疑似萊姆病併發多發性神經病變之個案報告暨文獻回顧

Suspect Lyme Disease Combined with Polyneuropathy: A Case Report and Review of Literature

劉孟達(Meng-Ta Liu) ； 吳立偉(Li-Wei Wu) ； 江昇達(Sheng-Ta Chiang) ； 李俊泰(Jiunn-Tay Lee) ； 陳永煌(Yeong-Hwang Chen)

《中華職業醫學雜誌》 18卷3期 (2011/07) Pp. 189-196

https://doi.org/10.30027/CJOM.201107.0004

摘要

萊姆病於1977年首次出現於文獻中。由美國康乃迪克州萊姆鎮醫師們注意到有許多人同時罹患了少年型類風濕性關節炎，並將慢性遊走性紅斑和先前蜱類叮咬的關係連結。1982年，在鹿蜱(Ixodes dammini)的中腸中鑑定出螺旋體，命名為伯氏疏螺旋體(Borrelia burgdorferi)，1984年，在蜱類及人體中分離出伯氏疏螺旋體(Borrelia burgdorferi)，證實是造成萊姆病的病原。因此美國疾病管制局於1980年代開始監測，整體發生率約為每十萬人口中有12例。而台灣自1998年始有第一例病例報告由國防醫學院的師健民教授發表。萊姆病的流行季深受硬蜱與宿主動物活動之影響，尤以每年春末夏初至秋天，若蜱最多的季節（約為5~8月）為流行高峰期。軍人、農林工作者，以及經常戶外活動與叢林探險者為高危險群。本文報告一位40歲有豢養寵物，居家於近山區且經常進行戶外活動之女性，陸續產生紅疹，顏面神經麻痺，及多發性神經病變等病症，且萊姆病血清學檢查呈陽性反應，通報疾病管制局為疑似病例者。並回顧相關文獻。希冀為臨床醫師提供這種台灣雖然少見卻可能產生嚴重病症的疾病診斷急治療方式。

關鍵字

蜱 ； 萊姆病 ； 伯氏疏螺旋體

並列摘要

Lyme disease first appeared in the literature in 1977. In Lyme town in U. S, several doctors noted that many people suffered from juvenile rheumatoid arthritis. Then, they linked the chronic erythema migrans with the previous illness which was due to tick bites. In 1982, spirochete which was named Borrelia burgdorferi was identified in the midgut of the deer ticks (Ixodes dammini). In 1984, Borrelia burgdorferi was isolated from the ticks and infected human, which confirmed that Lyme disease is caused by the pathogen. Therefore, the U. S. Centers for Disease Control began surveillance in the 1980s, the overall incidence of about 12 per million population in the cases. The first case of Lyme disease in Taiwan has been reported in 1998 by the professor of National Defense Medical College. The prevalence of Lyme disease depended on ticks quarter activities of the host animal, especially in early summer to autumn, the peak prevalence of the epidemic. (about 5 to 8 months) Military, agriculture, forestry workers, and frequent outdoor activities and jungle explorers as the most high risk. Here, we report a 40-year-old woman who has pets, home near the mountains and have frequent outdoor activities, gradually produce rashes, facial palsy, and polyneuropathy and serologic test for Lyme disease was positive. She was notified of suspected cases by CDC in Tiawan. We also review the literature of Lyme disease. Hope to provide the clinicians about the diagnosis and treatment for this rare but serious illness.

並列關鍵字

Tick ； Lyme disease ； Borrelia burgdorferi