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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 289 -294. doi: 10.3877/cma.j.issn.1674-1358.2022.05.001

综述

儿童恙虫病临床特点及诊治研究进展
李凤霞1, 毛静2, 杨军杰3, 钟炎平2, 刘鑫华2, 雷旭2, 雷飞飞2, 赵琴1, 饶荣1, 谭华炳2,†()   
  1. 1. 442000　十堰市，十堰市人民医院（湖北医药学院附属人民医院）感染性疾病科；442100　房县，房县人民医院儿科
    2. 442000　十堰市，十堰市人民医院（湖北医药学院附属人民医院）感染性疾病科
    3. 442000　十堰市，十堰市人民医院（湖北医药学院附属人民医院）感染性疾病科；442000　十堰市，锦州医科大学十堰市人民医院研究生培养基地
  • 收稿日期:2022-04-16 出版日期:2022-10-15
  • 通信作者: 谭华炳
  • 基金资助:
    国家自然科学基金青年科学基金资助项目(No. 82002149); 2014年度湖北省教育厅科学研究计划(No. Q20142106); 2021年十堰市科学技术研究与攻关项目(No. 2021K65); 2022年十堰市科技局引导性科研项目(No. 22Y78); 2022年湖北医药学院研究生科技创新项目(No. 2022HBUMY066)

Research progress on clinical characteristics, diagnosis and treatment of tsutsugamushi disease in children

Fengxia Li1, Jing Mao2, Junjie Yang3, Yanping Zhong2, Xinhua Liu2, Xu Lei2, Feifei Lei2, Qin Zhao1, Rong Rao1, Huabing Tan2,†()   

  1. 1. Department of Infectious Diseases, Hepatology Institute, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China; Departmemnt of Paediatrics, Fang County Renmin Hospital, Fang County 442100, China
    2. Department of Infectious Diseases, Hepatology Institute, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China
    3. Department of Infectious Diseases, Hepatology Institute, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China; Postgraduate Training Basement of Jinzhou Medical University, Shiyan Renmin Hospital, Shiyan 442000, China
  • Received:2022-04-16 Published:2022-10-15
  • Corresponding author: Huabing Tan
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引用本文：

李凤霞, 毛静, 杨军杰, 钟炎平, 刘鑫华, 雷旭, 雷飞飞, 赵琴, 饶荣, 谭华炳. 儿童恙虫病临床特点及诊治研究进展[J]. 中华实验和临床感染病杂志(电子版), 2022, 16(05): 289-294.

Fengxia Li, Jing Mao, Junjie Yang, Yanping Zhong, Xinhua Liu, Xu Lei, Feifei Lei, Qin Zhao, Rong Rao, Huabing Tan. Research progress on clinical characteristics, diagnosis and treatment of tsutsugamushi disease in children[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(05): 289-294.

恙虫病（TD）是由恙虫病东方体（Ot）感染而引起的自然疫源性疾病，人群对Ot普遍易感。因对儿童TD关注不够，导致我国TD儿童患者误诊、误治发生率较高。本文对儿童TD的临床特点进行综述，以提高对儿童TD的临床认知。TD特征性体征焦痂在儿童TD发生率为34.6%~70.5%，皮疹发生率仅为10%~20%，是导致误诊误治的主要原因。儿童TD神经系统感染发生率高，肝功能损伤发生率高，血小板减少、贫血、心肌炎发生率高，儿童高热伴多系统受累应怀疑TD。儿童TD病死率高达4.8%~12.2%，致死原因为多器官功能衰竭（MSOF）、急性呼吸窘迫综合征（ARDS）和嗜血细胞综合征（HPS）。儿童TD需要与发热伴血小板减少综合征（SFTS）、登革热、伤寒、钩端螺旋体病、流行性出血热、黑热病等相鉴别。运用聚合酶链式反应（PCR）检测血液和（或）焦痂Ot，酶联免疫吸附测定（ELISA）检测血液Ot抗体IgM是TD病原学诊断的成熟技术，也有应用宏基因二代测序技术（mNGS）诊断TD的报道。Ot为细胞内寄生菌，应用能进入细胞内的抗菌药物，如多西环素、阿奇霉素、氯霉素和克拉霉素均可取得显著疗效。

关键词: 恙虫病, 儿童, 临床特点, 诊断, 鉴别诊断, 抗菌药物

Tsutsutsugamushi disease (TD) is a natural epidemic disease caused by orientia tsutsugamushi (Ot) infection, and all people are generally susceptible to Ot. Insufficient attention to children with TD in China leads to a high incidence of misdiagnosis and mistreatment. This article reviews the clinical features of children with TD, in order to improve the clinical understanding of children’s TD. The incidence of characteristic signs of TD eschar in children with TD was 34.6%-70.5%, and the incidence of rash was only 10%-20%, which was the main cause of the misdiagnosis and mistreatment. TD has a high incidence of nervous system infection, liver damage, thrombocytopenia, anemia and myocarditis in children. TD should be suspected in children with high fever and multiple system involvement. The mortality rate of TD in children was as high as 4.8%-12.2%. The causes of death are multiple organ failure, acute respiratory distress syndrome and hemophagocytic syndrome. TD should be differentiated from severe fever with thrombocytopenia syndrome (SFTS), dengue fever, typhoid fever, leptospirosis, epidemic hemorrhagic fever and kala-azar. Detection of Ot in blood and/or eschar by polymerase chain reaction (PCR), detection of Ot antibody IgM in blood by enzyme-linked immunosorbent assay (ELISA) was a mature technology for TD etiological diagnosis, and there were also reports using macro gene second-generation sequencing technology to diagnose TD. Ot was an intracellular parasite, and the application of antibiotics doxycycline, azithromycin, chloramphenicol and clarithromycin, which could enter the cell and could achieve remarkable curative effect.

Key words: Tsutsugamushi disease, Children, Clinical characteristics, Diagnosis, Differential diagnosis, Antimicrobial drugs
图1 我国2006至2018年TD发病县区数
图2 我国2006至2018年TD发病例数化
表1 各种病原学检查方法敏感性和特异性
检查方法 敏感性（%） 特异性（%） 文献来源
ELISA法检测Ot-Ab-IgM 92.0 92.0 参考文献[62]
RDT法检测Ot-Ab-IgM 94.0 92.0 参考文献[62]
IFA法检测Ot-Ab-IgM 95.0 74.0 参考文献[62]
cPCR法检测Ot 76.0 97.0 参考文献[62]
qPCR法检测Ot 97.0 97.0 参考文献[62]
LAMP法检测Ot 91.7 91.7 参考文献[62]
W-F试验 17.6 96.0 参考文献[58]
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