Childhood Scrub Typhus in Eastern Taiwan: Ten-Year Experience from a Medical Center

背景：恙蟲病是立克次體造成的感染性疾病，可能會造成嚴重的併發症和死亡。主發生地區爲包括台灣在內的西太平洋地區。大多數的文獻主要在探討成年人的感染，兒童的感染也應是不容忽視的。方法：本文主要統計1997至2006年間，在本院兒科部以血清免疫學爲主診斷的個案進行臨床分析。結果：結果發現共有15位確診的個案，所有病童皆有發燒與蟲咬的病史，80%病人身體檢查發現焦痂(Eschar), 60%與40%的孩童分別主訴合併腹痛與頭痛。3位病患併發腦膜炎與噬血症候群(hemophagocytic syndrome)。一位病患死於進行性呼吸衰竭與肺出血，病理解剖發現心肌炎。其他病患皆對抗生素有良好的反應。結論：恙蟲病的診斷在發燒與蟲咬病史的孩童需納入鑑別診斷，雖然大多數的患者對抗生素的反應良好，但是仍需注意腦膜炎，呼吸窘迫症候群，噬血症候群及心肌炎，甚至死亡等之嚴重併發症。

關鍵字

恙蟲病；腦膜炎；噬血症候群；急性呼吸窘迫症候群

並列摘要

Background: Scrub typhus, a potentially fatal rickettsial infection, is endemic in western Pacific Rims including Taiwan. Most reports have been concerned about mainly adult patients, whereas serologic surveys suggested that as many as one-half of cases of scrub typhus might be in children. Methods: We conducted a retrospective study of childhood scrub typhus in our hospital from January 1997 to December 2006. Scrub typhus was diagnosed on the basis of serology tests or polymerase chain reaction (PCR) examination in fifteen children. Results: Fever and chigger bite history were presented in all 15 cases, and eschar lesion was identified in 12 patients (80%). Nine (60%) patients had headache and six (4000) complained of abdominal pain. Three patients (20%) had meningoencephalitis, and two (13%) hemophagocytic syndrome were confirmed by bone marrow biopsy. One patient died of progressive acute respiratory distress syndrome (ARDS) and pulmonary hemorrhage. Myocarditis was revealed in autopsy. All surviving patient responded well to antibiotic therapy, and the average duration to defervescence after treatment was 1.8 days. Conclusions: We conclude that scrub typhus should be taken into consideration among patients of acute systemic febrile illness, especially those with suspected exposure history and typical skin lesion. Although most patients responded well to treatment, severe complications such as meningoencephalitis, interstitial pneumonia, acute respiratory distress syndrome, hemophagocytic syndrome, and myocarditis might lead to morbidity and mortality.

並列關鍵字

Scrub typhus ； meningoencephalitis ； hemophagocytic syndrome ； acute respiratory distress syndrome

國際替代計量

Childhood Scrub Typhus in Eastern Taiwan: Ten-Year Experience from a Medical Center

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