广州老年人恙虫病50例临床分析

目的分析广州地区老年人恙虫病临床特点,以期降低老年人恙虫病的误诊率、漏诊率及病死率。方法将1983年5月至2008年1月收治的50例广州地区老年人恙虫病从流行病学、主要临床表现、实验室及辅助检查、预后等方面进行回顾性分析研究。结果广州地区老年人恙虫病仍具有发热、焦痂溃疡、淋巴结肿大的特点,但皮疹少见,外周血白细胞数多升高,血小板降低多见,起病隐匿,临床表现趋向多样化、复杂化,多脏器损害多见,易发生误诊、漏诊,病死率达14%。结论老年人恙虫病从流行病学、临床特征、实验室检查方面趋向不典型,极易造成误诊、漏诊,且病死率高,尤其是对病程超过两周的患者,应引起临床医师的高度重视。

Clinical Analysis of Elderly Patients with Tsutsugamushi Disease in Guangzhou Area

Objective To analyze the clinical features of the elderly patients with Tsutsugamushi disease and to identify the factors that may reduce the rate of misdiagnosis and the mortality. Method Clinical data of 50 elderly patients with Tsutsugamushi disease in our hospitals from May 1983 to January 2008 were retrospectively analyzed. Result Fever, eschar and swelling of lymph node were the major clinical features of Tsutsugamushi disease in the elderly patients. Skin rash was rare. The disease development was also associated with a low platelet count and an increase in the peripheral white blood cell count. Onset of the disease was usually insidious. Clinical manifestations were complex and multiple organ damage was frequently observed. Mortality rate was bout 14%. Conclusion There are no typical epidemiological, clinical and laboratory diagnostic features of Tsutsugamushi disease in elderly patients. The disease is frequently misdiagnosed. Mortality rate is especially high in patients with the infection for over 2 weeks. Attention should be paid to the elderly patients with Tsutsugamushi disease.