Luo Yonghan, Yang Xiaotao, Bai Houxi, Xiao Litao, Guo Yan, Jiao Feng, Wang Yanchun
Second Department of Infectious Disease, Kunming Children's Hospital, Yunnan Key Specialty of Pediatric Infection (Training and Education Program)/Kunming Key Specialty of Pediatric Infection, Kunming, Yunnan, 650000, China.
Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China.
Eur J Clin Microbiol Infect Dis. 2025 Apr;44(4):887-894. doi: 10.1007/s10096-025-05050-7. Epub 2025 Feb 4.
This study aims to investigate the clinical characteristics and analyze the diagnostic approaches employed for pediatric cases of scrub typhus (ST) that present without eschars.
A retrospective analysis was conducted on 256 ST cases hospitalized at Kunming Children's Hospital in Yunnan Province, China, from January 2015 to November 2022. Patients were categorized into an eschar group (n = 213) and a non-eschar group (n = 43). Clinical data were collected and analyzed for significant differences between the groups. This study particularly highlights the diagnostic methods for confirming ST in cases without eschars.
The non-eschar group exhibited a higher incidence of pneumonia, a lower history of outdoor activities prior to onset, and a longer hospital stay; however, the remaining clinical and laboratory characteristics did not show statistically significant differences. The most common site for eschar formation was the axilla (12.7%, n = 27), followed by the groin (9.4%, n = 20) and auricle (8.9%, n = 19). Other notable sites included the scalp (7.5%, n = 16) and shoulder (6.6%, n = 14). The Weil-Felix test (OXK) demonstrated a positivity rate of 69.7% (23 out of 33 cases), cerebrospinal fluid (CSF) PCR had a positivity rate of 50.0% (3 out of 6 cases), and blood PCR exhibited a positivity rate of 92.3% (24 out of 26 cases).
These findings underscore the importance for clinicians to consider ST in pediatric patients, even in the absence of eschars. A comprehensive evaluation based on epidemiology, symptoms, signs, and laboratory characteristics is essential. Blood PCR testing methods are recommended.
Not applicable.
本研究旨在调查无焦痂的小儿恙虫病（ST）病例的临床特征，并分析所采用的诊断方法。
对2015年1月至2022年11月在中国云南省昆明市儿童医院住院的256例ST病例进行回顾性分析。患者分为焦痂组（n = 213）和无焦痂组（n = 43）。收集临床数据并分析两组之间的显著差异。本研究特别强调了在无焦痂病例中确诊ST的诊断方法。
无焦痂组肺炎发生率较高，发病前户外活动史较少，住院时间较长；然而，其余临床和实验室特征无统计学显著差异。焦痂形成最常见的部位是腋窝（12.7%，n = 27），其次是腹股沟（9.4%，n = 20）和耳廓（8.9%，n = 19）。其他值得注意的部位包括头皮（7.5%，n = 16）和肩部（6.6%，n = 14）。外斐试验（OXK）阳性率为69.7%（33例中的23例），脑脊液（CSF）PCR阳性率为50.0%（6例中的3例），血液PCR阳性率为92.3%（26例中的24例）。
这些发现强调了临床医生即使在小儿患者无焦痂的情况下也应考虑ST的重要性。基于流行病学、症状、体征和实验室特征进行全面评估至关重要。推荐采用血液PCR检测方法。
不适用。
