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頁籤選單縮合
題名 | Serious Complications in Scrub Typhus=叢林型斑疹傷寒及其嚴重併發症 |
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作者姓名(中文) | 蔡人文; 張峰義; |
作者姓名(外文) | Tsay, Ren-wen; Chang, Feng-yee; |
書刊名 | 微免與感染雜誌 |
卷期 | 31:4 1998.12[民87.12] |
頁次 | 頁240-244 |
分類號 | 415.2746 |
語文 | eng |
關鍵詞 | 叢林型斑疹傷寒; 併發症; Scrub typhus; Orientia tsutsugamushi; Serious complication; |
中文摘要 | Scrub typhus, a mite-transmitted zoonosis caused by Oriential tsutsugamushi, is a disease endemic to Taiwan. Serious complications in scrub typhus were more common in the past 4 years than reported previously. Between August 1993 and July 1997,33 cases of scrub typhus were admitted at Tri-Service General Hospital. Symptoms and signs were: fever (100%), chills (39%), cough (24%), headache (21%), diarrhea (18%), dyspnea(18%), eschar(60%), adenopathy (33%) , and rash (21%) . Nineteen percent (6/23) had obvious leukopenia (WBC<4000/mm �� ) 34% (11/32) had leukocytosis (WBC>10, 000 /mm �� )and 44%(14/32) had thrombocytopenia (platelet count<100,000/mm �� ). Elevation of aspartate aminotransferase (AST) and elevation of alanine aminotransferase (ALT) were 81% (26/32)and 75% (24/32), respectively. Serious complications included pneumonitis 36% (12/33), acute respiratory distress syndrome (ARDS)15% (5/33), acute renal failure 9% (3/33), myocarditis 3% (1/33) and septic shock 3 % (1/33). One patient died of RADS due to delay in diagnosis. Other patients recovered after appropriate antibiotic and intensive supportive treatments. Emerging virulent strains of O. tsutsugamushi in Taiwan might be biologically plausible. Scrub typhus should be considered in a patient with fever, varying degree of respiratory distress, particularly if there is eschar or a history of environmental exposure in endemic areas. Prompt diagnosis, timely antimicrobial therapy and intensive supportive care are important for ARDS and other life-threatening complications. |
英文摘要 | 叢林型斑疹傷寒是由Oriential tsutsugamushi 引起並藉著恙虫傳染的人畜共通 疾病。在 1993 年 8 月至 1997 人 7 月間在三軍總醫院共有 33 例叢林型斑疹傷寒,其嚴 重併發症比以前文獻報告常見。 臨床症狀及徵侯如下: 發燒 (100%)、畏寒 (39%)、 咳嗽 (24%)、頭痛 (21)、 腹瀉 (18%)、 氣喘 (18%)、 焦痂 (60%)、淋巴腫大 (33%) 及皮膚疹 (21%)。 19% 病人有明顯的白血球減少,34% 病人有白血球增加,44% 病人有血小板減少。 另外 AST 及 ALT 分別有 81% 及 75% 的升高。嚴重的併發症包括肺炎 36% (12/33)、急性 呼吸窘迫症候群 15%(5/33)、 急性腎衰竭 9% (3/33)、 心肌炎 3% (1/33) 及敗血性休克 3%(1/33)。一位病患因延遲診斷而死於急性呼吸窘迫症候群。其餘病患在接受適宜的抗生素 及積極的支持性治療後,皆能完全康復。假使病患有發燒及不同程度的呼吸窘迫症狀,特別 身體檢查有焦痂的發現和環境的暴露的病史,叢林型斑疹傷寒應列入鑑別診斷。快速的診斷 、適宜的抗生素治療及積極的支持照護是治療叢林型斑疹傷寒嚴重併發症的不二法門。 |
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