Barclay A J, Coulter J B
Mvumi Hospital, Dodoma, Tanzania.
Trans R Soc Trop Med Hyg. 1990 Nov-Dec;84(6):852-6. doi: 10.1016/0035-9203(90)90106-o.
Between October 1985 and September 1986, 488 children aged less than 15 years, 45 pregnant women, 21 other women and 18 men with tick-borne relapsing fever (TBRF) were seen at Mvumi Hospital, Central Tanzania. 88% of the children were less than 5 years old and 36% were less than 1 year. Twelve children were less than 1 month old and some of the 10 infants diagnosed at between 4 and 12 days of age were cases of congenital infection. The clinical features of TBRF in the children and pregnant women were compared with 129 children with a similar age distribution and 52 pregnant women, respectively, who had blood smears positive for malaria but negative for spirochaetes. The common presenting features in children with TBRF were a high fever, splenomegaly, convulsions, and meningism. The difficulty of differentiation from malaria is described. Severe disease in both children and adults was associated with high density of spirochaetes in blood smears. Of the 45 infected pregnant women, 22 (49%) went into labour. One of the deliveries was an abortion and 10 were preterm infants, 4 of whom died. There were no maternal deaths. The estimated overall mortality for children was 1.6%, and 2.3% for those aged less than 1 years; for the 95 children admitted it was 8.4%. Penicillin was a satisfactory treatment for all ages, with a relapse rate of 4.7%. Recommendations for patient management are given.
1985年10月至1986年9月期间，坦桑尼亚中部姆武米医院接诊了488名15岁以下的儿童、45名孕妇、21名其他女性以及18名患蜱传回归热（TBRF）的男性。88%的儿童年龄小于5岁，36%的儿童年龄小于1岁。12名儿童小于1个月大，在4至12日龄时确诊的10名婴儿中有一些是先天性感染病例。分别将儿童和孕妇TBRF的临床特征与129名年龄分布相似的儿童以及52名孕妇进行了比较，这些儿童和孕妇的血涂片疟原虫阳性但螺旋体阴性。TBRF儿童的常见症状为高热、脾肿大、惊厥和脑膜刺激征。描述了与疟疾鉴别的困难。儿童和成人的重症疾病均与血涂片中高密度的螺旋体有关。45名感染孕妇中，22名（49%）分娩。其中1例分娩为流产，10例为早产儿，4例死亡。无孕产妇死亡。儿童的总体估计死亡率为1.6%，1岁以下儿童为2.3%；95名入院儿童的死亡率为8.4%。青霉素对各年龄段都是一种令人满意的治疗药物，复发率为4.7%。给出了患者管理的建议。
