摘要
目的分析宿迁地区恙虫病的临床特点,为早期诊断及治疗提供依据。方法回顾性分析宿迁市第一人民医院2016年1月-2019年12月收治的132例恙虫病患者的临床资料,总结其临床特点。结果132例患者中男女性别比为1∶1.69;发病年龄28~84岁,平均(57.63±15.29)岁;职业分布以农民为主,共98例(74.24%);发病时间集中于每年10-12月,共126例(95.45%);119例(90.15%)发病前有野外草地劳作或休息史;所有患者均存在不同程度发热,特异性焦痂或溃疡113例(85.61%),皮疹54例(40.91%),淋巴结肿大46例(34.85%),肝脾肿大47例(35.61%);实验室检查嗜酸性粒细胞计数下降114例(86.36%),丙氨酸氨基转移酶(ALT)升高87例(65.91%),天门冬氨酸氨基转移酶(AST)升高82例(62.12%),外斐试验检测95例,阳性仅7例(7.37%);多西环素或阿奇霉素单用或联合应用治疗恙虫病有效,治愈率为100.00%。结论恙虫病临床表现复杂多样,易误诊;流行病学资料及详细体格检查寻找特异性焦痂或溃疡是诊断关键,嗜酸性粒细胞减少及肝功能异常对恙虫病诊断有提示作用,外斐试验诊断价值低。
Objective To explore the clinical characteristics of 132 patients with tsutsugamushi disease in Suqian area,and provide basis for early diagnosis and treatment of this disease.Methods The clinical data of 132 cases of tsutsugamushi disease admitted to the Suqian First People.s Hospital from January 2016 to December 2019 were analyzed retrospectively,and the clinical characteristics of these cases were summarized.Results The sex ratio of male to female in 132 patients was 1∶1.69;their ages ranged from 28 to 84 years,with an average of(57.63±15.29)years old;occupation distribution was mainly farmers,98 cases(74.24%);the onset time was concentrated in October to December every year,126 cases(95.45%).119 cases accounted for 90.15%had a history of field work or rest before onset;among them,all patients showed different degree of fever,specific eschar or ulcer in 113 cases(85.61%),skin rash in 54 cases(40.91%),lymph node enlargement in 46 cases(34.85%),hepatosplenomegaly in 47 cases(35.61%);eosinophil count decreased in 114 cases(86.36%),alanine transaminase increased in 87 cases(65.91%),aspartic transaminase increased in 82 cases(62.12%),only 7 of the 95 cases were positive for Weil-Felix test,accounted for 7.37%.Doxycycline or azithromycin used alone or in combination were effective on tsutsugamushi disease,with the cure rate of 100.00%.Conclusion The clinical manifestations of tsutsugamushi disease were complex and varied,which often lead to misdiagnosis;to diagnose tsutsugamushi disease,the epidemiological data and detailed physical examination for specific eschar or ulcer were the key,and eosinophilic granulocytopenia and abnormal liver function might be additional indicators,but the diagnostic value of Weil-Felix test iwas low.
作者
朱芳
费媛媛
姬会春
严友德
ZHU Fang;FEI Yuan-yuan;JI Hui-chun;YAN You-de(Department of Infectious Diseases,the First People’s Hospital of Suqian,Suqian,Jiangsu 223800,China)
出处
《热带医学杂志》
CAS
2021年第4期460-463,共4页
Journal of Tropical Medicine
关键词
恙虫病
焦痂
临床特点
误诊
Tsutsugamushi disease
Eschar
Clinical feature
Misdiagnosis
