Dumler J S, Taylor J P, Walker D H
Department of Pathology, University of Texas Medical Branch, Galveston 77550.
JAMA. 1991 Sep 11;266(10):1365-70.
--The clinical and laboratory features of patients with murine typhus have not been extensively reviewed since 1946. We have updated these findings in patients from south Texas who were examined by modern clinical and laboratory methods from 1980 through 1987.
--Patients were identified by serological methods in this case series, and clinical, epidemiologic, laboratory, and therapeutic data were compiled and analyzed.
--The majority of patients (77 of 80) were identified in a primary care community hospital setting; the remainder (3 of 80) were ambulatory hospital outpatients.
--From 1980 through 1987, a total of 345 patients were diagnosed with murine typhus; 90 of these patients were seen at four hospitals in south Texas; of these, 80 had clinical and laboratory data available for review.
--The frequency of common clinical manifestations (eg, headache, fever, and rash) and laboratory findings (eg, leukocyte and platelet counts and serum chemistry abnormalities) of patients with infectious diseases was tabulated. Clinical severity was semiquantitatively assessed and was correlated with clinical, laboratory, and therapeutic results.
--Most cases (69%) occurred from April through August. Rash occurred in 54%; the triad of fever, headache, and rash was observed in only 12.5% of patients when first examined by a physician; respiratory and gastrointestinal symptoms were also frequent. Multiple organ involvement was documented by frequent abnormal laboratory findings of the hematologic, respiratory, hepatic, and renal systems. Disease severity was related to older patient age, the presence of renal dysfunction, leukocytosis, and hypoalbuminemia, and previous therapy with sulfa antibiotics.
--Infection by Rickettsia typhi causes a systemic illness with clinical and laboratory abnormalities not previously recognized or described. Early clinical diagnosis and treatment are needed to avoid undue morbidity and mortality.
自1946年以来，鼠型斑疹伤寒患者的临床和实验室特征尚未得到广泛综述。我们更新了1980年至1987年期间在得克萨斯州南部接受现代临床和实验室检查的患者的这些研究结果。
在本病例系列中，通过血清学方法识别患者，并收集和分析临床、流行病学、实验室和治疗数据。
大多数患者（80例中的77例）在一家基层医疗社区医院被识别；其余（80例中的3例）为门诊医院的门诊患者。
1980年至1987年期间，共有345例患者被诊断为鼠型斑疹伤寒；其中90例患者在得克萨斯州南部的四家医院就诊；其中80例有可供审查的临床和实验室数据。
列出传染病患者常见临床表现（如头痛、发热和皮疹）和实验室检查结果（如白细胞和血小板计数以及血清化学异常）的发生频率。对临床严重程度进行半定量评估，并与临床、实验室和治疗结果相关联。
大多数病例（69%）发生在4月至8月。54%的患者出现皮疹；医生首次检查时，仅12.5%的患者出现发热、头痛和皮疹三联征；呼吸道和胃肠道症状也很常见。血液学、呼吸系统、肝脏和肾脏系统频繁出现异常实验室检查结果，证明有多器官受累。疾病严重程度与患者年龄较大、存在肾功能不全、白细胞增多和低白蛋白血症以及先前使用磺胺类抗生素治疗有关。
伤寒立克次体感染会导致一种全身性疾病，其临床和实验室异常情况以前未被认识或描述。需要早期临床诊断和治疗以避免不必要的发病率和死亡率。
