| Background:Scrub typhus is an acute natural focus infectious disease caused by Orientia tsutsugamushi(Ot).It is clinically characterized by specific eschar or ulcer in the bite site,high fever,macular papules on trunk and limbs,lymphadenopathy,hepatosplenomegaly,etc.In severe cases,multiple organ dysfunction syndromeor even life-threatening can occur.In recent years,the incidence rate of tsutsugamushi disease has increased rapidly in China,and its distribution area has been expanding.At present,tsutsugamushi disease is still a serious public health problem in China.Therefore,it is particularly important to analyze the epidemiological and clinical characteristics of scrub typhus,reduce the misdiagnosis rate and missed diagnosis rate,improve the prognosis of patients and reduce the mortality.Objective: To analyze the epidemiological characteristics and clinical manifestations of scrub typhus patients in Zhenjiang First People’s Hospital,and to provide scientific basis for the development of scrub typhus related prevention and control strategies and measures in Zhenjiang area.Methods: 41 cases of scrub typhus were selected from Zhenjiang First People’s Hospital from November 2016 to December 2020,and their epidemiological characteristics,clinical manifestations,laboratory examination and imaging findings were analyzed.Result:1.In this study,2 cases of incomplete data collection and refusal of examination were excluded.A total of 39 patients with tsutsugamushi disease were included,including 25 male patients and 14 female patients.2.Farmers were the main occupation(41.03%,16/39),most of them had field or field work history(76.92%,30/39),and some of them had poultry contact history(7.70%,3/39).The living environment was mainly near the Yangtze River,Beijing Hangzhou canal or reservoir(58.97%,23/39).3.From 2016 to 2020,39 patients were all concentrated in early November to early December.The main clinical manifestations were eschar or ulcer(100.0%,39/39),fever(100.0%,39/39),macular papules(97.44%,38/39)and peripheral lymph node enlargement(53.85%,21/39).Laboratory blood examination: adenosine deaminase(ADA)increased(97.44%,38/39),lactate dehydrogenase(LDH)increased(97.44%,38/39),C-reactive protein increased(92.31%,36/39),alanine / aspartate transaminase increased(82.05%,32/39),D-dimer increased(43.59%,17/39),thrombocytopenia(17.95%,7/39).Urine routine showed red blood cells(38.46%,15/39).Chest imaging abnormalities(35.90%,14/39),hepatosplenomegaly(7.70%,3/39).4.In terms of treatment,tetracycline drugs,such as minocycline or azithromycin,were mainly used in our hospital.39 cases were cured without serious complications and adverse events.Conclusion: Since the first concentrated incidence of tsutsugamushi disease in early November 2015 in Zhenjiang area,the cases are scattered and closely related to occupation,geographical location and whether it is close to water source.Gaoqiao Town and Yaoqiao town are the high incidence areas of tsutsugamushi disease in Zhenjiang area.The clinical manifestations of the disease are typical and the diagnosis is not difficult,almost all patients have a eschar or ulcer,the main systemic symptoms are chills and high fever with systemic macular papules,but some lesions are hidden and difficult to find.In order to reduce the rate of misdiagnosis and missed diagnosis,clinical medical workers should identify and diagnose as soon as possible.Therefore,in the high incidence season of tsutsugamushi disease in Zhenjiang area,the Yangtze River Basin and the surrounding areas of the canal should become the focus of the prevention and control work. |
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