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題名 | 恙蟲病:在蘇澳地區感染的病例報告=Scrub Typhus: Report of a Case from Su-Ao Area |
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作者 | 林幸玟; 方啟泰; 謝維銓; Lin, Hsing-wen; Fang, Chi-tai; Hsieh, Wei-chuan; |
期刊 | 中華民國家庭醫學雜誌 |
出版日期 | 19971200 |
卷期 | 7:4 1997.12[民86.12] |
頁次 | 頁194-199 |
分類號 | 415.26 |
語文 | chi |
關鍵詞 | 恙蟲病; 蘇澳地區; Scrub typhus; Rickettsia tsutsugamushi; |
中文摘要 | 蘇澳,一般觀念上並不認為是恙蟲病流行地區。本文報告一位 45 歲男性,因持 續 6 天高燒,第三天身體出現紅疹來診。 於發病前二週,至蘇澳附近山區溪釣時曾被昆蟲 咬傷。患者有頭痛、畏冷等症狀。理學檢查時可見全身大小不一的紅色丘疹、頸部及鼠蹊部 均有腫大淋巴結、肝脾輕度腫大,左膝膕處咬傷處發現 1 × 2 公分之無痛性焦痂。實驗室 檢查顯示周邊血液非典型淋巴球增多、肝功能異常、紅血球沈降速率增加。 Weil-Felix 反 應 Proteus OX-K 1:20 輕微陽性但未達顯著標準, 但以間接免疫螢光分析法測定對恙蟲立 克次體抗體 IgM 1:640(+) 呈強陽性反應。 投予 doxycycline 之後 12 小時,患者體溫即 恢復正常。一個月後再追�j白血球分類及肝功能,均在正常範圍內。恙蟲病在臺灣以往常為 基層醫療忽視,近年由於檢驗方法進步,確定病例逐漸增加,且各縣市皆有報告,不僅限於 外島、花蓮、臺東。此症對四環黴素治療反應極佳。在全國各縣市執業的家庭醫師若見到高 燒合併全身紅疹之病人,特別是曾有野外活動者,均應將恙蟲病列入鑑別診斷。 |
英文摘要 | Scrub typhus is presumed to be rare in Su-ao area, north east coast of Taiwan. However, we recently experienced a serologically proved case. A 45-year-old man was admitted due to persistent headache, fever and chills for 6 days. Skin rash appeared on the third day of his illness. Two weeks ago he had traveled to the mountain area near the area and got insect bites. Physical examination revealed cervical and inguinal lymphadenopathy, mild hepatosplenomegaly, and generalized erythematous papules, 0.3cm to 0.7cm in diameter, over the whole body except palms and soles. There was a 1 × 2cm painless blackish eschar with surrounding erythema in the left popliteal area. Laboratory examination revealed atypical lymphocytosis, abnormal liver function test, elevated ESR, and Weil-Felix reaction Proteus OX-K 1:20 (+). Indirect immunofluorescence assay of IgM antibody to Rickettsia tsutsugamushi was 1:640 strongly positive. Scrub typhus was diagnosed and doxycycline was started. Fever subsided 12 hours later. His white cell differential count and serum biochemistry profiles were within the normal range one month later. Family physicians in every county and city in Taiwan should be aware of this disease, which often responds dramatically to doxycycline therapy. |
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