恙虫病误诊病例临床诊治剖析  

Analysis of Diagnosis and Treatment for Misdiagnosed Patients with Tsutsugamushi Disease

作　　者：吴超[1] 姚成州 王改[2] 孙明[1] WU Chao YAO Cheng-zhou WANG Gai SUN Min(Emergency Department Department of Infection Diseases, Suqian People＇s Hospital of Nanjing Drum Tower Hospital, Suqian, Jiangsu 223800, China)

机构地区：[1]南京鼓楼医院集团宿迁市人民医院急诊中心,江苏宿迁223800 [2]南京鼓楼医院集团宿迁市人民医院感染科,江苏宿迁223800

出　　处：《临床误诊误治》2017年第3期51-54,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析恙虫病的临床特征及误诊原因,减少误诊误治。方法对我院2010年8月—2015年12月早期误诊的98例恙虫病的临床资料进行回顾性分析。结果本组病初均误诊,多以发热、咳嗽、上腹部不适、淋巴结增大及皮肤破溃形成焦痂或溃疡就诊,首诊多就诊于感染科、呼吸科、急诊内科,误诊疾病居前3位的分别为肺炎、急性肝炎、上呼吸道感染。查丙氨酸转氨酶升高67例,天冬氨酸转氨酶升高63例,C反应蛋白升高76例;尿隐血阳性23例,尿蛋白阳性25例。在外院就诊过程中多使用青霉素类、头孢菌素类抗生素,入我院后结合临床表现及外斐试验明确诊断为恙虫病,均予阿奇霉素静脉滴注,其中96例(97.96%)治愈,2例死亡(2.04%)。结论恙虫病早期误诊率高,加强医务人员专业培训,在流行季节对发热患者进行仔细查体,合理使用抗生素是减少误诊误治的关键。Objective To analyze clinical features and misdiagnosed causes of tsutsugamushi disease in order to avoid misdiagnosis and mistreatment. Methods Clinical data of 98 misdiagnosed patients with tsutsugamusbi disease during August 2010 and December 2015 was retrospectively analyzed. Results All patients were misdiagnosed at early period of the disease, and patients visited doctors mainly for fever, cough, epigastric discomfort, lymph node enlargement and eschar or ul- cer formation in skin ulceration. Departments of the first diagnosis were infectious diseases, respiratory diseases and emergen- cy departments, and top 3 misdiagnosed diseases were pneumonia, acute hepatitis and upper respiratory tract infection. Medi- cal examinations showed that elevated level of alanine aminotransferase was found in 67 patients, and elevated level of aspar- tate aminotransferase was found in 63 patients, elevated levels blood in 23 patients and positive urinary protein in 25 patients C-reactive protein （CRP） in 76 patients, positive urine occult Penicillins and Cephalosporin antibiotics were mainly used in other hospitals, and tsutsugamushi disease was confirmed by combination of clinical manifestations and Felix test after admis- sion in our hospital, and all patients were treated with Azithromycin iv gtt, and then 96 patients （97.96%） were cured, and 2 patients （2.04%） died. Conclusion Misdiagnosed rate of tsutsugamushi disease during early period is high, and it is the key to avoid misdiagnosis and mistreatment by strengthening professional training of medical staff, carefully checking in the popular season for fever patients and use antibiotics rationally.

关 键 词：恙虫病 误诊 肺炎 肝炎 呼吸道感染 

分 类 号：R513.2[医药卫生—内科学]