摘要
目的 总结分析恙虫病的罕见神经系统临床表现特点、治疗方案、预后.方法 通过检索数据库收录的恙虫病累及神经系统罕见临床表现的相关文献,筛选后提取文献中的一般信息,综合相关数据,回顾性分析恙虫病在神经系统的罕见临床表现、诊断、治疗方案、预后.结果 文献检索筛选后共纳入34篇研究文献,其中33篇病例报道、1篇回顾性研究.总计48例恙虫病合并神经系统症状患者,其中恙虫病引起的横贯性脊髓炎及长节段的急性脊髓炎5例、急性播散性脑脊髓炎3例、脑血管病6例、小脑炎5例、帕金森综合征4例、后部可逆性脑病综合征3例、脑神经病变6例、吉兰-巴雷综合征16例.临床表现:发热等流感样症状患者47例、合并皮肤焦痂患者26例.检测方法:采用ELISA检测20例、IFA检测18例、PCR检测1例、mGS检测1例、IFA和PCR检测4例、ELISA和IFA检测3例、未检测1例.治疗:服用多西环素42例、利福平2例、阿奇霉素1例、米诺环素1例,未使用抗生素2例.3例预后不好.结论 恙虫病罕见神经系统表现可以为多样,其中以吉兰-巴雷综合征发病率相对较高,大部分患者有发热等流感样症状,半数患者可有皮肤焦痂,可采用ELISA或IFA检测方法进行确诊,早期服用多西环素疗效好.
Abstract
Aim To summarise and analyze the clinical features,treatments and prognosis of rare neurological manifestations of scrub typhus.Methods The clinical manifestations,diagnosis,treatment and prognosis of neurological manifestations due to scrub typhus were analyzed retrospectively by searching the database,extracting general information from the literature,and the relevant data.Results Thirty four research papers,33 case reports and one retrospective study were enrolled after screening.There were 48 patients with combined neurological manifestations of scrub typhus.Among them,there were 5 cases of transverse myelitis and long-segment acute myelitis,3 cases of acute disseminated encephalomyelitis,6 cases of cerebrovascular disease,5 cases of encephalitis,4 cases of Parkinson's syndrome,3 cases of posterior reversible encephalopathy syndrome,6 cases of cerebral neuropathy,and 16 cases of Guillain-Barré syndrome.There were 47 patients with influenza-like symptoms such as fever,26 patients with combined skin crusting.In terms of detection method,20 cases with ELISA,18 cases with IFA,1 case with PCR,1 case with mGS,4 cases with IFA and PCR,3 cases with ELISA and IFA,and 1 case without detection.Doxycycline was taken in 42 cases,rifampicin in 2 cases,azithromycin in 1 case,minocycline in 1 case,and no antibiotics in 2 cases.3 cases had a poor prognosis.Conclusion The rare neurological manifestations of scrub typhus can vary,with a relatively high incidence of Guillain-Barré syndrome,most patients have influenza-like symptoms such as fever,and half of the patients may have skin crusting,which can be diagnosed by ELISA or IFA test,and early treatment with doxycycline is effective.
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