類固醇對廣東住血線蟲病患之影響：四病例報告

Effect of Steroid on Angiostrongyliasis: Report of Four Cases

彭家勛(Giia-Sheun Peng) ； 曹汶龍(Wen-Long Tsao)

《Journal of Medical Sciences》 16卷6期 (1996/06) Pp. 401-406

摘要

廣東住血線蟲症曾經盛行於台灣南部[1,2]，它的感染主要來自不良的飲食習慣，及食入處理不當而被其第三期幼蟲汙染的食物或螺類，軟體動物等中間宿主。臨床症狀以腦膜炎為主[1,3]，腦脊髓液檢查中，高百分比的嗜伊紅性白血球為其特徵[4]，腦部電腦斷層檢查通常無特殊發現[5]，但目前藉助核磁共振掃描檢查，常可發現腦部的炎性變化。要確定診斷除了靠腦脊髓液中發現廣東住血線蟲蟲體外，尚可利用酵素連結免疫吸著法，以偵測腦脊髓液中是否有廣東住血線蟲抗體的存在。文中四位患者，皆未在腦脊髓液中發現廣東住血線蟲蟲體，但利用酵素連結免疫吸著法，卻可在他們的血清和腦脊髓液中發現廣東住血線蟲抗體的存在。其中二位腦膜腦炎的患者接受了核磁共振掃描的檢查，發現在腦部有多發性散在的病灶。四位患者先接受保守治療一至二週，因效果不佳，乃嘗試使用類固醇來治療，發現臨床症狀皆獲得緩解，其中二位腦脊髓液追蹤檢查顯示嗜伊紅性白血球的百分比也顯著降低。所以治療廣東住血線蟲症的病患時，短期類固醇的使用是可以考慮的選擇之一。

關鍵字

廣東住血線蟲病 ； 免疫酵素反應

並列摘要

Angiostrongyliasis was prevalent in southern Taiwan thirty years ago. Most of patients were infected by inadvertently uptaking contaminated foods or intermediate molluscan hosts. One of the major clinical symptoms was eosinophilic meningitis. The finding of eosinophilia in cerebrospinal fluid is thus of diagnostic importance. We report four cases of angiostrongyliasis, diagnosed by the presence of Angiostrongylus cantonensis antibodies detected by enzyme linked immunosorbent assay in cerebrospinal fluid. Two more severe cases with mulitple brain lesions were further confirmed by brain MRI. The patients received conservative treatments for the first week after admission, but no improvement. After the next two weeks, all the patients received prednisolone 40mg per day for two weeks and showed significant improvement in clinical symptoms. In addition, two cases revealed considerable reduction of eosinophils in cerebrospinal fluid. Our results recommend short term prednisolone administration to be used in treatment of angiostrongyliasis with conscious disturbance or life threatened.

並列關鍵字

Angiostrongyliasis ； enzyme linked immunosorbent assay