Cause Analysis of 73 Misdiagnosed Cases of Tsutsugamushi Disease

WANG Wei

doi:10.3969/j.issn.1002-3429.2015.04.004

Abstract：Objective To analyze the causes of misdiagnosis in tsutsugamushi disease in order to improve diagnostic accuracy. Methods Clinical data of 122 tsutsugamushi cases during 2009 January and 2014 December in our hospital was an-alyzed retrospectively. Results The disease has been reported in all 4 seasons of the year without much seasonal difference. All the patients ran a fever while most of them also had anabrosis or eschar, and 76 cases (62. 30%) were positive for weil-felix test. There were 73 misdiagnosed cases (59. 84%) in total. 20 cases (27. 40%) were misdiagnosed as pneumonia, 11 cases (15. 07%) as typhus, 8 cases (10. 96%) as sepsis, 7 cases (9. 59%) as acute bronchitis, 6 cases (8. 22%) as in-fection in upper repository tract and another 6 cases as encephalitis, 4 cases (5. 48%) as infection in the urinary system, 3 cases (4. 11%) as acute gastroenteritis and another 3 as acute hepatitis, 2 cases (2. 74%) as panus inguinalis and another 2 as hemorrhagic fever with renal syndrome, the last single case was misdiagnosed as lymphatic tuberculosis (1. 37%). The root causes were identified as:37 cases (50. 68%) were caused by non-compliance of the patient, 21 cases (28. 77%) were caused due to negligent examination, 16 cases (21. 92%) by low sensitivity level of the laboratory test and another 16 by non-typical clinical symptoms. Conclusion The clinicians need to improve the level of understanding for tsutsugamushi disease, enquire for more details of the epidemiological history of the patient, perform more careful examinations, and give repetitive examinations for the suspected patients in order to prevent misdiagnosis of tsutsugamushi disease.