立克次氏体传染病：赣州市5例恙虫病调查报告

5例病人均有发热及典型的焦痂体征，焦痂率达80％；恢复期血清抗体阳性；对强力霉素高度敏感．发病时间为6、7月份，男女均有发病，以农民为主，均有野性作业史，呈散在流行。调查首次证明赣州市有恙虫存在，流行病学牲明显。[第一段]     

恙虫病四例报告

我县城关镇１９９０年发生恙虫病４例，均在本院确诊并治愈。４例均为男性，年龄３７－４８岁，１９９０年１１－１２月发病。主要症状为畏寒，高热３９℃左右，呈驰张热。全身散在淡红色斑丘疹，压之不退色。４例均有典型焦痂，大小为１．５×２．５ｃｍ，略低于皮肤面，...     

美国《Emerging Infectious Diseases》2006年第7期有关人兽共患病论文摘译

P1109恙虫病患者皮肤焦痂中的东方体//Yun-Xi Liu,Wu-Chun Cao,Yuan Gao,等为了证实恙虫病患者的皮肤焦痂在恙虫病诊断及东方体基因分型中的价值,我们用PCR检测了7名中国山东省恙虫病患者的皮肤焦痂和血中东方体的sta56基因。7名患者的急性期焦痂和血液标本的特异性DNA均阳性;经抗生素治疗后,其恢复期焦痂的特异性DNA仍阳性,而恢复期血液标本的特异性DNA则为阴性。这些结果表明,患者的焦痂可用于恢复期的病原检测及基因分型(见图1)。图1两例恙虫病患者的典型焦痂A)一患者颈部的焦痂(03PE1),B)一患者腰部的焦痂(04PE5)。恙虫病是…     

复方氨基酸治疗褥疮64例

复方氨基酸治疗褥疮６４例胶州中心医院（２６６３００）方萍我们应用复方氨基酸液治疗褥疮患者６４例，取得了较好疗效。现报告如下。治疗方法：①先用７５％酒精对创面周围皮肤进行消毒。②用双氧水清洁创面分泌物；有焦痂生成者，先去掉焦痂。③用生理盐水冲洗创面，创...     

对恙虫病的新认识

恙虫病是动物源性传染病,主要分布于亚洲、大洋洲,包括巴基斯坦、印度、尼泊尔、日本、中国、朝鲜、印度尼西亚及菲律宾。其病原为东方立克次体,是从感染的恙螨或人的皮肤组织液中分离到的。恙虫病的感染特征为恙螨叮咬部位的皮肤损害或焦痂,继之产生立克次体血症,随血流进入全身各脏器。潜伏期为6～18天(一般8～12天),此期可出现焦痂,一个或多个,始为2～4mm大小的无痛性丘疹,继而扩大形成水疱,中央部分发生坏死,成为无痛性溃疡,伴随全身症状。发病的第一周,焦痂形成圆形黑色的痂皮,周有红晕,第二周末,溃疡几乎完全愈合。恙虫病起病急,患者主诉发热、畏寒,前额及枕部疼痛,     

老年人恙虫病16例临床分析

恙虫病是由恙虫病立克次体引起的一种急性传染病。近年来文献上不断有病例报道,但有关老年人恙虫病报道甚少。我院近年来收治16例老年患者,现报道如下。临床资料一般资料16例中,男性12例,女性4例;年龄60～76岁,平均64岁,农民14例,干部和工人各一例。6月份发病5例,7～8月9例,9月2例。临床表现(1).发热均有发热,体温均在39℃以上,其中40℃以上者7例,热程最短3天,最长18天。(2).皮疹9例为暗红色斑丘疹,其中5例为全身性。(3).溃疡或焦痂出现溃疡或焦痂者14例,均为单个,分布于躯干部5例,下肢4例,臀部2     

58例恙虫病并发肺部感染的流行病学及临床分析

目的探讨恙虫病并发肺部感染的流行病学及临床特点。方法回顾性收集2013年1月至2015年12月我院58例恙虫病并发肺部感染患者资料,进行流行病学和临床特点分析。结果恙虫病患者的职业主要为农民,其次为部队官兵和学生,发病无性别差异,发病率较高的年龄组为41~60岁。四季均有病例发现,发病高峰在7月,其次为6、8、9、10月。感染者均有野外草地接触史。主要症状为畏寒、发热(100%),咳嗽、咳痰、气喘、胸痛,体征主要为皮肤焦痂或溃疡(96.6%),局部淋巴结肿大57例(98.3%)。予多西环素治愈56例,治愈率96.6%,2例死亡,死亡率3.4%。死因为恙虫病合并脓毒性休克、急性呼吸窘迫综合征、血小板减少症、多器官功能衰竭等。该病确诊前绝大多数被误诊,误诊率98.3%,分别被误诊为急性上呼吸道感染、急性气管支气管炎、社区获得性肺炎、颅内感染、血液病等,误诊时间最长达21天。结论恙虫病并发肺部感染的临床表现复杂,全身系统并发症多,误诊率高,流行病学史及特异性焦痂溃疡有助于确诊,加强健康教育,避免坐草地,仔细寻找焦痂溃疡可提高确诊率,改善预后。     

