Bernabeu-Wittel M, Pachón J, Alarcón A, López-Cortés L F, Viciana P, Jiménez-Mejías M E, Villanueva J L, Torronteras R, Caballero-Granado F J
Service of Infectious Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain.
Arch Intern Med. 1999 Apr 26;159(8):872-6. doi: 10.1001/archinte.159.8.872.
Fever of intermediate duration (FID), characterized by a febrile syndrome lasting from 7 to 28 days, is a frequent condition in clinical practice, but its epidemiological and etiologic features are not well described. Murine typhus (MT) is a worldwide illness; nevertheless, to our knowledge, no studies describing its epidemiological and clinical characteristics have been performed in the south of Spain. Also, its significance as a cause of FID is unknown.
To determine the epidemiological features, clinical characteristics, and prognosis of MT and, prospectively, its incidence as a cause of FID.
Prospective study of cases of MT over 17 years (1979-1995) and of all cases of FID treated in a tertiary teaching hospital in Seville, Spain.
One hundred and four cases of MT were included, and MT was the cause in 6.7% of 926 cases of FID. Insect bites were reported in only 3.8% of the cases of MT previous to the onset of illness. Most cases (62.5%) occurred in the summer and fall. A high frequency of rash (62.5%) was noted. Arthromyalgia (77%), headache (71%), and respiratory (25%) and gastrointestinal (23%) symptoms were also frequent. Laboratory findings were unspecific. Organ complications were uncommon (8.6%), but they were severe in 4 cases. The mean duration of fever was 12.5 days. Cure was achieved in all cases, although only 44 patients received specific treatment.
Murine typhus is prevalent in the south of Spain and is a significant cause of FID. Clinical signs are benign, but some patients may develop severe complications. A high degree of clinical suspicion is required for diagnosis.
中度持续发热（FID）以持续7至28天的发热综合征为特征，是临床实践中常见的病症，但其流行病学和病因学特征尚未得到充分描述。鼠型斑疹伤寒（MT）是一种全球性疾病；然而，据我们所知，西班牙南部尚未开展描述其流行病学和临床特征的研究。此外，其作为FID病因的重要性尚不清楚。
确定MT的流行病学特征、临床特征和预后，并前瞻性地确定其作为FID病因的发病率。
对17年（1979 - 1995年）间MT病例以及西班牙塞维利亚一家三级教学医院治疗所有FID病例进行前瞻性研究。
纳入104例MT病例，在926例FID病例中，MT占6.7%。仅3.8%的MT病例在发病前有昆虫叮咬史。大多数病例（62.5%）发生在夏季和秋季。皮疹发生率较高（62.5%）。关节痛（77%）、头痛（71%）以及呼吸道症状（25%）和胃肠道症状（23%）也很常见。实验室检查结果无特异性。器官并发症不常见（8.6%），但有4例较为严重。发热平均持续时间为12.5天。所有病例均治愈，尽管只有44例患者接受了特异性治疗。
鼠型斑疹伤寒在西班牙南部流行，是FID的重要病因。临床症状较轻，但部分患者可能出现严重并发症。诊断需要高度的临床怀疑。
