Pulmonary Leptospirosis after Mountain Climbing in Southern Taiwan: A Case Report

南台灣爬山旅遊後所引起的肺部鈎端螺旋體病：病例報告

施穎銘(Ying-Ming Shih) ； 張西川(Shi-Chuan Chang) ； 杜瑞煌(Ruay-Wang Duh)

《胸腔醫學》 21卷5期 (2006/10) Pp. 433-438

https://doi.org/10.29806/TM.200610.0005

摘要

鈎端螺旋體病(leptospirosis)是一種全球性人畜共通疾病，在熱帶或亞熱帶地區較盛行，通常發生在戶外工作者如農夫，或是到野外從事休閒活動的人。被感染病人的臨床表現，可從無症狀、自限性無黃疸熱病到嚴重肺出血、黃疸、急性腎衰竭或甚至死亡。肺部侵犯的臨床表徵，包括：發燒、咳嗽、咳血和胸部X片出現以肺周邊分布為主的細小結節(micronodule)、毛玻璃狀(ground-glass)、實質化(consolidation)的病灶。若病人有上述表徵加上野外活動的接觸史，臨床上對治療社區性肺炎的經驗療法反應不佳，則要懷疑被鈎端螺旋體感染的可能，尤其在亞熱帶的台灣。
我們在此報告一位61歲男性病人，因發燒、咳血及胸部X光片異常被轉診到本院急診。初時，被當成社區性肺炎治療，病人持續發燒，在確認病人有野外活動的暴露史，經血清抗體檢查後確立診斷為鈎端螺旋體病。病人在接受盤尼西林(penicillin)治療後病況迅速好轉，痊癒出院。

關鍵字

鈎端螺旋體 ； 黃疸 ； 急性腎衰竭

並列摘要

Leptospirosis is a worldwide zoonotic disease, more prevent in tropical and subtropical regions. It usually occurs in subjects with occupational exposure, such as those involved in rice farming, and occasionally in those who participate in recreational activities in wilderness areas. The clinical features of leptospirosis vary widely, ranging from self-limited anicteric illness to severe pulmonary hemorrhage, jaundice, acute renal failure, and even death. A diagnosis of leptospirosis may be difficult, particularly in those without occupational exposure, because of a lack of specific clinical features and radiographic findings. We report a 61-year-old male who was transferred to our hospital due to fever, hemoptysis, and abnormal CXR findings. The patient was treated for community-acquired pneumonia, but with a poor response. Due to his history of recent wilderness recreation, leptospirosis was highly suspected, and subsequently confirmed by serological testing. The patient responded well to penicillin treatment.

並列關鍵字

leptospirosis ； jaundice ； acute renal failure