湖南老年医院首例恙虫病多器官受累病例实验室分析

目的对湖南老年医院首例恙虫病可疑病例进行实验室快速诊断及病原分子流行病学分析。方法病人急性期及恢复期血清恙虫病IgM、IgG抗体进行胶体金快速定性及ELISA定量。环介导等温扩增(LAMP)病人血液及焦痂恙虫病东方体56KD 基因及巢氏PCR扩增热休克蛋白基因(groEL)并分析groEL遗传进化关系。结果病人发热期(发病24天)及恢复期(发病32天)血清IgM、IgG抗体定性试验均为阳性,ELISA定量试验双份血清IgM、IgG抗体滴度均达1∶2 560。急性期血液及焦痂DNA样本LAMP检测及巢氏PCR扩增groE阳性。结论本报道为湖南老年医院首例恙虫病病例报道。应加强立克次体病诊断及鉴别诊断。     

恙虫病立克次体肺炎二例

恙虫病立克次体肺炎二例吴新军［例１］男，４６岁。因寒热、焦痂四天于１９９６年８月２１日入院。有野外草丛接触史。无咳嗽、咯血。体检：Ｔ３９．２℃。背、腰见直径１ｃｍ焦痂各一个，右腋下触及直径１．５ｃｍ淋巴结数枚有触痛，心、肺阴性，肝肋下２ｃｍ，脾肋下１...     

云南省儿童恙虫病50例临床特征分析

目的了解儿童恙虫病的临床特征,避免漏诊和误诊。方法回顾性分析2018年1月—2019年12月,在昆明市儿童医院住院的50例恙虫病患儿的流行病学资料、临床表现及辅助检查结果。结果50例恙虫病患儿中,男29例、女21例,年龄10个月~13岁,平均年龄5.73岁、年龄中位数5岁;发病月份集中在6—11月,78.0%的患儿在7—9月发病;病例来源于云南省14个地(州、市),均有发热症状;96.0%的患儿来自农村,所有患儿均有草地游玩史,94.0%的有焦痂;患儿存在多脏器损害,其中肝功能损伤41例(82.0%)、呼吸系统受累22例(44.0%)、神经系统受累18例(53.0%)和血液系统受累(血细胞下降、低纤维蛋白血症)46例(92.0%)。结论临床上发现儿童持续反复发热、表现多样和多脏器损害症状应警惕恙虫病,及时询问其流行病学史、仔细查体寻找焦痂、完善相关检查,避免漏诊和误诊。     

Historical epidemics of scrub typhus in Queensland and Papua New Guinea

Undifferentiated febrile diseases (e.g., Mossman fever) from northern Queensland were eventually partially attributed to mite-transmitted rickettsial infections known as scrub typhus or tsutsugamushi fever. Scrub typhus became a major medical threat to military operations in Papua New Guinea during the Second World War and killed more Australian soldiers than malaria in the pre-antibiotic era. Further investigations showed scrub typhus to be an occupational disease of rural workers in north Queensland especially around Cairns and Innisfail. Occasional small epidemics of scrub typhus still occur during military exercises in Queensland, but as scrub typhus is not a reportable disease, its presence in the civilian community is largely unknown. Increased use of serological testing in patients with fever and rash illnesses after exposure in northern Queensland is likely to show that scrub typhus is a modern infection that remains treatable with antibiotics once it is identified.     

Possible scrub typhus coinfections in Thai agricultural workers hospitalized with leptospirosis

Possible coinfections with Orientia tsutsugamushi the causative agent of scrub typhus, were prospectively evaluated in rice farmers hospitalized with leptospirosis in Northeast Thailand. Of 22 adults with leptospirosis diagnosed by the microscopic agglutination test, 9 also had serologic evidence of scrub typhus. Of 9 individuals with possible coinfections, 5 had signs or symptoms typical of scrub typhus and atypical of leptospirosis. Patients who appeared to have mixed infections had significantly higher median platelet counts and significantly lower median serum bilirubin and creatinine concentrations (P < 0.05, Mann-Whitney U test) than did individuals with leptospirosis alone. One patient with serologic evidence of scrub typhus and leptospirosis was treated only with penicillin, to which scrub typhus is not sensitive. Respiratory distress worsened during therapy, and the patient died of respiratory failure. Physicians should consider the possibility of scrub typhus infection in leptospirosis patients who respond poorly to treatment or who have atypical disease manifestations.     

