摘要： 目的 总结恙虫病合并中枢神经系统感染的临床表现、实验室检查、影像学检查、基因检测、治疗及预后。方法与结果 共4例恙虫病脑炎患者为天津市环湖医院2021年10-11月诊断与治疗病例，临床主要表现为焦痂及淋巴结肿大（4例）、头痛（4例）、恶心呕吐（3例）、发热（3例）、皮疹（3例）、精神行为异常（3例）；实验室检查肝功能异常3例；3例行腰椎穿刺脑脊液检查，压力升高3例、白细胞计数增加2例、蛋白定量升高3例、免疫功能异常3例；影像学检查MRI无异常3例，1例表现为双侧枕叶部分脑沟内FLAIR成像呈线样稍高信号影；3例完善脑脊液宏基因组第二代测序技术，均检出恙虫病立克次体。4例明确诊断为恙虫病脑炎，经有效的抗生素治疗后痊愈。结论 恙虫病合并中枢神经系统感染的临床表现缺乏特异性，对于不明原因发热的中枢神经系统感染患者，若出现皮疹、肝功能异常等多系统受累，特别是在恙虫病流行季节，有农田劳作史或郊外活动史，均应考虑恙虫病的可能。

关键词: 丛林斑疹伤寒, 中枢神经系统, 感染, 脑炎, 宏基因组

Abstract: Objective To summarize the clinical manifestations, laboratory examination, imaging examination, genetic test, treatment and prognosis of scrub typhus combined with central nervous system (CNS) infection.Methods and Results The clinical data of 4 cases of scrub typhus encephalitis diagnosed and treated from October to November in Tianjin Huanhu Hospital were analyzed. The main clinical manifestations were eschar and lymphadenopathy (4 cases), headache (4 cases), nausea and vomiting (3 cases), fever (3 cases), rash (3 cases), and mental behavior disorder (3 cases); laboratory examination of hepatic in 3 cases were abnormality. Three patients underwent lumbar puncture of cerebral spinal fluid (CSF), including 3 cases with elevated pressure, 2 with elevated white blood cell count, 3 with elevated protein quantification, and 3 with abnormal immune function. Head MRI examination in 3 cases were normal, and one case showed a slightly linear hyperintensity of FLAIR in the bilateral occipital lobes. Metagenomic next-generation sequencing (mNGS) of CSF was completed in 3 patients, and Orientia tsutsugamushi was detected in all of them. All 4 cases were diagnosed as scrub typhus encephalitis and recovered after effective antibiotic treatment.Conclusions The clinical manifestations of scrub typhus combined with CNS infection are not specific, so it is necessary to be vigilant against the occurrence of scrub typhus in patients with CNS infection of unknown etiologys. In particular, scrub typhus should be considered during the epidemic season, if there is a history of farm work or suburban activities.

Key words: Scrub typhus, Central nervous system, Infections, Encephalitis, Metagenome