- 期刊
1987年至1988年在高雄地區流行的登革熱之臨床研究
Clinical Study on Dengue Fever during 1987-1988 Epidemic at Kaohsiung City, Southern Taiwan
摘要
在本診所所收集的250個病例中，年齡層以20歲到40歲為最多。男女的比例是1：1.4。98%的病人會發燒，其中以發燒3到6天為最多。體痛有98%，其中以頭痛和全身酸痛為最多。95%的病人有胃腸道的症狀，以食慾不佳、噁心和嘔吐為最常見。97%的病人感到頭暈和無力。22.4%的病人有出血的現象。出血處主要有七：皮下、牙齦、子宮、鼻腔、胃腸道、眼底和泌尿道。出疹的比率有78%，大多數的疹子由手腳先出現，再散播到軀幹。約有45%的病人在恢復期過後二個月會脫髮，脫髮期間約一個月，之後漸漸好起來。62.6%的病人有結膜炎，而淋巴腺腫大的只有1.3%。整個病程約714天。白血球自第二天開始下降，第五天達到最低點，約在第910天恢復正常。有247個採血檢體，做血清學檢查，84例被證實，而157例因為沒有抽到第二次血，而沒有證實。35例病毒分離成功之檢體，其中34例是屬於登革熱第一型，而1例是第4型。另外，我們就收集13例嚴重之登革熱的病例，也一併提出報告。在登革熱流行期間，在疫區的住民，或3到8天前曾到疫區之人，有發燒、體痛、胃腸道症狀、頭暈、無力時，首先就該懷疑登革熱。鑑別診斷包括：流行性感冒、麻疹、德國麻疹、急性扁桃炎、腸病毒感染、食物或藥物過每等等。處理上主要是症狀性和支持性療法。類固醇和抗生素沒有幫忙，嚴重的登革熱出血熱的病人宜住院仔細觀察和治療。在本診所的病人中，沒有死亡的病例。
關鍵字
無資料並列摘要
This is a report of the clinical analysis of 250 cases of dengue fever-like patients during the 1987-1988 epidemic in Southern Taiwan at Harn's clinic, Kaohsiung city. The results were: The peak age groups were between 20-40 years old. The ratio of male to female was 1:1.4. 98% patients presented with fever of mainly 3 to 6 days duration. 98% reported body pain, which included headache (82%), generalized soreness (65%), low back pain (50%). 95% patients had GI symptoms, such as anorexia (73%), nausea (60%, vomiting (45%). 97% patients complained of dizziness and weakness, and 22.4% patients had a bleeding tendency. The common bleeding sites were involving the subcutaneous (skin), gum, uterus, nasal cavity, GI tract, retina, and GU tract. The eruption rate was 78%. A majority of rashes appeared on the extremities, and then spread to the trunk. Less common symptoms were insomnia, chest tightness, urgency of urination, cough, running nose, palpitation, and shock. 45% patients were noted with hair loss. The hair loss was the latest presenting symptom, which tended to occur about two months after the recovery stage, and lasted for about one month. On physical examination, 62.6% patients had conjunctivitis, while only 1.3% had lymph node enlargement. Usually, the whole clinical course lasted for 7 to 14 days. Laboratory examination showed that leucopenia was noted from the second day and reached the lowest count on the fifth day, and recovered on 9th or 10th day. In 247 blood sera tested serologically for dengue fever, 84 were confirmed, while 157 were not confirmed yet due to patients' reluctance to accept a second blood drawing. From 35 positive virus isolations, 34 were identified as dengue type 1, and one was identified as type 4. An analysis of 13 cases of severe dengue fever patients was also reported. During the epidemic period of dengue fever, people living in the epidemic areas with symptoms of fever, body pain, GI upset, and weakness, should first be suspected of having dengue fever, unless proven to be otherwise. The differencial diagnosis includes influenza, measles, german measles, acute tonsillitis, entero virus infection, food or drug allergy. Management was mainly supportive and symptomatic. Steroids and antibiotics are not necessary. Severe dengue fever patients were hospitalized for close observation and proper treatment. There was no mortality in these patients.