome(ARDS),acute renal failure,myocarditis,meningitis,DIC and other complications.At present,people have a poor understanding of this disease.Because the first doctors are mostly primary-level doctors,the rate of misdiagnosis and missed diagnosis of tsutsugamushi is still high.According to the different strains of tsutsugamushi disease in different regions,the differ-ence in disease detection time,and the difference in population genetics,the positive rate of Weifi test is poor.Currently,there are few studies on Tsutsugamushi disease combined with acute respiratory distress syndrome.This paper reviews the latest research progress in diagnosis and clinical treatment of Tsutsugamushi disease combined with acute respiratory distress syndrome.The aim is to provide reference for clinical diagnosis and treatment of scrub typhus complicated with ARDS.