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題名 | Multi-organ Dysfunction Caused by Scrub Typhus Initially Misinterpreted as Acute Tonsillitis=初期誤判為急性扁桃腺炎之恙蟲病併發多器官功能障礙 |
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作者姓名(中文) | 陳君志; 阮春榮; 阮祺文; 曾賢志; 黃梅; | 書刊名 | 中華民國急救加護醫學會雜誌 |
卷期 | 18:4 2007.12[民96.12] |
頁次 | 頁161-166 |
分類號 | 415.262 |
關鍵詞 | 多重器官功能異常; 恙蟲立克次體; 叢林型斑疹傷寒; 焦痂; Multi-organ dysfunction; Orientia tsutsugamushi; Scrub typhus; Eschar; |
語文 | 英文(English) |
中文摘要 | 恙蟲病是因立克次體感染所引起的一種急性熱病。在台灣,此病好發於北台灣、東台灣、南台灣、澎湖、金門及馬祖等外島地區,反而在台灣西岸並不常見。由於不熟悉此病,急診醫師可能誤判為其他感染性疾病而造成診斷及治療上的延誤。雖然恙蟲病是可治癒的疾病,延誤診斷而沒有立即給予正確的抗生素治療將導致多重器官功能受損、衰竭,死亡率可以高到30%。我們報告一個由馬祖移入的恙蟲病個案,該病患正於外島馬祖服兵役。返台休假兩天後出現全身不適、倦怠、肌肉酸痛及發燒等類似一般感冒症狀。起初他先去地區醫院求診,經診斷為急性扁桃腺炎後住院並接受盤尼希林之抗生素治療。住院第四天在左側前胸壁出現一個約1.5公分的黑色焦痂(eschar),但為臨床醫師所忽略。因病情惡化包括高燒不退、呼吸困難、黃膽、肝功能異常、尿量減少、血小板減少等,進而轉至本院。我們根據胸壁的黑色焦痂診斷為恙蟲病,給予四環黴素並通報疾病管制局。該病患於第二天即退燒。住院期間,缺血性心臟病、心臟腫大、心包膜積水、急性肺水腫、及骨髓造血功能抑制等併發症陸續出現。該病患經過住院七天後逐漸痊癒出院。在急診室,不明原因的高燒一直是醫師診斷上極具挑戰性的難題。診斷恙蟲病需靠臨床高度的懷疑,仔細的病史探詢及理學檢查。黑色焦痂是診斷恙蟲病很好的參考,其他昆蟲叮咬的疾病,很少形成此黑色焦痂。由於血清抗體的上升常在發病兩週以後,實驗室的檢查在急性期幫助有限,主要角色為確定臨床診斷。 |
英文摘要 | Scrub typhus is an acute febrile infectious disease caused by Orientia tsutsugamushi. Although not uncommonly seen in northern, eastern and southern Taiwan and the offshore islands, an imported case from the offshore islands might be misdiagnosed in western Taiwan hospitals. Herein, we presented an initially unrecognized case of scrub typhus in a 21 year-old man who was a soldier in Ma-Tzu. He developed nonspecific symptoms including general malaise, muscle pain and fever and was diagnosed with acute tonsillitis at a district hospital in Chang-Hua County. The clinical condition did not respond to penicillin and was complicated by multi-organ dysfunction. After being transferred to our department of emergency medicine, a clinical diagnosis of scrub typhus was made on the basis of chest wall eschar and axillary lymphadenopathy. Although the fever subsided quickly after the administration of tetracycline (100mg, intravenous, every 12 hours), cardiac ischemia, pericardial effusion and acute pulmonary edema together with bone marrow suppression occurred in addition to liver and kidney dysfunction. After one week of above antibiotic control and other supportive treatment, the patient recovered gradually and was discharged uneventfully. Coping with fever of unknown origin in the emergency department remains challenging. Early recognition of eschar, which is rarely seen in other insect-bite diseases, helps differentiate scrub typhus from other infectious diseases and guides the clinician to the proper antibiotics.Diagnosis of scrub typhus depends on a high index of clinical suspicion, detailed travel history and complete physical examination. Serum tests play a limited role in the acute stage but help in eventual confirmation of the clinical diagnosis. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。