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題名 | Scrub Typhus Complicated by Intracranial Hemorrhage--A Case Report=恙蟲病感染合併顱內出血--病例報告 |
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作者 | 楊士賢; 王立信; 梁忠詔; 何愉懷; 張恩庭; 陳俊亨; | 書刊名 | 慈濟醫學 |
卷期 | 17:2 民94.04 |
頁次 | 頁111-114+133 |
分類號 | 415.291 |
關鍵詞 | 恙蟲病; 顱內出血; 血管炎; 散在性血管內凝血病變; 血小板缺少症; Scrub typhus; Intracranial hemorrhage; Vasculitis; Disseminated intravascular coagulation; Thrombocytopenia; |
語文 | 英文(English) |
中文摘要 | 恙蟲病是經由遭受Orientia tsutsugamushi感染的氧蟲叮咬而致病。叮咬處多會出現潰瘍性焦痂(eschar)與局部淋巴結腫大、發燒、頭痛以及肝功能異常、白血球或血小板過少等病變。嚴重的併發症括心肌炎、腦膜腦炎、散在性血管內凝血病變、血管炎、急性腎衰竭、急性呼吸窘迫候群、間質性肺炎、徵至是多重器官衰竭。這篇文章佳我們報告一位感染恙蟲病而引發顱內出肇的病例。臨床上他出現斷斷續續的高燒、咳嗽、喉嚨痛,症狀持續約一周,隨後右側肢體乏力、步行與說話困難。經電斷層掃描發現其大腦左側視岳局部出血,是為出血性腦中風,而血清學檢查與聚合酶鏈鎖反應( polymerase chain reaction)為陽性,證實為恙蟲病感染。經四環黴素與積極復健治療後,此個案之運動功能、語言與吞嚥均恢復正常。回顧文獻尚未有氧蟲病合併出血性腦中風的病例報告。顱內出血是恙蟲病的嚴重併發症,因此在疑似的個案中,若能及早診斷,並及時給予藥物與復健治 療,可改善症情,增水運動功能與自我照顧的能力,並減輕後遺症的產生。 |
英文摘要 | Taiwan is an endemic area for scrub typhus, especially in Kinmen, Natou, Penghu, Hualien and Taitung counties. The manifestations and complications of this systemic illness are protean. We describe a 56-year-old male forest worker who suffered from intermittent fever, cough, an d sore throat for about one week, followed by weakness in the right limbs, dysarthria, and difficulty walking. Eschar was found on the left scrotum. The patient developed disseminated intravascular coagulation (DIC) and thrombocytopenia on admission. Brain computed tomography (CT) showed intracranial hemorrhage over the left thalamic area. Our patient responded to tetracycline therapy. The fever subsided tow days later after tetracycline adminstration. The diagnosis of scrub typhus was confirmed by polymerase chain reaction (PCR) and serological tests. After medical and comprehensive rehabilitative theraphy, the patient regained his walking ability and demonstrated no remarkable enuroslogical sequelae. Scrub typhus presenting as intracranial hemorrhage with prominent focal neurological signs and associated neuroradiolgoic abnormalities has rarely been reported. We suggest that scrub typhus should be considered one of the causes of hemorrhagic stroke in endemic reas. |
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