一起伤寒聚集性发病事件临床分析  

Clinical analysis on typhoid fever patients in a clustering event

作　　者：田地 王爱彬 葛子若 韩冰 宋美华 徐艳利 宋蕊 蒋荣猛 刘志强[2] 陈志海 Tian Di;Wang Aibin;Ge Ziruo;Han Bing;Song Meihua;Xu Yanli;Song Rui;Jiang Rongmeng;Liu Zhiqiang;Chen Zhihai(Department of Infectious Diseases,National Clinical Key Specialty for Infectious Diseases,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Center for Disease Control and Prevention,Pinggu District,Beijing 101200,China)

机构地区：[1]首都医科大学附属北京地坛医院感染性疾病诊疗中心、感染病科国家临床重点专科,北京100015 [2]北京市平谷区疾病预防控制中心,北京101200

出　　处：《中华实验和临床感染病杂志（电子版）》2019年第6期496-500,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：首都医科大学附属北京地坛医院院内科研基金“育苗计划”(No.DTYM201811);国家科技重大专项(No.2018ZX09711003)

摘　　要：目的了解伤寒聚集性发病事件的流行病学及临床表现,进一步指导临床诊治、减少漏诊误诊。方法回顾2018年8月首都医科大学附属北京地坛医院一起伤寒聚集性发病事件,分析事件人群的流行病学、临床症状以及实验室检查特点。结果13例患者均为北京市平谷地区环卫工人,其中女性8例、男性5例,年龄36~48岁,流行病学史相似。均以发热为首要表现,12例(92.3%)患者伴消化道症状,6例(46.2%)患者出现呼吸道症状。13例患者白细胞计数为(5.22±1.73)×10^9/L,5例(39.5%)患者白细胞减少;7例(53.9%)患者嗜酸性粒细胞计数低于正常值下限。11例(84.6%)患者肝功能轻度异常。C-反应蛋白(CRP)为32.5(8.15,49.45)mg/L。仅1例患者降钙素原(PCT)升高,余12例患者PCT未见明显异常。9例患者腹部超声提示异常。1例患者胸片提示右肺下野外带索条影;1例患者胸片提示左肺舌叶炎症。血培养阳性率为84.6%(11/13);恢复期肥达反应阳性率为61.5%(8/13);13例患者病程第2~3周行便培养均为阴性,经治疗后均好转出院。结论本次13例患者为聚集性发病,病情较轻、症状不典型,肝功能损伤多见。故应警惕呼吸道症状,以肺炎为首要表现者,避免误诊,而轻型、不典型患者应避免漏诊;尽早行血培养有助于明确诊断,肥达反应阴性并不能排除伤寒。Objective To investigate the epidemiological and clinical features of a occurrence of typhoid fever,and to furtherly guide the clinical diagnosis and treatment to reduce the misdiagnosis of missed diagnosis.Methods A clustering event of typhoid fever from Beijing Ditan Hospital,Capital Medical University in August 2018 was reviewed,retrospectively.The epidemiology,clinical symptoms and laboratory examination were analyzed,respectively.Results All the 13 patients were sanitation workers in Pinggu Area of Beijing,including 8 females and 5 males,aged 36-48 years old,with similar epidemiological history.Fever was the primary manifestation,12 patients(92.3%)of the patients had digestive tract symptoms,and 6 patients(46.2%)had respiratory symptoms.The white blood cell count of 13 patients was(5.22%±1.73)×10^9/L,5 patients(38.5%)with white blood cell decreased;the counts of eosinophils of 7 patients(53.9%)were lower than the lower limit.There were 11 patients(84.6%)with abnormal liver function.The average level of C-reactive protein(CRP)was 32.5(8.15,49.45)mg/L.The level of procalcitonin(PCT)was elevated in only one patient,and there were no significant abnormalities in PCT of the other 12 patients.Abdominal ultrasound showed abnormality in 9 patients.Chest radiography of 1 patient showed cord shadow in the right lung,and chest radiography of 1 patient showed inflammation in the left lingual lobe.The positive rate of blood culture was 84.6%;the positive rate of Widal’s reaction in convalescent period was 61.5%(8/13);13 patients were all discharged after treatment.Conclusions The 13 patients were aggregation disease,with mild condition,atypical symptoms,and liver function damage were more common.The symptoms of the respiratory tract should be alerted to,in order to avoid misdiagnosis of cases with pneumonia as the primary expression;mild and atypical patients should avoid missed diagnosis.It is necessary to carry out the blood culture as early as possible to help clarify the diagnosis,Widal’s reaction negative cann

关 键 词：伤寒 聚集性事件 临床分析 

分 类 号：R516.3[医药卫生—内科学]