摘要
目的分析秭归县日本斑点热患者的流行和临床特征,为提高日本斑点热的防治措施提供依据。方法病例系列分析。研究秭归县人民医院2021年4月至2022年8月确诊并住院的18例日本斑点热患者,其中男7例,女11例;年龄60(54,68)岁。收集病历资料,分析其流行病学特征、临床特征、实验室检查及影像学特点。结果18例日本斑点热患者,17例为农民,1例为教师,均有野外接触史。主要发病时间为4至10月,春秋季最多。患者首发症状一般为高热、头痛、乏力、全身肌肉酸痛;15例患者出现皮疹,12例出现焦痂,3例患者无皮疹和焦痂;患者中10例双下肢水肿,3例出现意识障碍等精神症状。实验室检查发现:15例患者白细胞正常或降低,11例血小板降低,C反应蛋白、降钙素原、D-二聚体、乳酸脱氢酶、α-羟丁酸脱氢酶均升高,17例白蛋白降低;13例丙氨酸转氨酶和14例天冬氨酸转氨酶升高;11例尿蛋白异常。结论日本斑点热最常见的临床表现为高热寒战、乏力、头痛、全身肌肉酸痛,作为立克次体感染主要特征的焦痂与皮疹并非在所有患者中存在,因此增加了日本斑点热的诊断难度,造成患者病情的延误,甚至死亡。医疗工作者应在日本斑点热高发季节提高对有野外接触史的不明原因高热患者感染立克次体的警惕,结合患者临床表现、实验室检查结果、影像学资料等及早诊断并给予正确的抗菌药物治疗,控制病情。
Objective The epidemiological and clinical characteristics of 18 cases of Japanese spotted fever(JSF)in Zigui County were analyzed in order to improve the prevention and treatment of JSF.Methods This is a case series analysis.The epidemiological and clinical data,laboratory tests and imaging characteristics of 18 JSF cases with median age of 60 years(54,68)identified by The People′s Hospital of Zigui from April 2021 to August 2022 were collected and analyzed retrospectively.Results Most(17/18)of the patients were farmers and all had a field exposure history.The patient′s onset was from April to October.Spring and autumn were the seasons with the highest incidence of JSF.The first symptoms of patients were high fever,headache,and fatigue.Of the 18 cases,15 had a rash and 12 presented an eschar and 3 had neither rash nor eschar.In addition,10 of 18 cases experienced edema of both lower extremities,and 3 got disturbance of consciousness.Laboratory tests found that 15 patients had abnormal white blood cells and 11 patients had decreased platelets.C-reactive protein,procalcitonin,D-dimer,lactate dehydrogenase,and alpha-hydroxybutyrate dehydrogenase were elevated in all patients;13 patients with elevated alanine aminotransferase,14 patients with elevated aspartate transamination.Kidney damage caused by Rickettsia japonica infection showed by abnormal proteinuria in 11 of the patients.Conclusions The most common clinical manifestations of JSF are non-specific indications such as high fever,chills,fatigue,headache.The eschar and rash,which are the main features of Rickettsia infection,are not present in all patients,resulting delay of diagnosis or misdiagnosis.Medical workers should be more alert to rickettsial infections in patients with fever of unknown origin,especially in seasons of high incidence of spotted fever.Early diagnosis and correct antibiotic treatment shall be given according to the patient′s clinical manifestations,laboratory results and imaging test to control disease progression.
作者
龚萍
陈新
鲁军霖
史海霞
寇友祥
汪长珍
龚发明
秦雪芬
周剑楠
林雪冰
Gong Ping;Chen Xin;Lu Junlin;Shi Haixia;Kou Youxiang;Wang Changzhen;Gong Faming;Qin Xuefen;Zhou Jiannan;Lin Xuebing(Department of Clinical Laboratory,The People′s Hospital of Zigui County,Yichang 443600,China;Department of Clinical Laboratory,Zigui County Hospital of Traditional Chinese Medicine,Yichang 443600,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2023年第2期150-154,共5页
Chinese Journal of Laboratory Medicine
基金
中国疾病预防控制中心传染病预防控制国家重点实验室开放课题(2022SKLID304)
湖北省科学技术厅重点研发课题(2022BCA019)。
