Narita Masashi, Monma Naota, Chiba Kazuki, Suzuki Rie, Fujita Shohei, Hoshino Chisho, Nakamura Kiwamu, Sekikawa Yoshiyuki, Ikeda Hiroshi, Inoue Minoru, Shimbo Takuro, Yamamoto Seigo, Ando Shuji, Takada Nobuhiro, Fujita Hiromi
Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Nambu Medical Center & Children's Medical Center, Haebaru, Japan.
Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan.
Open Forum Infect Dis. 2024 Apr 25;11(5):ofae215. doi: 10.1093/ofid/ofae215. eCollection 2024 May.
Scrub typhus (ST) is endemic in Fukushima, with the largest number of cases reported in Japan from 2009 to 2010. Although ST is highly treatable, its atypical clinical presentation impedes diagnosis, causing delays in treatment.
We review the clinical features of ST in adults from 2008 to 2017 at Ohta Nishinouchi General Hospital in Fukushima, Japan.
Fifty-five cases (serotype Karp 24, Irie/Kawasaki 21, Hirano/Kuroki 10) of ST were confirmed via serology based on elevated immunoglobulin (Ig)M and IgG and polymerase chain reaction positivity of eschar samples. The mean age was 69 years, and 64% were female. The case fatality rate was 1.8% (1/55). Approximately 70% of cases (38/55) were not diagnosed as ST upon the initial clinic visit. Inappropriate use of antibiotics was identified in 22% of cases (12/55). In terms of atypical clinical features, 1 or more of the manifestations, fever, rash, and eschar, was absent in 31% of cases (17/55). Approximately 11% of cases presented without eschar (6/55; Karp 1, Irie/Kawasaki 1, Hirano/Kuroki 4). Moreover, severe complications were observed with shock and disseminated intravascular coagulation in 7% of cases (4/55), Thus, while 53% of cases presented with the typical triad (29/55), unusual complications and atypical features occurred in 40% (22/55).
Diagnosis of ST becomes clinically challenging in the absence of typical features. In Fukushima, an endemic area of ST, an atypical presentation involving multisystem disease is common.
恙虫病在福岛为地方性疾病，2009年至2010年期间日本报告的病例数最多。尽管恙虫病极易治疗，但其非典型临床表现妨碍诊断，导致治疗延误。
我们回顾了2008年至2017年期间日本福岛太田西之内综合医院成人恙虫病的临床特征。
基于免疫球蛋白（Ig）M和IgG升高以及焦痂样本聚合酶链反应阳性，通过血清学确诊了55例恙虫病（血清型Karp 24例、Irie/Kawasaki 21例、Hirano/Kuroki 10例）。平均年龄为69岁，64%为女性。病死率为1.8%（1/55）。约70%的病例（38/55）在初次门诊就诊时未被诊断为恙虫病。22%的病例（12/55）存在抗生素使用不当情况。在非典型临床特征方面，31%的病例（17/55）不存在发热、皮疹和焦痂中的1种或更多表现。约11%的病例无焦痂表现（6/55；Karp 1例、Irie/Kawasaki 1例、Hirano/Kuroki 4例）。此外，7%的病例（4/55）出现了休克和弥散性血管内凝血等严重并发症。因此，虽然53%的病例表现为典型三联征（29/55），但40%（22/55）出现了不寻常并发症和非典型特征。
在缺乏典型特征的情况下，恙虫病的临床诊断具有挑战性。在恙虫病的地方性流行区福岛，涉及多系统疾病的非典型表现很常见。
