ABSTRACT
@#Abstract: Objective To analyze the epidemiological characteristics of scrub typhus in 680 patients with unexplained fever in Hainan Island and provide guidance for local scrub typhus prevention and control. Methods Blood samples from patients with clinically diagnosed unexplained fever in the First Affiliated Hospital of Hainan Medical University, Second Affiliated Hospital of Hainan Medical University, Haikou Municipal People's Hospital and Central South University Xiangya Medical College Affiliated Hospital, People's Hospital of Qiongzhong Li Miao Autonomous County were collected between 2018 and 2021, then samples were tested for Orientia tsutsugamushi specific IgM, IgG antibodies and Orientia tsutsugamushi 56kD-specific antigen genes using colloidal gold immunochromatography and PCR methods. The clinical and epidemiological information of the samples were also collected. Epidemiological analysis was carried out on the obtained sample information and test results. Results A total of 680 samples from patients with clinically unknown fever were collected. The positive rates of scrub typhus IgM antibody, IgG antibody, PCR were 23.97% (163/680), 36.62% (249/680), 20.88% (142/680), respectively, and eschar or rash was observed in 12.06% (82/680) of all patients. According to the diagnostic criteria, 223 patients were finally diagnosed with scrub typhus. Among them, there were 111 males (49.78%) and 109 females (48.88%); the average age was (53.14±15.12) years old, and the 40-<60 years old was the main incidence group (98 cases, accounting for 43.95%). The ethnicity of the patient with scrub typhus was mainly Han ethnicity (136 cases, accounting for 60.99%). Farmers were the main morbidity group (93 cases, 41.70%). The patient with scrub typhus distributed throughout the island except for Sanya and Wuzhishan, with Haikou and Qiongzhong show the highest number of cases. The number of cases in autumn was the highest (114 cases, 51.12%). The clinical manifestations of infected patients were mainly non-specific symptoms and signs, 36.77% of patients developed skin-specific ulcers or eschars, which were mainly distributed in the shoulder and neck, armpits, elbow fossa, chest and abdomen, back, buttocks, groin, scrotum and other joints and skin folds of the upper and lower limbs. Conclusions Hainan Island is the foci of scrub typhus and the epidemic time has obvious seasonality. Its prevention should focus on rural areas in autumn, and its clinical features are mainly high fever and eschar or ulceration.
ABSTRACT
Haemophagocytic lymphohistiocytosis (HLH) is a clinicopathologic syndrome, characterised by hyperinflammation due to inherited or acquired defects in the immune function, leading to unchecked proliferation of histiocytes and lymphocytes resulting in multiorgan dysfunction. HLH can be primary (familial) occurring in young children caused by underlying genetic defects in natural killer cells/cytotoxic T cells or secondary HLH occurring in older children or adults following infections, rheumatological disorders or malignancies. HLH is a medical emergency, having varied clinical presentations and lacks a pathognomonic clinical or laboratory abnormality. Clinical presentations include unexplained fever, hepatomegaly, splenomegaly, skin rash, cytopenias, liver dysfunction, coagulation abnormality and neurological manifestations. It carries a poor prognosis. Early diagnosis based on HLH 2004 criteria and initiation of treatment is crucial in the management strategy, which is likely to improve the outcome of this life-threatening disease. The treatment strategies include immunosuppressive drugs, immunomodulatory therapy and autologous hematopoietic stem cell transplant in selected cases. Here with authors report a case of young adult, presenting with fever, thrombocytopenia, splenomegaly, and multi organ dysfunction, diagnosed as a case of secondary HLH based on the HLH 2004 guidelines.
ABSTRACT
The incidence of human brucellosis is on the rise worldwide. The disease can affect various systems. The clinical manifestations are complex and non-specific, and the diagnosis is difficult. Especially the clinicians in the non-epidemic areas have sporadic cases on the pest free areas. Lack of experience in diagnosis and treatment leads to misdiagnosis and mistreatment, which affects prognosis. This article reports on the epidemiology, clinical manifestations, laboratory tests and treatment of a patient with unexplained fever and brucellosis in our department in June 2019. Raise the attention of clinicians in non-epidemic areas to the disease and enhance people's awareness of protection in non-epidemic areas.