| 摘要: |
| ［摘要］ 目的 分析伤寒误诊为病毒性脑膜炎的原因。方法 分别对7例误诊为病毒性脑膜炎的伤寒患者及9例病毒性脑膜炎患者的临床资料进行回顾性分析。结果 16例患者均以发热、头痛为主要表现。伤寒患者中发热时表现头痛5例，寒颤4例，肌肉酸痛5例，相对缓脉4例，7例患者最高体温均>39 ℃，血C-反应蛋白（CRP）均值85.21 mg/L，血沉（ESR）均值54.67 mm/h，颅内压均值166 mmH+O，脑脊液（CSF）有核细胞数均值2.86×106/L。病毒性脑膜炎患者中持续头痛7例，肌肉酸痛1例，颈抵抗6例，无寒颤及相对缓脉患者，血CRP均值26.10 mg/L，ESR均值39.99 mm/h，颅内压均值229.44 mmH+O，CSF有核细胞数均值85×106/L。结论 伤寒症状不典型,与病毒性脑膜炎有较多相似点，缺乏对病情的全面分析是误诊误治的主要原因。伤寒更易表现为高热（>39 ℃）、寒颤、肌肉酸痛、相对缓脉等，CRP及ESR增高更明显，而颈抵抗、高颅压、CSF有核细胞数增高等少见。 |
| 关键词: 伤寒 病毒性脑膜炎 误诊 |
| DOI：10.3969/j.issn.1674-3806.2016.10.26 |
| 分类号:R 512.3 |
| 基金项目: |
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| Typhoid misdiagnosed as viral meningitis |
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HUANG Hua-sheng, ZHONG De-fang, WEI Shi-rong, et al.
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Department of Neurology, the People′s Hospital of Hechi, Guangxi 547000, China
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| Abstract: |
| ［Abstract］ Objective To analyze the causes of misdiagnosing typhoid as viral meningitis.Methods The clinical data of 7 typhoid patients who were misdiagnosed as viral meningitis and 9 cases with viral meningitis were retrospectively analyzed.Results All the 16 patients manifested fever and headache, in which the typhoid patients manifested headache after fever in 5 cases, chills in 4 cases, muscle pain in 5, relative bradycardia in 4 cases, the highest temperature >39 ℃ in 7 cases, the mean of blood CRP in 85.21 mg/L, ESR in 54.67 mm/h, the mean of intracranial pressure in 166 mmH+O and the mean of CSF nucleated cells 2.86×106/L and the viral meningitis headache manifested patients persistent in seven cases, muscle ache in one case and neck resistance six cases, the mean of serum CRP in 26.10 mg/L, ESR in 39.99 mm/h; the mean of intracranial pressure in 229.44 mmH+O and the mean of CSF nucleated cells was 85×106/L, but without the symptoms of chills and relative bradycardia.Conclusion Both typhoid and viral meningitis have the similar symptoms. The main reason of misdiagnosing typhoid as viral meningitis is the lack of a comprehensive analysis of the disease. The typical symptoms of typhoid are manifested as high fever(>39 ℃), chills, muscle aches and relative bradycardia. CRP and ESR are commonly increased in typhoid patients, and their neck resistance, high intracranial pressure, and elevated CSF nucleated cells are common. |
| Key words: Typhoid fever Viral meningitis Misdiagnosis |
