背景:立克次体包括一个专性细胞内短革兰氏阴性可可杆菌家族,并通过昆虫传播,螨虫,跳蚤,虱子,和刻度向量。斑疹伤寒,北亚洲蜱斑疹伤寒,立克次体痘,布托尼尔发烧在印度和亚洲很常见。在最初五天的疾病早期阶段,所有这些都是无法区分的;而且,它们模仿任何其他自限性病毒性发热。患者通常表现为发热,头痛,肌痛,萎靡不振,恶心,呕吐,和厌食症。患者很少出现皮疹,或者有接触过动物或蜱叮咬的历史。因此,立克次体病在早期被错过,当它们容易治疗时,由于缺乏怀疑。
目的:研究临床特征,调查,结果,以及影响立克次体热转归的因素。
方法:这是一项观察性研究,于2012年12月至2014年11月在一家三级医院进行。研究人群包括13岁以上有以下任何一种或多种病史的患者:头痛,黄疸,改变的感官,肾功能不全,蜱叮咬,按职业划分的农民,接触牛、羊或狗,多器官衰竭;通过Weil-Felix试验(ox-19/ox-2/ox-k≥1:320)或立克次体抗体IgM≥1.1)或PCR阳性,有立克次体感染的血清学证据。本研究的最终分析考虑了40个样本量。使用推断性统计检验如卡方检验和比值比(OR)进行统计分析。
结果:最常见的症状是发烧(100%),几乎每个患者都有身体疼痛(72.5%),关节痛(62.5%),黄疸(62.5%)。一般检查显示黄疸(37.5%),低血压(30%),水肿(22.5%),淋巴结肿大(22.5%),脸色苍白(15%)。入学那天,发现17例患者的Weil-Felix试验呈阳性,OR为0.538462(CI=0.151-1.917),而在第二周进行的Weil-Felix检验在37例患者中呈阳性,OR为5.4(CI=0.439-63.11)。立克次体抗体仅在3例患者入院当天呈阳性,OR为0.381(CI=0.0317-4.58),而在第二周,27例患者立克次体抗体阳性,OR为16.25。13例患者立克次体PCR检测呈阳性,OR为1.48(CI=0.3857-5.722)。出现呼吸困难和呼吸道并发症如肺炎的患者死亡率很高,肺水肿,和急性呼吸窘迫综合征。同样,出现低血压和需要离子型支持的患者死亡率较高.
结论:虽然立克次体感染的临床表现相似,致病物种和流行病学可能因地区而异。重要的是要认识到特定地区的典型症状和流行病学,以便及时正确诊断和治疗这些感染,因为它们可能与显著的发病率和死亡率相关。通过这项研究,我们试图提高对这种疾病的认识,这将有助于临床医生在并发症发生之前尽早怀疑并开始治疗。
BACKGROUND: Rickettsiae comprise a family of obligate intracellular short gram-negative coco-bacilli and are transmitted by insects, mites, fleas, louse, and tick vectors. Scrub typhus, north-Asian tick typhus, rickettsia pox, and boutonniere fevers are common in India and Asia. In the early phase of illness during the initial five days, all these are indistinguishable among themselves; also, they mimic any other self-limiting viral fever. Patients usually present with fever, headache, myalgia, malaise, nausea, vomiting, and anorexia. Rarely do patients present with rash, or give a history of exposure to animals or tick bite. Thus, rickettsial diseases are missed in the early phase, when they are easily treatable, due to lack of suspicion.
OBJECTIVE: To study clinical features, investigations, outcomes, and factors affecting the outcome of rickettsial fever.
METHODS: This was an observational study conducted from December 2012 to November 2014 in a tertiary care hospital. The study population consisted of patients above the age of 13 years with a history of any one or more of the following: fever, headache, jaundice, altered sensorium, renal dysfunction, tick bite, a farmer by occupation, exposure to cattle or sheep or dog, multiorgan failure; with serological evidence of rickettsial infection by Weil-Felix test (ox-19/ox-2/ox-k ≥ 1:320) or rickettsial antibody IgM ≥ 1.1) or PCR positive. A sample size of 40 was considered for the final analysis of this study. Statistical analysis was done using inferential statistical tests such as the chi-square test and odds ratio (OR).
RESULTS: The most common presenting symptom was fever (100%) seen in almost every patient followed by body aches (72.5%), joint pain (62.5%), and jaundice (62.5%). General examination showed icterus (37.5%), hypotension (30%), edema (22.5%), lymphadenopathy (22.5%), and pallor (15%). On the day of admission, 17 patients were found to have the Weil-Felix test positive with an OR of 0.538462 (CI = 0.151-1.917), while the Weil-Felix test done in the second week was positive in 37 patients with an OR of 5.4 (CI = 0.439-63.11). Rickettsial antibodies were positive only in three patients on the day of admission with an OR of 0.381 (CI = 0.0317-4.58), while in the second week, rickettsial antibodies were positive in 27 patients with an OR of 16.25. The rickettsial PCR test was positive in 13 patients with an OR of 1.48 (CI = 0.3857-5.722). The mortality rate was significantly high in patients presenting with breathlessness and respiratory complications like pneumonia, pulmonary edema, and acute respiratory distress syndrome. Similarly, patients presented with hypotension and required Ionotropic support had a high mortality rate.
CONCLUSIONS: While the clinical presentation of rickettsia infection is similar, the causative species and epidemiology can vary depending on the region. It is important to recognize both the typical symptoms and the epidemiology of a given region to correctly diagnose and treat these infections promptly, as they can be associated with significant morbidity and mortality. Through this study, we attempt to bring awareness about this disease which would help clinicians to suspect and start treatment at the earliest before complications set in.