以長期咳嗽及吸血表現之糞小桿線蟲感染

Strongyloidiasis Presenting with Long-term Cough and Hemoptysis

王登鶴(Teng-Ho Wang)

《北市醫學雜誌》 1卷3期 (2004/07) Pp. 352-357

https://doi.org/10.6200/TCMJ.2004.1.3.13

摘要

糞小桿線蟲是流行於熱帶及亞熱帶的腸道寄生蟲多數感祿的病人沒有症狀其他多為腸胃道症狀,如腹瀉、腹脹、腸道阻塞等。肺部感染糞小桿線蟲非常少見,很難早期診斷,到肺部大量感染時患者死亡率已非常高。本文報告一位五十九歲男性農民,咳嗽數個月,入院前二週出現呼吸急促、發燒、咳血現象。入院後持續發燒,結果在糞便中找到大量活動性強的付出rhabdiform糞小桿線蟲幼蟲。因為病人有喘、咳嗽、咳血現象,疑似有肺部侵犯,雖然痰中未能發現蟲體,但檢查錄的鎵67核醫掃描呈現出兩側肺葉有放射性同位素活性增加現象,顯示出此病人應該是有早期肺部侵犯。在使用mebendazole治療後病人症狀很快的改善,一週後再追蹤糞便,已見不到蟲體。本文目的主要是提醒醫師對於長期咳嗽、咳血的病人,除了常見的肺結核、肺癌、支氣管擴張等常見疾病外,糞小桿線蟲感染也應該列入考慮。

關鍵字

糞小桿線蟲 ； 糞小桿線蟲過度感染 ； 自體感染

並列摘要

Strongyloides stereoralis is prevalent in tropical and subtropical areas. Most infected patients are asymptomatic, while others may present with gastrointestinal symptoms such as diarrhea, abdominal distension or intestine obstruction. Pulmonary strongyloidiasis is rare and difficult to diagnose early. When large numbers of S. stereoralis larvae invade the lung, the mortality rate is very high. We report a case of strongyloidiasis in a 59-year-old farmer who developed cough for several months, followed by dyspnea, fever, hemoptysis in the two weeks before admission. After admission, fever was persistent. Active S. stereoralis rhabdiform larvae were found in the stool. Although the presentation of dyspnea, cough, and hemoptysis suggested lung involvement, S. stercoralis larvae were not found in the sputum specimen. Gallium67 inflammation scan revealed increased uptake over bilateraliung fields, suggestive of the early phase of pulmonary strongyloidiasis. The patient’s symptoms soon improved after the start of mebendazole treatment. Followup the stool examination one week later revealed no any larvae. This case may serve to remind clinicians of the need to consider the possibility of strongyloidiasis in the differential diagnosis of patients presenting with symptoms characteristic of pulmonary tuberculosis, lung cancer, and bronchiectasis, including long-term cough and hemoptysis patient. (Full text in Chinese)

並列關鍵字

Strongyloides stereoralis ； hyperinfection strongyloidiasis ； autoinfection