恙虫病66例临床分析

目的：探讨恙虫病的诊治特点。方法：对恙虫病66例进行临床分析。结果：以农民多见(75．8％)。本组发病前均有草地等野外活动史。发病在9～11月份。临床以发热(100．0％)、焦痂及溃疡(81．8％)、淋巴结肿大(72．7％)、皮疹(39．4％)和肝脾肿大(47．0％)为主。辅助检查可出现WBC升高(27．3％)，血沉增快(84．8％)，尿RBC阳性(4．5％)及蛋白阳性(4．5％)，外斐反应阳性(90．9％)，ALT升高(59．1％)等。误诊27例。均用强力霉素、氯霉素、氧氟沙星等治疗，治愈率98．5％。因多脏器功能衰竭死亡1例。结论：恙虫病临床表现多样复杂，误诊率高。提高对本病的认识，做到早诊断、早治疗是改善其预后的关键。

Clinical Analysis of 66 Cases of Tsutsugamushi Disease

Objective:To study characteristics of the diagnosis and therapy of tsutsugamushi disease.Methods:The data of 66 cases of tsutsugamushi disease were clinically analysed.Results:Most of the patients(75.8%)were farmers.All the patients had the history of activing in grassplot,with onset from September to November.The main clinical symptoms were pyrexia(100.0%),eschar and ulcer (81.8%),enlarged lymph nodes(72.7%),skin rash(39.4%),hepectomegaly and splenomegaly (46.9%).The laboratory examination showed an increase of leukocytes (27.3%),an increase of erythrocyte sedimentation rate (84.8%),an increase of ALT(59.1%).The urine RBC positive rate was 4.5%,the positive rate urinary protein was 4.5%,and Wei-Felix reaction positive rate was 90.9%,Twenty-seven cases were misdiagnosed with nephritis,hepatitis or pneumonia,and treated with chloromycetin,doxycycline and ofloxacin,with 98.5% of the healing rate.Only one case died of multi-organ failure.Conclusion:The misdiagnosis rate of tsutsugamushi disease is high,with a variety of the clinical manifestations.The early diagnosis and treatment are the key to improve the prognosis.