Scrub typhus during pregnancy and its treatment: a case series and review of the literature

Although scrub typhus is uncommon in pregnant women, when present, it can have serious repercussions for the mother and developing fetus. Since it is uncommon, the clinical impact of scrub typhus on pregnancy has not been elucidated and an effective and safe therapeutic regimen has not been validated. The medical records of pregnant women whose scrub typhus were treated at Chungnam National University Hospital were reviewed and their clinical outcomes were evaluated. A review of the literature was also performed on pregnant women with scrub typhus and their clinical outcomes. Eight pregnant women with scrub typhus were treated successfully with a single 500-mg dose of azithromycin, and no relapses were reported. They all delivered healthy babies at term, without congenital or neonatal complications. In the reviews, azithromycin was effective against scrub typhus and had favorable pregnancy outcomes. Ciprofloxacin and cefuroxime failed to treat scrub typhus and fetal loss resulted. A single 500-mg dose of azithromycin may be a reasonable treatment regimen for pregnant women with scrub typhus. Ciprofloxacin might not be advisable for the treatment of scrub typhus during pregnancy. Scrub typhus itself seems to have serious adverse effects on pregnancy if not appropriately controlled.     

Acute respiratory distress syndrome in scrub typhus

Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi. Acute respiratory distress syndrome (ARDS) is a serious complication of scrub typhus. This study retrospectively reviewed the medical records of 72 patients diagnosed with scrub typhus from January 1998 to August 2006 in Kaohsiung Chang Gung Memorial Hospital in Taiwan. Eight of 72 scrub typhus patients with ARDS were included in the study; the other patients without ARDS were used as controls. The mortality rate for the scrub typhus patients with ARDS was 25%. The eight patients seldom had underlying diseases. Initial presentations of dyspnea and cough, white blood cell count, hematocrit, total bilirubin, and delayed used of appropriate antibiotics use were significant predictors of ARDS. Multivariate analysis showed that albumin, prothrombin time, and delayed use of appropriate antibiotics were independent predictors of ARDS. Identification of these relative risk factors may help clinicians evaluate clinical cases of scrub typhus with ARDS.     

Scrub Typhus: Surveillance,Clinical Profile and Diagnostic Issues in Shandong,China

To elucidate the epidemic status, clinical profile, and current diagnostic issues of scrub typhus in Shandong Province, we analyzed the surveillance data of scrub typhus from 2006 to 2011 and conducted a hospital-based disease survey in 2010. Scrub typhus was clustered in mountainous and coastal areas in Shandong Province, with an epidemic period from September to November. The most common manifestations were fever (100%), eschar or skin ulcer (86.3%), fatigue (71.6%), anorexia (71.6%), and rash (68.6%). Predominant complications included bronchopneumonia, toxic hepatitis, and acute cholecystitis in 21.6%, 3.9%, and 2.9% of the cases, respectively. Severe complications including toxic myocarditis, heart failure, pneumonedema, pleural effusion, and emphysema were first reported in Shandong. Missed and delayed diagnosis of scrub typhus was common in local medical institutions. Alarm should be raised for changes of clinical features and current diagnostic issues of scrub typhus in newly developed endemic areas.     

1952-1989年和2006-2017年中国大陆恙虫病流行及时空分布特征

目的 研究并阐明中国大陆恙虫病流行趋势和时空分布特征, 为恙虫病的预防和控制提供参考依据。方法 根据1952-1989年和2006-2017年中国大陆恙虫病疫情报告数据,采用描述性流行病学方法、空间自相关分析和ArcGIS 10.4软件的可视化技术等,全面系统研究中国大陆恙虫病流行及时空分布特征,并确定高风险地区。结果 在1952-1989年和2006-2017年期间,我国累计报道恙虫病病例156 234例,死亡180例。1952-1989年的年均发病率0.13/10万。2006年以后,年均发病率急剧上升,由2006年的0.09/10万上升到2017年的1.62/10万,增长了18倍,年平均增长率为33%。流行季节仍以夏季和秋冬为主,多数病例主要集中在10月,女性发病率高于男性(χ²=168.34, P<0.001)。云南、安徽、广东、福建、江苏、山东、广西和四川8个省(自治区)的病例数最多,占全国总病例数的91.31%。全局空间自相关分析结果表明,在全国范围内恙虫病整体上存在着空间正相关,具有空间聚集性(I=0.085, P<0.05)。局部空间自相关分析结果显示,广西、福建及其周边地区为“热点区域”,是恙虫病高发区。结论 1952-1989年和2006-2017年我国恙虫病发病率存在逐年升高趋势,病例以夏季型和秋冬型为主。空间自相关分析可以及时发现该病的聚集情况并确定高发区和危险区。     

