儿童恙虫病45例临床特征及误诊原因分析

目的总结安徽省阜阳地区临床诊断为恙虫病患儿的临床特征和流行病学。方法选择2009年1月至2010年12月在安徽省界首市人民医院和阜阳市妇幼保健院病案史中检索出院第1诊断为≤14岁恙虫病病例为研究对象。采集居住地（农村和城市）、发病月份、野外郊游史、诊断时年龄和性别等流行病学资料;采集高热、特征性溃疡或焦痂、淋巴结肿大、皮疹等主要临床特征,以及病史中各系统损害的症状和体征。结果因两家医院均不能开展外斐试验和恙虫病立克次体检查,只符合临床诊断的45例恙虫病病例资料进入分析,其中41例为乡村医生转诊。①男性30例,女性15例;9个月至3岁16例,～7岁21例,～13岁8例;居住地城市3例,农村42例。45例均有野外游玩史或接触秸秆史。②45例均表现为高热和特征性溃疡或焦痂,分布于阴部和腹股沟居多。均表现为淋巴结肿大,其中全身浅淋巴结肿大28例。44例表现为皮疹,其中8例为全身性。③45例均有肝肿大表现,其中脾肿大6例,咳嗽13例,头痛28例。实验室检查肝功能均异常,心肌酶增高26例,乳酸脱氢酶增高26例。④住院后24h第一诊断误诊26例（57.8%）,其中误诊为呼吸道感染13例。⑤临床诊断病例均予阿奇霉素和地塞米松治疗,治疗后72h内退热,治愈出院,无一例复发。结论儿童恙虫病有临床特征性表现,合并多系统损伤,特别是肝肿大和肝功能异常是儿童恙虫病的特点。

Analysis of misdiagnosis and clinical features of 45 children with scrub typhus

Objective To summarize the epidemiology and clinical features of children clinically diagnosed as scrub typhus in Fuyang,China.Methods Children younger than 14 years old whose the first diagnosis was scrub typhus hospitalized in the People＇s Hospital of Jieshou and Maternal and Child Care Hospital of Fuyang from January 2009 to December 2010 were retrospectively investigated.Epidemiological characteristics including residence（urban and rural areas）,incidence of the month,history of field excursions,age at diagnosis,gender as well as clinical features including high fever,typical ulcer or eschar,lymph nodes and other symptoms and signs of impairment were collected.Results Forty-five children clinically diagnosed as scrub typhus were enrolled since Petri test and Rickettsia test could not be taken in the two hospitals.41 were transfered from countryside.①Thirty children were boys and 15 were girls.Sixteen children aged 9 months to 3 years,21 aged-7 years,8 aged-13 years.Three children lived in urban areas and 42 lived in rural areas.All patients had history of exposure to the wild stalk and straw.②Forty-five patients had high fever（30 remittent fever and continued fever）,typical ulcer or eschar mainly distributed in perineum and groin and lymph nodes（28 patients with superficial lymph nodes）.Forty-four patients had rashes,8 out of which had systemic rashes.③Forty-five patients had hepatomegaly,6 with splenomegaly,13 with cough and 28 with headache.Liver function of 45 patients were abnormal,activity of enzymes elevated in 26 patients and lactate dehydrogenase increased in 26 patients.④In the first 24 h after admission,26 patients（57.7%）were misdiagnosed,of them 13 patients were misdiagnosed as respiratory infection.⑤All patients were treated with azithromycin and dexamethasone,fever was reduced and recovered within 72 h after treatment.No patient recurred.Conclusions Children with scrub typhus have typical clinical features,especially characterized as hepatomegaly and abnormal liver function,which can be complicated with multiple organ damages.