安徽省一起恙虫病暴发的流行病学特点及临床特征分析  

Investigation of the epidemiological and clinical characteristics of an outbreak of tsutsugamushi disease in Anhui Province

作　　者：于乐成 汪茂荣 何长伦 汪朝晖 王寿明 高蕾 郭恒彬 王长军 

机构地区：[1]解放军第八一医院感染内科,南京210002 [2]南京军区疾病控制中心

出　　处：《中华传染病杂志》2009年第5期277-280,共4页Chinese Journal of Infectious Diseases

摘　　要：目的分析安徽省滁州地区一起恙虫病暴发的流行病学特点及临床特征，了解我国恙虫病疫源地的某些新变化。方法采用现场流行病学调查、临床特征分析、胶体金免疫色谱法和外斐反应检测恙虫病立克次体特异性抗体相结合的策略诊断恙虫病，并对新疫源地的地貌及气候特征进行调查。结果本次暴发季节为2007年10至11月份，疫源地为偏潮湿山区丛林地带，昼夜气温20～4℃。共发现恙虫病患者19例，其中9例住院治疗，9例在院外已基本恢复并通过血清学试验获得诊断，1例有典型临床表现但因故未获得血清学诊断。19例患者的主要临床特征为：畏寒14例，发热19例，头痛15例；9例住院患者中，淋巴结大8例，皮疹7例，脾大4例，体表焦痂和溃疡7例，抗OXk外斐反应阳性4例；18例检测恙虫病立克次体特异性抗体均为阳性。所有患者均无严重并发症。在首例患者确诊前，所有其他患者均未得到及时和正确的诊断，也未得到抗生素治疗。9例住院患者予多西环素治疗后迅速康复。结论安徽省本次恙虫病暴发系过渡型疫源地秋季型恙虫病。皖北地区存在恙虫病疫源地。多西环素治疗恙虫病快速有效。Objective To investigate the epidemiological and clinical characteristics of an outbreak of tsutsugamushi disease in Chuzhou region, Anhui Province, and to clarify the new changes of epidemic focus of tsutsugamushi disease in China. Methods Field epidemiological investigation and analysis of clinical features were done. The detections of specific antibodies against Rickettsia tsutsugamushf were conducted to diagnose tsutsugamushi disease using colloidal gold immunochromatography assay combined with Well-Felix reaction. The geomorphic and climatic characteristics of the new epidemic focus were investigated. Results The outbreak occurred from October to November, 2007. The epidemic focus located on mountainous brushland regions, and the air temperature fluctuated from 20-4 ℃. Nineteen cases of tsutsugamushi disease in the new-found epidemic focus were finally diagnosed, 9 cases out of them were hospitalized, another 9 had recovered when diagnosed by serological tests; the remaining one had classical manifestations of tsutsugamushi disease but did not receive the serological test for certain cause. The main clinical symptoms were chilly in 14 cases, fever in 19 cases, headache in 15 cases; among the 9 hospitalized patients, the symptoms were lymphadenectasis in 8 inpatients, skin rash in 7 inpatients, splenomegaly in 4 inpatients and skin eschar and ulcer in 7 inpatients and Weil-Felix reaction by OXK antigen positive in 4 cases; the specific antibodies against Rickettsia tsutsugamushi of 18 tested cases were all positive. No severe complications occurred in all patients. Before the first case was identified, all other cases were not diagnosed in time and did not receive correct antibiotic treatment. Nine hospitalized patients recovered rapidly with the treatment of doxycycline. Conclusions The outbreak of tsutsugamushi disease in Anhui Province in 2007 is type of emerged in autumn and transitional epidemic focus. There is epidemic focus of tsutsugamushi disease in northern region of Anhui Province. DoxycycIine is

关 键 词：丛林斑疹伤寒 血清学试验 安徽 流行病学研究特征 多西环素 

分 类 号：R686[医药卫生—骨科学]