重症恙虫病延治致多器官功能衰竭1例

目的 报告临床确诊为重症恙虫病延误治疗致多器官功能衰竭病例1则,结合文献学习,以提高临床医生对重症恙虫病的认识。 方法 报告广州中医药大学第一附属医院1例重症恙虫病患者的临床及实验室检查结果并进行分析,结合文献学习,对重症恙虫病的诊治进行总结。 结果 患者,男,47岁,因反复胸闷半月,加重伴发热、意识障碍2 d入院,查体见全身红色斑丘疹、阴囊处一火山口焦痂,外周血宏基因组新一代测序(mNGS)提示恙虫病东方体。予多西环素抗感染、支持治疗等对症处理后,患者白细胞、中性粒细胞百分比等逐日升高、氧合指数持续下降、凝血功能障碍、心肝肾多器官功能衰竭,病情持续恶化,最终死亡。 结论 恙虫病的预后在于尽早诊治,合理施治。早期诊治,一般预后良好。恙虫病的延误诊治可加重患者的器官损害,增加患者死亡风险。

Multiple organ dysfunction caused by delayed treatment of severe tsutsugamushi disease: report of 1 case

Objective To report a clinically confirmed case of multiple organ dysfunction caused by delayed treatment of severe tsutsugamushi disease, in order to improve clinicians understanding of the disease. Methods The clinical and laboratory data of the patient were analyzed, relevant literature was reviewed, and the diagnosis and treatment were summarized. Results The patient, a 47-year-old male, was admitted due to symptoms including repeated chest tightness for half a month, fever and disturbance of consciousness for 2 days. Physical examination showed red macules and papules all over the body, and an eschar at the scrotum. Metagenomic next-generation sequencing(mNGS)suggested Orientia tsutsugamushi. After doxycycline and supportive therapy, the percentage of white blood cells and neutrophils increased day by day; oxygenation index continued to decrease; coagulation dysfunction occurred; heart, liver and kidney failed; the condition continued to deteriorate and the patient eventually died. Conclusion The key to the prognosis of tsutsugamushi disease is early diagnosis and reasonable treatment, which generally lead to good prognosis. Delay diagnosis and treatment can aggravate organ damage and increase the risk of death.