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目的:分析恙虫病的临床特点,为早期诊断及治疗提供依据。方法:对2012~2014年本院急诊科收治的38例恙虫病住院患者的临床特点及诊治过程进行回顾性分析。结果:38例患者发病时间为每年10~11月,临床均有发热、特异性溃疡或焦痂、淋巴结肿大、嗜酸细胞减少等典型表现;其中皮疹22例(57.9%),肝脾肿大19例(50.0%);血常规示白细胞正常者29例(76.3%),白细胞增高者3例(7.9%),白细胞下降者6例(15.8%),血小板下降者12例(31.6%),嗜酸细胞计数为0者27例(71.1%);尿常规示蛋白尿者12例(31.6%),尿隐血者16例(42.1%);血生化示肝功能异常者26例(68.4%),心肌损伤者22例(57.9%);X线检查示支气管炎者7例(18.2%),肺炎者12例(31.6%);所有病例予阿奇霉素抗感染治疗后24~48h体温均恢复正常。结论:恙虫病临床表现复杂且无特异性,易误诊;详细询问流行病学史、全面体格检查、寻找特异性焦痂是减少误诊关键;及早应用阿奇霉素抗感染可减少出现并发症的机会。
Objective: To analyze the clinical features of scrub typhus and provide basis for early diagnosis and treatment. Methods: A retrospective analysis was performed on the clinical features and diagnosis and treatment of 38 tsutsugamushi inpatients admitted to our emergency department during 2012-2014. Results: The onset time of 38 patients was from October to November every year. The clinical manifestations were fever, specific ulcer or eschar, lymph node enlargement and eosinophilia. Among them, 22 cases (57.9%) of rash, hepatosplenomegaly 19 cases (50.0%) were diagnosed as large blood vessel, 29 cases (76.3%) with normal white blood cells, 3 cases (7.9%) with leukocytosis, 6 cases (15.8%) with decreased white blood cells and 12 cases (31.6% 27 cases (71.1%) had eosinophil count of 0, 12 cases (31.6%) had urinary routine proteinuria, 16 cases (42.1%) had urinary occult blood and 26 cases (68.4% ), Myocardial injury in 22 patients (57.9%); X-ray examination showed bronchitis in 7 patients (18.2%), pneumonia in 12 patients (31.6%); all cases of azithromycin anti-infection treatment 24 ~ 48h body temperature returned to normal . Conclusion: The clinical manifestation of scrub typhus is complex and non-specific, easily misdiagnosed; inquiring epidemiological history in detail, comprehensive physical examinations, looking for specific eschar is the key to reduce misdiagnosis; and early application of azithromycin can reduce the chance of complications.