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題 名 | An Outbreak Report of Shigellosis in Taipei County=臺北縣桿菌性痢疾爆發流行之報告 |
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作 者 | 許蔚輝; 楊東和; 曹為霖; 張斯濤; 江維鏞; 王琨; 唐鴻舜; | 書刊名 | 臺灣家庭醫學雜誌 |
卷 期 | 11:4 2001.12[民90.12] |
頁 次 | 頁191-197 |
分類號 | 415.133 |
關鍵詞 | 桿菌性痢疾; Shigellosis; Waterborne; Elderly; Outbreak; |
語 文 | 英文(English) |
中文摘要 | 桿菌性痢疾(shige11osis)為高度傳染性的大腸炎疾病,在衛生條件落後的地區特別容易引發流行。常見症狀有嘔吐、發燒、下痢或伴隨血便等。致病原為痢疾桿菌(又稱志賀氏菌),在1898年由日本醫師Shiga發現。經由接觸傳染或經由污染的飲水或食物亦可能導致大規模的爆發流行。在臺灣Shigella flexneri常見於安養院或精神院內之群突發而S. sonnei常發生於學校或社區內。納莉颱風在北臺灣(90年9月16到9月18)引起淹水,土石流,及水污染。臺北縣新店某安養中心在 90年9月18開始有腹瀉病人而且爆發桿菌性痢疾的流行。安養院的平時飲用水是外加逆滲透處理之山澗水。9月24日測餘氯量為零、9月26日衛生署疾病管制司前往瞭解疫情、9月28日取自水龍頭的水有1.6~1.9x10大腸桿菌數。肛門拭子培養報告S. flexneri 2a。對ampicillin具有抗藥性,確定病例(糞便檢體經實驗室檢驗培養出痢疾桿菌並有臨床症狀者)有30名。安養院總收容民187名中沒發病的有133位佔71.1%、疑似病例有24位佔12.9%、確定病例有30位佔16%。工作人員都沒有驗出S. flexneri 2a。送到本院急診的有54位,收住院的有48位(9/20-9/28)。治療包含給液體及電解質,抗生素等。部分患者用ciprofrosacin、也有症狀輕的病人直接使用trimethoprim-sulfamethoxazole。雖然患者大部分約一到兩週內恢復後出院,但仍有4人併發綠膿桿菌菌血症而死亡,之中3人合併有肺炎。另有8位合併尿道感染及13位有褥瘡。對於這次臺北縣某安養中心爆發之桿菌性痢疾的發生情況,有必要加以描述與探討,因此強調在老弱人群爆發的痢疾需要緊急通報有效的處理,治療的重要性,而提出可行之防治對策。 |
英文摘要 | Shigellosis is an acute infectious colitis due to one of the members of the genus Shigella, first isolated by Japanese physician Shiga in 1898. Outbreaks may occur by person-to-person or waterborne transmission. The most commonly isolated Shigella bacteria in Taiwan are Shigella sonnei found mostly in cities and Shigella flexneri in rural or mountainous areas. The nursing center in this report is located in Taipei County near the mountain area and their water supply came from a mountain stream, except the drinking water was made by reverse osmosis cleaning system. The typhoon Nari in September 2001 brought with it heavy downpours that caused mudslides and flash flood and contaminated groundwater. This water-borne outbreak lasted for about one week. Center for Disease Control investigated and found large amount of Escherichia coli in the water used by the nursing center. Among the residents of the center, 133 people (71.1%) were not effected and 54 cases of acute diarrhea visited our emergency department. Among them 48 patients were admitted to our hospital. Stool culture done with rectal swab specimen.Thirty cases were confirmed culture-positive for ampicillin resistant S. flexneri 2a. Management included enteric isolation and precautions, fluid & electrolyte replacement, anti-diarrhea and antimicrobial agents; ciprofloxacin in severe cases & trimethoprim-sulfamethoxazole in less severe cases. The outbreak was well controlled in short duration of about one week. Morbidity and mortality noted in those with underlying disease as chronic obstructive pulmonary disease, diabetes mellitus, poor nutritional status and co-infections as urinary tract infection, pneumonia. |
本系統中英文摘要資訊取自各篇刊載內容。