78例伤寒、副伤寒临床分析

目的了解近10年广州地区伤寒、副伤寒的流行、临床表现及并发症。方法采用回顾性分析1997～2006年间我院伤寒、副伤寒的住院病例。结果78例病例中，伤寒63例（80-8％），副伤寒15例（19．2％）其中副伤寒甲13例、副伤寒乙2例，副伤寒病例占构成比从1997～2001年的8．3％（3／36）上升至2002～2006年的28．6％（12／42）。男性41例、女性37例，全年均有散发。发热，肝、脾肿大，白细胞正常或减少，嗜酸粒细胞减少是伤寒、副伤寒的主要临床特征，表情淡漠、相对缓脉、玫瑰疹均较少见。常见并发症为中毒性肝炎、心肌炎。血小板减少、肾损害亦不少见。血／骨髓培养阳性率33．3％，肥达反应阳性率82．1％。伤寒、副伤寒对氟喹诺酮类或第二、三代头孢菌素类敏感，平均热退时间（5．3±2．5）d。结论近年伤寒病例所占比例有下降，副伤寒病例所占比例有增加趋势，伤寒、副伤寒多呈不典型临床表现，最常见并发症为中毒性肝炎，血小板减少、肾损害亦不少见。

Clinical analysis of typhoid fever and paratyphoid fever

Objective To understand the prevalence, clinical manifestations and complications of patients with typhoid fever and paratyphoid fever in Guangzhou. Methods A retrospective survey of 78 cases （including 41 males and 37 females） with typhoid fever or paratyphoid fever was conducted in Second Affiliated Hospital of Guangzhou Medical College during 1997 - 2006. Results Out of 78 patients there were 63 typhoid fever cases （80.8%） and 15 paratyphoid fever cases （19.2%）. The proportion of paratyphoid fever was increased from 8.3% during 1997 - 2001 to 28.6% during 2002 - 2006. The disease occurred all year - round. The predominant clinical manifestations were fever, hepatomegaly, splenamegaly, leucopenia and eosinopenia etc. Typhoid hepatitis was the most frequent complication found in this survey. Thrombocytopenia, renal lesion were more frequency too. The results of Widal test was positive for 64 cases （82.1% ） and blood cultures was positive for 26 cases （33.3 % ）. Salmonella typhi and Salmonella paratyphi were still sensitive to fluoroquinolones and the second, third generation of cephalothins . The average fever clearance time after antibiotic therapy was（5.3 ± 2.5） days. Conclusion In recent years the proportion of paratyphoid fever tends to increase and the clinical manifestations of patients with typhoid fever and paratyphoid fever are atypical. Typhoid hepatitis are the most frequent complica- tions, thromboeytopenia , renal lesion are more frequent.