日本立克次体感染致脓毒性休克的个案和文献分析  

Case and literature analysis of septic shock caused by Rickettsia Japonica infection

作　　者：王点 高依丹 刘是奕 陈公英[2] WANG Dian;GAO Yidan;LIU Shiyi;CHEN Gongying(Department of Respiratory Medicine,Deqing Third People’s Hospital,Huzhou 313201,China;Department of Infectious Diseases,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;Department of Infectious Diseases,Shengzhou People’s Hospital,Shaoxing 312400,China)

机构地区：[1]德清县第三人民医院呼吸内科,浙江湖州313201 [2]杭州师范大学附属医院感染(肝病)科,浙江杭州310015 [3]嵊州市人民医院感染科,浙江绍兴312400

出　　处：《健康研究》2024年第5期591-594,600,共5页Health Research

摘　　要：目的 基于个案和文献,分析日本立克次体感染致脓毒性休克的临床特征,为预防日本斑点热(Japanese spotted fever, JSF)重症化提供参考。方法 报道1例日本立克次体感染迅速进展为脓毒性休克的患者,并通过文献分析,总结日本斑点热的临床特征及诊治措施。结果 报道的病例以消化道症状为首发,病情迅速进展,出现脓毒性休克,宏基因组二代测序(metagenomics next-generation sequencing,mNGS)明确诊断为JSF,经四环素类抗生素等治疗后病情恢复,整体预后良好。通过文献检索纳入国内发病的15例日本立克次体感染患者均表现出发热、皮疹,发病至入院时间多为7天以上;实验室检查以血小板减少(12/15,80%)、低蛋白血症(8/15,53.3%)、嗜酸性粒细胞缺乏(7/15,46.7%)、凝血功能异常(6/15,40%)为主,46.7%(7/15)的患者进展为重症,1例死亡。结论 JSF患者发病至入院的时间延长、出现凝血功能障碍可能为JSF重症化及预后不良的危险因素。mNGS检查可提高JSF诊断效率,疑似或确诊病例出现临床症状应尽早治疗,有助于减少并发症,改善预后。Objective Based on the cases and literature,the clinical characteristics of septic shock caused by Rickettsia Japonica infection were analyzed to provide reference for the prevention of severe Japanese spotted fever(JSF).Methods By reporting a case of Rickettsia Japonica infection which rapidly progressed to septic shock,and combining with literature analysis,the clinical characteristics,diagnosis and treatment measures of JSF were summarized.Results The reported case presented with gastrointestinal symptoms as the initial manifestation,with a rapid progression to septic shock.The diagnosis was confirmed by metagenomics next-generation sequencing(mNGS),and the patient responded well to treatment with tetracycline antibiotics,leading to a full recovery and a favorable overall prognosis.A literature search identified 15 cases of Rickettsial infections caused by Rickettsia Japonica in domestic settings.All patients exhibited fever and rash,with a majority having more than seven days from onset to hospital admission.Laboratory tests revealed thrombocytopenia(12/15,80%),hypoproteinemia(8/15,53.3%)eosinopenia(7/15,46.7%)and coagulation dysfunction(6/15,40%)were the main cases.46.7%(7/15)patients progressed to severe disease and 1 case died.Conclusions Patients with JSF who experience prolonged time from onset to hospital admission and those with coagulation dysfunction may be at higher risk for severe JSF and poor prognosis.mNGS examination can improve the diagnostic efficiency of JSF.Suspected or confirmed cases of clinical symptoms should be treated as early as possible to help reduce complications and improve prognosis.

关 键 词：日本立克次体 日本斑点热 脓毒性休克 文献复习 

分 类 号：R513[医药卫生—内科学]