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近年来,由于耐药伤寒杆菌菌株广泛存在及变异型伤寒杆菌菌株的增多,使伤寒的临床表现变异颇大,常规实验检查阳性率也减低,致使伤寒的早期诊断有一定困难。我院自1993年3月～1996年6月共收散发性伤寒50例,全部病例均经血培养和(或)血清学证实而确诊。报告如下。 1 临床资料 1.1 一般情况:本组男36例,女14例。年龄5～65岁,平均年龄35岁;本组均为散发病例,发病时间以4～10月为多,共35例,占70％。就诊时间为病后2～50天,确诊时间为病后10～50天。 1.2 临床表现:本组病人的主要症状与体征:发热40例(稽留高热8例,弛张热11例,不规则热21例),腹痛腹泻15例,咳喘、肺部有湿啰音10例,皮肤出血、贫血8例,血尿、蛋白尿8例,胸闷、心悸、室性早搏6例,黄疸、转氨酶增高3例。相对缓脉10例,玫瑰疹6例,肝大18例,脾大8例。而同时有腹痛腹泻、持续稽留高热、肝脾肿大、玫瑰疹和相对缓脉等典型伤寒症状仅5例。
In recent years, the wide range of resistant Salmonella typhi strains and the increase of mutant Salmonella typhimurium strains make the clinical manifestations of typhoid fever vary greatly, and the positive rate of routine laboratory tests is also reduced, resulting in some difficulties in the early diagnosis of typhoid fever. Our hospital from March 1993 to June 1996 received a total of 50 cases of typhoid fever, all cases were confirmed by blood culture and / or serological confirmed. The report is as follows. 1 Clinical data 1.1 General situation: The group of 36 males and 14 females. Aged 5 to 65 years old, with an average age of 35 years; this group are sporadic cases, the onset time in April to October as much, a total of 35 cases, accounting for 70%. The treatment time is 2 to 50 days after the illness, the diagnosis time is 10 to 50 days after the illness. 1.2 Clinical manifestations: The main symptoms and signs of this group of patients: fever in 40 cases (8 cases of retention of high fever, relaxation fever in 11 cases, irregular heat in 21 cases), abdominal pain and diarrhea in 15 cases, cough, lungs with wet rales 10 Cases, skin hemorrhage, anemia in 8 cases, hematuria, proteinuria in 8 cases, chest tightness, palpitations, ventricular premature beats in 6 cases, jaundice, elevated transaminase in 3 cases. Relatively slow pulse in 10 cases, 6 cases of rose rash, liver in 18 cases, 8 cases of splenomegaly. At the same time, abdominal pain and diarrhea, persistent high fever, hepatosplenomegaly, roseola and relative slow pulse typical typhoid symptoms in only 5 cases.