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題名 | Meningoencephalitis, Myocarditis and Disseminated Intravascular Coagulation in a Patient with Scrub Typhus=恙蟲病敗血症合併腦膜腦炎及心肌炎:病例報告 |
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作者 | 班仁知; 馮南雄; 顧長生; | 書刊名 | 微免與感染雜誌 |
卷期 | 32:1 1999.03[民88.03] |
頁次 | 頁57-62 |
分類號 | 415.26 |
關鍵詞 | 恙蟲病; 腦膜腦炎; 心肌炎; Scrub typhus; Orientia tsutsugamushi sepsis; Meningoencephalitis; Myocarditis; Disseminated intravascular coagulation; |
語文 | 英文(English) |
中文摘要 | 病患是21歲男性,來自高雄燕巢,因喉痛,頭痛,兩側頸部淋巴病變及持續高燒 達12天之久,又因右上腹部疼痛及漸進性黃疸合併休克而住院,入院當日下午即 發生神智變化,輕度發燒,短暫陣攣性癲癇發作,隨即譫妄,激燥不安,實驗室檢 查顯示WBC:11,900/mm�纂Aplatelet:73,000/mm��,prothrombin time:11 sec(12.9 sec),partial thromboplastin time:39.8 sec (26.6 sec), D-dimer:陽性。心電圖顯 示,竇性心搏過速,第一度房室傳導阻滯,非特異性ST-T波變化。腦脊髓液檢查 顯示WBC:84/mm�纂A其中以淋巴球細胞佔多數,protein:97 mg/dL,glucose:79 mg/dL。急性期及緩解期兩套血清針對Orientia tsutsugamushi之間接免疫螢光抗 體反應,呈四倍上升且IgM抗體效價為:1:640。恙蟲病之診斷確定。入院時即因臆 斷為恙蟲病,遂投與口服四環素,因症狀持續,加上氯黴素靜脈注射,隔日燒退, 症狀緩解。恙蟲病如能早期發現,及早使用專一性抗生素治療,可避免因病程持 續,衍生腦膜腦炎,心肌炎及瀰漫性血管內凝血等嚴重併發症。 |
英文摘要 | A 21-year-old male soldier was admitted due to a sorethroat, headache, generalized lymphadenopathy and persistent fever for 12 days. Despite empirical antibiotic treatment for four days at a clinic prior to admission, he continued to have persistent abdominal pain over his right upper quadrant region and progressive jaundice was followed by shock. After admission, he developed an episode of clonic seizures and became delirious and agitated. An electrocardiogram showed first degree atrioventricular (AV) block and non-specific ST-T wave changes. Hematological studies revealed thrombocytopenia, hypofibrinogenemia, abnormal partial thromboplastin time (PTT) and a positive test for D-dimer. The cerebrospinal fluid analysis showed pleocytosis with white cells of 84/mm �� with a lymphocyte predominance, protein of 97 mg/dL and glucose of 79 mg/dL. Indirect immunofluorescence assay showed a fourfold rise in antibodies to Orientia tsutsugamushi in paired serum with IgM antibody titer of 1:640. The patient had a favorable response after parenteral chloramphenicol in addition to oral tetracycline. Early ricognition of scrub typhus and early prescription of anti-rickettsial agents prevent complications of central nervous system involvement and further deterioration of cardiac and hematological function. |
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