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目的:探讨以发热伴呼吸道感染症状为主要临床表现的非典型伤寒的早期诊断及影响因素。方法:分析63例以发热伴呼吸道感染为主要表现,经血培养或血清肥达氏反应达诊断标准,确诊伤寒或副伤寒病例的临床表现及实验室检查。结果:伴有上呼吸道感染症状的非典型伤寒患者,呈稽留热型表现者少、部分病例无相对缓脉、多数无无欲貌和玫瑰疹等伤寒的典型临床表现及肥达反应单次检出率低,极易造成对伤寒的漏诊和延诊。但仍有白细胞计数减低及嗜伊红细胞绝对计数减少、血清酶改变、B超检查肝、脾肿大的特点。结论:早期不规则的使用抗生素和退热药,可能是造成以发热伴呼吸道感染为主的非典型伤寒发生的主要原因,高度重视该病的发生,综合临床检查仍是提高该病早期诊断率的方法,并有助于控制疾病的发展及传播。
Objective: To investigate the early diagnosis and the influential factors of atypical typhoid fever, the main clinical manifestations of fever and respiratory tract infection. Methods: The clinical manifestations and laboratory tests of 63 cases of typhoid fever or paratyphoid fever were confirmed by the diagnostic criteria of 63 cases of fever with respiratory tract infection, menstrual blood culture or serum Widal reaction. Results: The atypical typhoid fever patients with symptoms of upper respiratory tract infection were characterized by few persistent hot type symptoms, some cases with no relative slow pulse, most of the typical clinical manifestations of typhoid fever without rubella and rosea, A low rate, easily lead to missed diagnosis and extension of typhoid fever. However, there is still a decrease in white blood cell count and absolute eosinophil count decreased, serum enzyme changes, B-ultrasound liver and splenomegaly characteristics. Conclusion: Irregular use of antibiotics and antipyretics in the early stage may be the main cause of atypical typhus with fever and respiratory tract infection. The high incidence of this disease is still the most important factor. Comprehensive clinical examination is still to improve the early diagnosis rate And help to control the development and spread of the disease.