Epidemiological Characteristics,clinical Features And Risk Factors Related To MODS Of 321 Patients With Scrub Typhus

Objective:Retrospective analysis of the epidemiology,clinical features and risk factors of MODS in 321 patients with scrub typhus admitted to the First Affiliated Hospital of Kunming Medical University from 2008 to 2017,for early detection,early diagnosis,early treatment of scrub typhus and reduction of MODS The occurrence provides a theoretical basis.Methods:This is a retrospective descriptive study(from January 2008 to December 2017),the subject of which are composed of 321 patients(from the First Affiliated Hospital of Kunming Medical University,Yunnan,China),in order to study epidemiological characteristics and clinical features of patients with scrub typhus.Tose 321 patients were divided into MODS group(80 cases)and non-MODS group(241 cases),and the risk factors related to MODS were analyzed.Using SPSS 21.0 statistical software for statistical analysis.Results:1.Epidemiological characteristicsTime distribution:The number of cases admitted in 2008-2017:21 cases,29 cases,39 cases,20 cases,22 cases,25 cases,23 cases,39 cases,68 cases,35 cases.In 2016,the number of cases was the highest,with 68 cases(21.2%);from January to December,the incidence was mainly concentrated in July-October,with the highest number of cases in August,with 101 cases(31.5%).Triple distribution:Among 321 patients,174 males and 147 females,male:female was 1.18:1;the age of onset was 1-74 years old,the average age was(41.87±16.24)years old,and the number of cases was 41-65 years old,with 165 cases(51.4%);occupational distribution is the largest proportion of farmers,with 204 cases(63.6%).Spatial distribution:There are cases in 16 cities in Yunnan,with the largest number in Kunming,with 125 cases(38.9%).2.Clinical features2.1 Main symptoms and signsThere are 321 cases(100%)with fever and 245 cases(76.3%)with high fever.The heat type was mainly due to heat retention,231 cases(72%)with fatigue,227 cases(70.7%)with anorexia,and 203 cases(63.2%)with chills,107 cases of shivers(33.3%),192 cases of headache(59.8%),145 cases of muscle soreness(45.2%),103 cases of cough(32.1%),40 cases of abdominal pain(12.5%),59 cases of nausea(18.4%),36 cases(11.2%)with dizziness,31 cases(9.7%)with chest tightness,and 37 cases(11.5%)with shortness of breath.There are 264 cases(82.2%)with eschar or ulcer,41 cases(12.8%)with rash,159 cases(49.5%)with lymphadenopathy,20 cases(6.2%)with hepatic enlargement,and 135 cases(42.1%)with splenomegaly.The area of eschar is more common in the groin,perianal,perineum,scrotum,armpit,popliteal space,and elbow fossa,accounting for 39.8%.2.2 laboratory featuresBlood routine:WBC increased in 95 cases(29.6%);EO disappeared or ruduce in 232 cases(72.3%);HB decreased in 87 cases(27.1%);PLT decreased in 183 cases(57.0%).Blood biochemistry:ALT increased in 268 cases(83.5%),AST increased in 279 cases(86.9%),ALB decreased in 304 cases(94.7%),and TB increased in 98 cases(30.5%).Cr increased in 42 cases(13.0%)and BUN increased in 46 cases(14.3%).K+decreased by 130 cases(40.5%);Na+decreased by 207 cases(64.5%);191 cases of Ca2+detection decreased 154 cases(80.6%).Coagulation parameters:262 patients underwent coagulopathy,PT prolonged in 23(8.8%),APTT prolonged in 40(15.3%).Infection index:CRP increased by 297(92.5%);204 cases of PCT test,increased by 115 cases(56.4%);148 cases of ESR test,increased by 87 cases(58.8%).Thyroid function:136 cases of thyroid function test,abnormal cases of 62 cases(45.7%),of which 60 cases showed that T3,T4,FT3,FT4 decreased to varying degrees,mainly FT3,accounting for 76.7%(46/60)Secondly,T3 decreased,accounting for 51.7%(31/60).Feces and urine routine:268 routine urine tests,184(68.7%)abnormal results,including 133 urine protein positive(71.1%).Of the 217 cases,routine stool examination was performed,and 54 cases of fecal occult blood test were positive(24.9%).Weil-Felix test:258 cases of Weil-Felix test,26 cases(10.1%)of agglutination titer≥1:160,the first week of detection,the positive rate of 4.3%;the second week of detection,the positive rate of 14.5%;and the third week is 8.3%.Electrocardiogram:184 patients underwent electrocardiogram examin ation,111 cases(60.3%)were abnormal.Imaging examination:263 cases of chest X-ray or CT examination,and 215 cases(81.7%)had abnormal results.223 cases underwent B-ultrasound examination of abdominal and superficial lymph nodes,133 cases(59.6%)with splenomegaly,73 cases(32.7%)with superficial lymph node enlargement,and 14 cases(6.3%)with enlarged liver.3.ComplicationThere are 289 cases(90.0%)with liver injury,184 cases(57.3%)with hematuria,170 cases(53.0%)with pneumonia,20 cases(6.2%)with ARDS,87 cases(27.1%)with renal injury,and 53 cases with myocardial injury(16.58%),4 cases(1.6%)of central nervous system involvement.4.Analysis of risk factors related to MODSThe indexes of MODS group and non-MODS group were compared.There was no difference in gender,age,and WBC between the two groups.There were differences in fever course,heat peak,N,CRP,PLT,and ALB.Multivariate logistic regression analysis showed that the course of fever,CRP was a risk factor.5.Treatment and outcomeMost of patients were treated with tetracycline,doxycycline and azithromycin,respectively,239(74.5%),24(7.5%),and 45(14.0%),305 cases(95.0%)were cured or improved,14 cases(4.4%)were discharged automatically,and 2 cases(0.6%)died.Conclusions:1.The onset season is concentrated in July-October.The scrub typhus in this area is "summer-autumn type",the age of onset is mainly concentrated in middle-aged and elderly groups,and the occupational distribution is mainly farmers.2.The clinical manifestations of scrub typhus are complex and diverse.Fever is the most common symptom,and it is mainly caused by high fever.The heat type is mainly heat retention.Specific eschar or ulcer,spleen and lymph node enlargement are the main signs,and the rash is not much.The area of eschar is common in skin wrinkles,dark and damp areas.3.PLT reduction,EO reduction or disappearance are more common in scrub typhus and have certain implications for diagnosis;scrub typhus is prone to electrolyte imbalance,and hypocalcemia is most common;tcrub typhus can lead to hypothyroidism,and its pathogenesis needs further study;the positive rate of the Weil-Felix test t is low,and the positive rate is lower in the first week,which is of little significance in the early diagnosis of scrub typhus.4.Scrub typhus can accumulate multiple organ system damage,of which liver injury is the most common,and symptomatic supportive treatment such as liver protection should be paid attention to during treatment.5.The course of fever and CRP are risk factors for scrub typhus complicated with MODS.For patients with scrub typhus with long fever and high infection index,we should be alert to the occurrence of MODS.