Scrub Typhus Complicated with Acute Respiratory Distress Syndrome, Meningoencephalitis and Disseminated Intravascular Coagulation: A Case Report

恙蟲病併發急性呼吸窘迫症候群、腦膜腦炎及血管內凝血病變：一病例報告

陳鴻仁(Hung-Jen Chen) ； 杭良文(Liang-Wen Hang) ； 夏德椿(Te-Chun Hsia)

《胸腔醫學》 17卷3期 (2002/09) Pp. 264-270

摘要

恙蟲病存在於台灣各縣市，尤其好發於金門縣、南投縣、澎湖縣及花東等地區。其發病特徵為持續性高燒、頭痛、淋巴腺腫大、螯口處形成特有的無痛性焦痂。病況由多數的自限性痊癒到少數的嚴重致死皆有可能。本文報告一例居住於南投信義鄉的 42 歲農夫，在持續約一星期的發燒、乾咳和劇烈頭痛後，因併發意識不清及呼吸衰竭而轉診至本院。理學檢查發現臍旁有一 0.5x0.5 cm2 的焦痂。胸部 x 光呈現雙側肺野瀰漫性浸潤，腦脊髓液分析呈現白血球增多（180/ul）、蛋白質上升（183 mg/dl）及糖份下降（32 mg/dl）。血液檢查呈現血管內凝血病變。在高度懷疑為恙蟲病的情況下，投予 minocycline 治療，症狀獲得迅速改善並脫離呼吸器之使用。本例最後經衛生署疾病管制局證實為恙蟲病感染。

關鍵字

恙蟲病 ； 急性呼吸窘迫症候群 ； 腦膜腦炎 ； 血管內凝血病變

並列摘要

Scrub typhus can be found everywhere in Taiwan, especially in Kinmen, Nantou, Penghu, Hualien, and Taitung Counties. The clinical manifestations are persistent high fever, headache, lymphadenopathy, and a painless eschar at the site of chigger feeding. The illness varies in severity from mild and self-limiting to fatal.
We report a 42-year-old farmer who lived in Shinyi Shiang, Nantou County, and who suffered from fever, dry cough, and severe headache for one week, complicated with disturbed consciousness and acute respiratory failure. A 0.5 x 0.5 cm2 eschar was found near the patient’s navel. A radiograph of the chest showed air-space disease involving the bilateral lungs. A cerebrospinal fluid (CSF) study revealed mononuclear leukocytosis, an increased protein concentration, and decreased glucose concentration. Hematological values showed thrombocytopenia (platelets: 119x103/ul), an abnormal prothrombin time (PT 19.93 seconds), partial thromboplastin time (PTT 65.50 seconds), FDP (＞20 ug/ml), and D-Dimer (＞2.0 ug/ml). The patient’s critical condition dramatically improved after urgent intravenous minocycline therapy. The final laboratory diagnosis was proved to be scrub typhus, using a serum antibody, in the Center for Disease Control, Department of Health, Taiwan.

並列關鍵字

Scrub typhus ； ARDS ； Meningoencephalitis ； DIC