恙虫病在临床上伴有多脏器损害的病例有增多的趋势,以致病情危重和复杂化,是近年来临床上误漏诊病例较多的原因之一,应引起同道重视。我院于1994年6～11月恙虫病流行高峰期间,曾收治恙虫病伴多脏器损害者4例,现分析报告如下。 一、诊断根据本组诊断参照于恩庶提出的标准:(一)有野外接触史;(二)突发高热并发特异性焦痂或溃疡;(三)淋巴结肿大、皮疹、肝脾肿大;(四)变形杆菌OXk凝集试验阳性或恙虫病立克次体抗体(IFA)阳性者,凡具有上述4项中之3项可诊断之,本组4例即据此标准而诊断。 二、4例恙虫病多脏器损害情况见附表。 讨论 一、恙虫病伴多脏器损害 恙虫病的发病机理是病原体先在局部繁殖后,进入血流到达各脏器组织,立克次体死亡后所释放的毒素为致病的主要原因。由于立克次体血症和毒血症,引起各脏器的基本病变为血管炎,特异性病变是广泛的血管周围炎和血栓性血管炎,有学者认为立克次体被吞噬细胞溶解后,其降解 Tsutsugamushi disease in clinical cases associated with multiple organ damage have an increasing trend, so critically ill and complicated, is one of the reasons for the more clinical missed cases in recent years, should be given equal attention. Our hospital in 1994 6 ~ November tsutsugamushi epidemic peak period, had admitted tsutsugamushi with multiple organ damage in 4 cases, the analysis is as follows. First, the diagnosis based on the diagnosis of reference to the standard of grace Shu: (a) a history of exposure to the wild; (b) sudden high fever complicated with specific eschar or ulcer; (c) lymph nodes, rash, hepatosplenomegaly ; (D) Proteus OXk agglutination test positive or scrub typhus Rickettsia antibody (IFA) positive, who have the above four in 3 can be diagnosed, the group of 4 cases that are diagnosed under this standard. Second, 4 cases of tsutsugamushi disease multiple organs see Schedule. Discussion First, the scrub typhus with multiple organ damage The pathogenesis of scrub typhus is the pathogen first after local propagation into the bloodstream to reach the organs, rickettsia after the release of toxins is the main cause of disease. Due to rickettsiaemia and toxemia, the basic disease caused by various organs of vasculitis, specific lesions are extensive perivascular inflammation and thrombotic vasculitis, some scholars believe that rickettsia is dissolved by phagocytes , Its degradation