蜱传感染继发的噬血细胞淋巴组织细胞增多症(HLH)是一种罕见但可能危及生命的综合征。我们根据PRISMA指南进行了范围审查,以系统分析有关该主题的现有文献。共纳入98例患者,平均年龄43.7岁,其中64%是男性。大多数情况下,31%,来自美国的报道。免疫抑制存在于21.4%,最常见的原因是以前的实体器官移植。宪法症状是最常见的,在83.7%的患者中观察到,而70.4%的病例报告发热。脓毒症发生率为27.6%。该队列中最常见的实验室异常是81.6%的患者的血小板减少症。而贫血,白细胞减少症,白细胞增多率75.5%,55.1%,和10.2%,分别。在63.3%的病例中发现肝酶升高。分析了64例患者的H评分,平均值为209,61.2%的患者进行了骨髓分析.埃里希菌属。是与HLH相关的主要分离药物占45.9%,其次是立克次体。在14.3%和吞噬细胞无性体在12.2%。值得注意的是,没有患有Powassan病毒感染或莱姆病的患者发生HLH。最常见的并发症为急性肾损伤(AKI)占35.7%,休克伴多器官功能障碍占22.5%,脑病/癫痫发作占20.4%,呼吸衰竭16.3%,7.1%的患者出现心脏并发症。治疗包括单纯抗生素治疗占43.9%,而5.1%的患者仅接受免疫抑制剂治疗。51%的患者同时使用抗生素和免疫抑制剂治疗。62.2%使用适当的经验性抗生素。在43.9%的由蜱传疾病引起的HLH病例中,患者仅接受抗菌治疗,88.4%的患者完全康复,无需免疫抑制治疗。我们审查的死亡率为16.3%,接受不适当或延迟经验性治疗的患者结局更差.因此,我们建议对因蜱传疾病而疑似患有HLH或因诊断延迟而诊断不确定持续的患者进行经验性抗生素治疗,以降低死亡率.
Hemophagocytic lymphohistiocytosis (HLH) secondary to tick-borne infections is a rare but potentially life-threatening syndrome. We performed a scoping
review according to PRISMA guidelines to systematically analyze the existing literature on the topic. A total of 98 patients were included, with a mean age of 43.7 years, of which 64% were men. Most cases, 31%, were reported from the USA. Immunosuppression was present in 21.4%, with the most common cause being previous solid organ transplantation. Constitutional symptoms were the most common, observed in 83.7% of the patients, while fever was reported in 70.4% of cases. Sepsis was present in 27.6%. The most common laboratory abnormalities in this cohort were thrombocytopenia in 81.6% of patients, while anemia, leukopenia, and leukocytosis were observed in 75.5%, 55.1%, and 10.2%, respectively. Liver enzyme elevation was noted in 63.3% of cases. The H-score was analyzed in 64 patients, with the mean value being 209, and bone marrow analysis was performed in 61.2% of patients. Ehrlichia spp. was the main isolated agent associated with HLH in 45.9%, followed by Rickettsia spp. in 14.3% and Anaplasma phagocytophilum in 12.2%. Notably, no patient with Powassan virus infection or Lyme borreliosis developed HLH. The most common complications were acute kidney injury (AKI) in 35.7% of patients, shock with multiple organ dysfunction in 22.5%, encephalopathy/seizure in 20.4%, respiratory failure in 16.3%, and cardiac complications in 7.1% of patients. Treatment included antibiotic therapy alone in 43.9%, while 5.1% of patients were treated with immunosuppressants alone. Treatment with both antibiotics and immunosuppressants was used in 51% of patients. Appropriate empiric antibiotics were used in 62.2%. In 43.9% of cases of HLH due to tick-borne disease, patients received only antimicrobial therapy, and 88.4% of those recovered completely without the need for immunosuppressive therapy. The mortality rate in our
review was 16.3%, and patients who received inappropriate or delayed empiric therapy had a worse outcome. Hence, we suggest empiric antibiotic treatment in patients who are suspected of having HLH due to tick-borne disease or in whom diagnostic uncertainty persists due to diagnostic delay in order to minimize mortality.