Vivekanandan M, Mani Anna, Priya Yamini Sundara, Singh Ajai Pratap, Jayakumar Samuel, Purty Shashikala
Department of Medicine & Microbiology, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry - 605 014.
J Assoc Physicians India. 2010 Jan;58:24-8.
To describe the diverse clinical and laboratory manifestations of scrub typhus diagnosed in Pondicherry Institute of Medical Sciences, Pondicherry.
All cases of febrile illness diagnosed as scrub typhus over a period of 2 years were analysed. Diagnosis was based on the presence of the eschar and/or positive Weil Felix test with a titre of > 1:80.
Fifty cases of scrub typhus were seen over a period of 2 years (April 2006 and April 2008). Common symptoms were high grade fever of 7-14 days duration, nausea, vomiting, headache, myalgia, cough and breathlessness. Eschar was seen in 23 cases (46%) and the common sites were axilla, breast and groin. Weil Felix test was positive in 39 cases (78%). Liver enzymes were elevated in nearly all cases (95.9%). Multiple Organ Dysfunction Syndrome (MODS) was present in one third of our patients (17 out of 50, 34%). Hypotension (8 patients, 16%), renal impairment (6 patients, 12%), ARDS (4 patients, 8%) and meningitis (7 patients, 14%) were some of the important complications. There was a dramatic response to doxycycline in nearly all the patients.
Scrub typhus has emerged as an important cause of febrile illness in Pondicherry. Empirical treatment with doxycycline is justified in endemic areas.
描述在本地治里医学科学研究所诊断出的恙虫病的多样临床和实验室表现。
分析了2年期间所有被诊断为恙虫病的发热性疾病病例。诊断基于焦痂的存在和/或外斐试验阳性（滴度>1:80）。
在2年期间（2006年4月至2008年4月）共见到50例恙虫病病例。常见症状为持续7 - 14天的高热、恶心、呕吐、头痛、肌痛、咳嗽和呼吸困难。23例（46%）可见焦痂，常见部位为腋窝、乳房和腹股沟。39例（78%）外斐试验呈阳性。几乎所有病例（95.9%）的肝酶都升高。三分之一的患者（50例中的17例，34%）出现多器官功能障碍综合征（MODS）。低血压（8例患者，16%）、肾功能损害（6例患者，12%）、急性呼吸窘迫综合征（ARDS，4例患者，8%）和脑膜炎（7例患者，14%）是一些重要并发症。几乎所有患者对多西环素都有显著反应。
恙虫病已成为本地治里发热性疾病的一个重要病因。在流行地区，用多西环素进行经验性治疗是合理的。
