中华皮肤科杂志 ›› 2011, Vol. 44 ›› Issue (3): 208-209.

• 研究报道 • 上一篇    下一篇

恙虫病皮肤损害的特征

杨晴1,黄明星2,周耀勇1,李春娜2,洪仲思2   

  1. 1. 中山大学附属第五医院
    2.
  • 收稿日期:2010-07-20 修回日期:2010-08-05 出版日期:2011-03-15 发布日期:2011-03-10
  • 通讯作者: 杨晴 E-mail:yangqing7007@126.com

Characteristics of skin lesions in patients with tsutsugamushi disease

  • Received:2010-07-20 Revised:2010-08-05 Online:2011-03-15 Published:2011-03-10

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摘要：

目的 分析恙虫病皮肤损害的临床特征。方法 分析17例住院恙虫病患者的皮肤损害及临床特征。结果 恙虫病有88.2%（15/17）的患者出现皮肤焦痂及溃疡，有64.7%（11/17）的患者伴有皮肤出疹。焦痂出现在发热后4 ～ 10 d，其发生部位不一，数量为1个，平均直径1.2 cm（0.5 ～ 3.0 cm），表面干燥呈黑色，周边绕以环形红晕，不伴疼痛及瘙痒，于出现后5 ～ 9 d焦痂脱落形成浅溃疡。出现焦痂者中有80.0%的患者伴有焦痂附近浅表淋巴结肿大。66.7%的患者首诊时未发现焦痂。伴有皮肤出疹者为充血性丘疹（45.5%）和斑丘疹（54.5%），不伴瘙痒，于出疹后2 ～ 5 d消退。结论 恙虫病的皮肤损害包括皮肤焦痂和皮疹。皮肤焦痂是本病的重要特征，为临床诊断的主要依据。

关键词: 皮疹

Abstract:

Objective To investigate the clinical characteristics of skin lesions of tsutsugamushi disease. Methods The skin lesions and clinical characteristics of 17 hospitalized patients with tsutsugamushi disease were analyzed. Results Of the patients, 88.2% （15/17） developed eschar and skin ulcer, 64.7% （11/17） had skin rashes. The patients often developed solitary, painless and nonpruritic eschar 4 to 10 days after the occurrence of fever, with indefinite locations and average diameter of 1.2 cm （range: 0.5 - 3.0 cm）. The eschar was covered with a black and dry surface and surrounded by a ring-shaped erythematous halo, and usually shedded 5 to 9 days after the appearance with the formation of shallow ulcer. Superficial lymphadenectasis was observed near the eschar in 80% of the patients with eschar, and no eschar was observed at the first visit in 66.7% of the patients. Skin rashes mainly included nonpruritic congestive papules （45.5%） and maculopapular rashes （54.5%）, and often subsided 2 to 5 days after emergence. Conclusions The skin lesions of tsutsugamushi disease include eschar and skin rashes. Eschar is an important characteristic and highly suggestive of this entity.