Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong Province, People's Republic of China.
Am J Trop Med Hyg. 2012 Dec;87(6):1099-104. doi: 10.4269/ajtmh.2012.12-0306. Epub 2012 Oct 22.
To elucidate the epidemic status, clinical profile, and current diagnostic issues of scrub typhus in Shandong Province, we analyzed the surveillance data of scrub typhus from 2006 to 2011 and conducted a hospital-based disease survey in 2010. Scrub typhus was clustered in mountainous and coastal areas in Shandong Province, with an epidemic period from September to November. The most common manifestations were fever (100%), eschar or skin ulcer (86.3%), fatigue (71.6%), anorexia (71.6%), and rash (68.6%). Predominant complications included bronchopneumonia, toxic hepatitis, and acute cholecystitis in 21.6%, 3.9%, and 2.9% of the cases, respectively. Severe complications including toxic myocarditis, heart failure, pneumonedema, pleural effusion, and emphysema were first reported in Shandong. Missed and delayed diagnosis of scrub typhus was common in local medical institutions. Alarm should be raised for changes of clinical features and current diagnostic issues of scrub typhus in newly developed endemic areas.
为阐明山东省恙虫病的流行态势、临床特征和当前诊断问题，我们分析了 2006 年至 2011 年恙虫病监测数据，并于 2010 年开展了医院为基础的疾病调查。山东省恙虫病呈聚集性分布于山区和沿海地区，流行期为 9 月至 11 月。最常见的表现为发热（100%）、焦痂或皮肤溃疡（86.3%）、乏力（71.6%）、食欲不振（71.6%）和皮疹（68.6%）。主要并发症包括支气管肺炎、中毒性肝炎和急性胆囊炎，分别占 21.6%、3.9%和 2.9%。在山东省首次报道了严重并发症，包括中毒性心肌炎、心力衰竭、肺水肿、胸腔积液和肺气肿。在当地医疗机构中，恙虫病的漏诊和误诊较为常见。在新发生恙虫病流行地区，应警惕临床特征和当前诊断问题的变化。
