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題 名 | 糞小桿線蟲肺炎合併噬血症候群:一病例報告=Pulmonary Strongyloidiasis with Hemophagocytic Syndrome: A Case Report |
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作 者 | 王甯祺; 陳威廷; 謝安臺; 張峰義; | 書刊名 | 內科學誌 |
卷 期 | 13:1 2002.02[民91.02] |
頁 次 | 頁38-42 |
分類號 | 415.291 |
關鍵詞 | 糞小桿線蟲; 糞小桿線蟲過度感染; 噬血症候群; Strongyloides stercoralis; Hyperinfection strongyloidiasis; Hemophagocytic syndrome; |
語 文 | 中文(Chinese) |
中文摘要 | 糞小桿線蟲 (Strongyioides stercoralis) 是流行於熱帶及亞熱帶許多區域的腸道寄生蟲。約 15~30% 的感染病人沒有症狀,其他多半有腸胃道相關的症狀,如腹脹、腸道阻塞等。肺部感染糞小桿線蟲非常少見,並且很難早期診斷, 病人多數是在肺部大量感染糞小桿線蟲的階段才被診斷出來,這也因此導致患者的死亡率高達 80% 。細菌、病毒及徽菌感染引發噬血症候群常見於文獻報告,但因糞小桿線蟲感染而產生噬血症候群則相當少見。本文報告一位六十四歲男性,因診斷為腎病症候群 (nephrotic syndrome)而投予類固醇 prednisolone 每日 30 毫克,持續一個多月。病患入院前一週有呼吸急促、發燒現象, 因症狀加重且檢查有肺部兩側囉音 (rales) 與胸部 X 光片顯示浸潤型肺炎而入院。住院期間抗生素治療依疲 液細菌培養結果使用 aztreoman 及 piperacillin。肺炎症狀持續惡化 , 第 11 天出現呼吸衰竭。第 11 天骨髓檢查發現有噬血症候群 (hernophagocytic smdrome)。第 12 天做支氣管鏡檢查, 肺泡沖洗液發現糞小桿線蟲幼蟲。雖立即給予 thiabendazole 1000mg q12h, 但病人症狀仍惡化為成人呼吸窘迫症候群而在第 14 天死亡。本文目的主要是提醒臨床醫師對於有胃酸分泌不足( 如胃切除後、使用制酸劑等 ) 或接受類固醇治療的病人,若出現不尋常的肺炎症狀或血液實驗室檢查值,必須抱持高度的警覺,積極的診斷,儘快給予適當的治 療,才能改善此類患者的預後與增加存活率。 |
英文摘要 | Strongyloides stercoralis is widespread in tropical and subtropical regions. Among the infected patients, 15%- 30% are asymptomatic. Most of the patients presented with intestinal related syndrome, such as abdominal distension or bowel obstruction. Pulmonary strongyloidiasis is rare and difficult to be diagnosed early, until the patients are infected by large amount of Strongyloides stercoralis larvae. The mortality rate is up to 80%. Hemophagocytic syndrome has been documented in patients with bacterial, viral, and fungal infections. Hemophagocytic syndrome has been associated with Leishmania and Babesia infections, but is rare in strongyloidiasis. We reported the case of 64-year-old male has been diagnosed nephrotic syndrome about 6 months ago and treated with prednisolone 30 mg per day for more than one month. Patient was admitted because of fever and dyspnea for one week. Physical examinations found rales over bilateral lung fields and chest X-ray showed infiltrative lesions over bilateral lobes. Sputum culture was Acinetobacter genomospecies 2. Pneumonia persisted in spite of treating with aztreonam and piperacillin. Bone marrow biopsy and bronchoscopy were done at 1lth and 12th hospital day, respectively. The Strongyloides stercoralis larvae were found in bronchoalveolar larvage fluid. Bone marrow revealed hemophagocytic syndrome. Thiabendazole with dosage of 1000 mg po ql2h were administrated immediately since the 13th hospital day, but patient was died of adult respiratory distress syndrome at 14th hospital day. We presented this case to remind clinicians that if unusual clinical course of pneumonia or abnormal laboratory data are found in patients who have achlohydria, hypochlohydria(i.e. gastrectomy or using H2-blockers or antacids) or receive steroid treatment, pulmonary strongyloidiasis should be in the list of differential diagnosis. (J Intern Med Taiwan 2002;13: 38-42 ) |
本系統中英文摘要資訊取自各篇刊載內容。