[Clinical characteristics of 32 cases of tsutsugamushi disease in Suqian Municipality].

OBJECTIVE: To understand the clinical characteristics of tsutsugamushi disease in Suqian Municipality, Jiangsu Province so as to guide the diagnosis and treatment of this disease. METHODS: The clinical data of 32 patients diagnosed as tsutsugamushi disease in our hospital during the past 2 years were analyzed retrospectively. RESULTS: Tsutsugamushi disease occurred frequently between August and December. All the 32 patients had the history of contacting grass and brushwood, and all of them showed the signs of pyrexia, eschar, ulcer, swelling of lymph nodes and rash. Liver damages were observed in 30 cases (93.75%). Pulmonary imaging changes were observed in 14 cases (43.75%). Heart damages were noticed in 9 cases (28.13%). Kidney damages were noticed in 6 cases (18.75%). One case was complicated by multiple organ dysfunction syndromes (MODS) and disseminated intravascular coagulation (DIC). The OX19 and OX2 antigen agglutination reaction of bacillus proteus were negative in all the cases. The OXK antigen agglutination reaction of bacillus proteus was positive in 6 cases (18.75%). Among 32 cases, 24 cases were misdiagnosed in the first visiting clinic. The misdiagnosis rate of the initial diagnosis of this disease reached as high as 75%. Azithromycin was effective. The curative rate was 96.88% and the mortality was 3.13% (1 case). CONCLUSIONS: Clinical characteristics of tsutsugamushi disease are complicated, and it is commonly complicated with liver damages. The Weil-Felix test is not very important to initial diagnosis for tsutsugamushi disease in local. For patients as fever with unknown origin (FUO) and with the liver damage, the diagnosis of tsutsugamushi disease should be reminded.

[Clinical features of hypokalemic periodic paralysis].

OBJECTIVE: To explore the clinical features of hypokalemic periodic paralysis, and compare clinical features of primary group with those of thyrotoxicosis secondary group. METHODS: Clinical data of 44 patients with hypokalemic periodic paralysis in Peking University First Hospital from 1996 December to 2008 December were retrospectively analyzed. RESULTS: There were 22 patients in primary group, and 22 in thyrotoxicosis group. Identical clinical features of both the groups: (1)It had a predilection in young men. (2)Main symptoms were limb movement disorder and fatigue, and paralysis recurrent attacked in most patients. (3) 40.9% to 68.2% patients had obvious incentives, and the common ones were a heavy meal, sweet drinks, or strenuous exercise. (4) Serum potassium levels of the two groups were obviously lower than the normal range. (5)In 20% patients of primary group and 25% patients of thyrotoxicosis secondary group, CK levels were higher than normal, while LDH and HBDH levels were normal. (6)The doses of potassium replishment were not correlated to serum potassium levels at the onset. Different clinical features of the two groups: (1) Patients of thyrotoxicosis group had hypermetabolism symptoms and thyroid dysfunction. Patients of primary group had no hypermetabolism symptoms, and all of them were euthyroid. (2)Serum potassium levels of thyrotoxicosis secondary group were lower than those of primary group significantly [(2.25 +/- 0.67) vs (2.78 +/- 0.49) mmol/L, P=0.007]. (3) Hyperkalemia is easier than primary group to rebound in thyrotoxicosis secondary group, after replenishment of potassium. CONCLUSION: Hypokalemic periodic paralysis has its clinical features, and patients with early diagnosis and replenishment of potassium in time have good prognosis. The doses of potassium replenishment are not determined by serum potassium levels at the onset. Hyperkalemia is easier to rebound in thyrotoxicosis secondary group after replenishment of potassium, serum potassium levels should be monitored closely, and hyperthyrosis radically cured.