警惕小儿伤寒及副伤寒伴血小板减少的误诊

目的充分认识伴血小板减少的伤寒、副伤寒的临床表现,以避免误诊。方法回顾性分析我科2003年9月—2011年8月收治的伴血小板减少的伤寒、副伤寒16例的临床资料。结果本组16例占同期伤寒、副伤寒病例总数的20.51%（16/78）。16例均有发热,伴乏力及食欲缺乏13例,腹痛6例,头痛5例,咳嗽4例;肝大及肝功能异常9例,出血倾向及相对缓脉各3例,双下肢皮肤出血点、肝脾大及腹水1例。血小板计数30×109/L、60×109/L、74×109/L及83×109/L各1例,余12例为（88～92）×109/L;嗜酸粒细胞计数为0有9例,10×106/L 7例。初诊误诊为发热伴血小板减少原因待查4例,特发性血小板减少性紫癜2例,白血病或恶性肿瘤可能1例。确诊后均予抗感染、补液及对症等处理,除1例因疗效不佳放弃治疗外,余15例预后良好。结论伤寒、副伤寒患者可出现一过性轻度血小板减少或轻度出血倾向,随原发病治疗可好转,嗜酸粒细胞明显下降或消失是伤寒、副伤寒的重要特点。

Misdiagnosis of Typhoid and Paratyphoid Combined with Thrombocytopenia in Young Children

Objective To understand clinical manifestations of typhoid or paratyphoid combined with thrombocytopenia in order to avoid misdiagnosis.Methods Clinical data of 16 patients with typhoid fever or paratyphoid fever combined with thrombocytopenia admitted during September 2003 and August 2011 to our department were respectively analyzed.Results All the 16 patients(20.51%,16/78) with typhoid fever or paratyphoid ran a fever,among whom,13 patients with anergy and anorexia,6 patients with abdominal pain,5 patients with headache,4 patients with cough,9 patients with hepatomegaly and hypohepatia,3 patients with hemorrhagic tendency,3 patients with relatively slow pulse and only 1 patient with petechia on both lower limbs,hepatosplenomegaly and ascites.Platelet counts were 30×109/L,60×109/L,74×109/L,83×109/L in 4 patients and(88~92)×109/L in the other 12 patients.Eosinophilic granulocyte count was zero in 9 patients and 10×106/L in 7 patients.4 patients were misdiagnosed as having undefined fever combined with thrombocytopenia at the first visit,2 patients were misdiagnosed as having idiopathic thrombocytopenic purpura and 1 patient was misdiagnosed as having leukemia or malignancy.15 patients had eusemia except 1 patient who abandoned treatment due to unsatifacfory results.Conclusion Typhoid or paratyphoid always has a transient mild thrombocytopenia or a light bleeding tendency.These symptoms will disappear with the cure of the primary disease.The decrease or disappearance of eosinophilic granulocytes are the important characteristics of typhoid or paratyphoid.