Short report: Abnormal liver function in scrub typhus

Scrub typhus is one kind of rickettsial disease and may cause fever, cough, and skin rashes in infected humans. Regarding liver involvement, it was uncommon to be reported in previous medical literature from Western countries. This study observes the relationship between scrub typhus and liver function. From January 1998 to August 2003 in Kaohsiung Chang Gung Memorial Hospital in Taiwan, we observed 30 patients with scrub typhus, and 29 of them had liver function abnormality. In these patients, we found 89.3% with elevated aspartate aminotransferase (AST) levels, 91.7% with elevated alanine aminotransferase (ALT) levels, 84.2% with elevated alkaline phosphatase (ALP) levels, and 38.5% with elevated total bilirubin levels. In our study, there is a close relationship between scrub typhus and impaired liver function tests. Therefore, if patients are found with fever of unknown origin and abnormal liver function, we should take scrub typhus into consideration.     

Scrub Typhus-Associated Hemophagocytic Syndrome

Summary A patient was admitted to our hospital with fever of unknown origin, lymphadenophathy and moderate anemia. The diagnosis of scrub typhus (tsutsugamushi disease) was established on specific serologic demonstration of antibodies to the cross-reacting proteins OX-K antigen and reaffirmed by successful treatment with doxycycline. The diagnosis of hemophagocytic syndrome (HPS) was made on the cytologic findings of many histiocytes containing phagocytosed blood cells in the marrow aspirate. The hemophagocytosis phenomenon disappeared after the scrub typhus was successfully treated, thus suggesting the relationship between scrub typhus and hemophagocytosis. In a patient with rickettsial diseases including scrub typhus, associated with HPS, it is important to understand the relationship between the two disorders since the prognosis for HPS, if untreated, is very poor. Received: December 8, 1999 · Revision accepted: January 30, 2000     

Evaluation of a newly developed dipstick test for the rapid diagnosis of scrub typhus in febrile patients

Scrub typhus is a potentially fatal, febrile disease prevalent in rural Asia. The etiological agent, Orientia tsutsugamushi, is transmitted to humans by the bite of a larval trombiculid mite. No current diagnostic test is sufficiently practical for use by physicians working in rural areas. A new dipstick test using a dot blot immunoassay format has been developed for the serodiagnosis of scrub typhus. We evaluated this test on 83 patients presenting with acute fever of unknown origin at Maharaj Hospital, a tertiary care medical center in Nakhon Ratchasima, Northeast Thailand. The diagnosis of scrub typhus was confirmed in 30 of these patients (36%) by the indirect immunoperoxidase test. The sensitivity of the test was 87% and its specificity was 94%. The dot blot immunoassay dipstick is accurate, rapid, easy to use, and relatively inexpensive. It appears to be the best currently available test for diagnosing scrub typhus in rural areas where this disease predominates.     

Rapid Increase in Scrub Typhus Incidence in Mainland China, 2006–2014

Scrub typhus is a vector-borne disease, which has recently reemerged in China. In this study, we describe the distribution and incidence of scrub typhus cases in China from 2006 to 2014 and quantify differences in scrub typhus cases with respect to sex, age, and occupation. The results of our study indicate that the annual incidence of scrub typhus has increased during the study period. The number of cases peaked in 2014, which was 12.8 times greater than the number of cases reported in 2006. Most (77.97%) of the cases were reported in five provinces (Guangdong, Yunnan, Anhui, Fujian, and Shandong). Our study also demonstrates that the incidence rate of scrub typhus was significantly higher in females compared to males (P < 0.001) and was highest in the 60–69 year age group, and that farmers had a higher incidence rate than nonfarmers (P < 0.001). Different seasonal trends were identified in the number of reported cases between the northern and southern provinces of China. These findings not only demonstrate that China has experienced a large increase in scrub typhus incidence, but also document an expansion in the geographic distribution throughout the country.