儿童恙虫病误诊分析并文献复习  

Misdiagnosis of Tsutsugamushi Disease in Children and Literature Review

作　　者：李鑫 张婷 LI Xin;ZHANG Ting(Department of Emergency,Kunming Children's Hospital,Kunming 650228,China;Department of Respiratory,Kunming Children's Hospital,Kunming 650228,China)

机构地区：[1]昆明市儿童医院急诊科,昆明650228 [2]昆明市儿童医院呼吸科,昆明650228

出　　处：《临床误诊误治》2025年第5期11-15,共5页Clinical Misdiagnosis & Mistherapy

基　　金：昆明市卫生健康委员会卫生科研课题项目(2020-06-01-119)。

摘　　要：目的探讨儿童恙虫病误诊原因及预防措施。方法回顾分析2020年收治曾误诊的儿童恙虫病2例临床资料。结果2例均来自恙虫病疫区。1例男性患儿1岁9个月,7月份发病,因发热、皮疹10 d,双足硬肿、肛周脱皮1 d入院,伴有眼结膜充血、口唇干裂等表现,早期诊断为川崎病,予静脉注射丙种球蛋白治疗无效,入我院后查体发现左侧腋窝恙虫病特征性溃疡,确诊为恙虫病,误诊时间为12 d。予多西环素治疗后症状体征迅速改善。1例女性患儿7岁10个月,9月份发病,因发热7 d就诊,外院诊断为扁桃体炎,予头孢曲松治疗无效入我院。查体见全身散在充血性皮疹、结膜充血、唇红、口唇皲裂、杨梅舌,全身未见焦痂,经外斐反应证实为恙虫病,误诊时间为9 d。予红霉素治疗后痊愈出院。结论恙虫病症状不典型,易误诊。加强对恙虫病的认识,熟知其发病特点,仔细寻找焦痂(溃疡),详细询问病史,必要时完善恙虫病病原体检查,可减少或避免恙虫病误诊误治。Objective To explore the causes and preventive measures of misdiagnosis of tsutsugamushi disease in children.Methods The clinical data of 2 misdiagnosed patients with tsutsugamushi disease treated in 2020 were retrospectively analyzed.Results Two patients were from tsutsugamushi epidemic area.A male child aged 1 year and 9 months developed the disease in July.He was admitted to hospital with fever and rash for 10 days,hard swelling of both feet,and perianal peeling for 1 day,accompanied by conjunctival congestion,chapped mouth and perianal descalation.Kawasaki disease was initially diagnosed,and intravenous injection of gammaglobulin was ineffective.Physical examination after admission to our hospital revealed characteristic ulcers of tsutsugamushi disease in the left axilla,which was confirmed.The misdiagnosis lasted 12 days.Symptoms and signs improved rapidly after Doxycycline treatment.A female child aged 7 years and 10 months developed the disease in September,presented with fever for 7 days,and was diagnosed as tonsillitis in another hospital.She was admitted to our hospital after ineffective treatment with Ceftriaxone.Physical examination showed scattered congestive rash,conjunctival congestion,red lips,chapped lips,bayberry tongue,and no eschar in the whole body.The patient was confirmed as tsutsugamushi disease by the external field test,and the misdiagnosis lasted 9 days.She was discharged after treatment with erythromycin.Conclusion The symptoms of tsutsugamushi disease are not typical and it is more likely to be misdiagnosed.Strengthening the understanding of tsutsugamushi disease,being familiar with its pathogenesis,carefully searching for eschar(ulcer),inquiring about the history in detail,and perfecting the pathogen examination if necessary can help reduce or avoid the misdiagnosis and mistreatment of tsutsugamushi disease.

关 键 词：恙虫病 儿童 误诊 川崎病 扁桃体炎 东方立克次体感染 焦痂 诊断 

分 类 号：R513.2[医药卫生—内科学]