- 期刊
鉤端螺旋體引起黃膽及急性腎衰竭
Leptospirosis-induced Jaundice and Acute Renal Failure
摘要
鉤端螺旋體好發於熱帶地區。發生國家遍布世界各地，以中國大陸、韓國及東南亞較多病例。感染的病人其臨床症狀為高燒、全身酸痛、乏力、結膜充血、淋巴結腫大和明顯的腓腸肌疼痛。重者可併發肺出血、黃膽、胸膜炎和腎衰竭，為人畜共通病。嚴重時將有致命的可能性，死亡率高達5-10%。鉤端螺旋體感染很少見，容易被忽視，但近幾年來，國內陸續出現病例，其中不乏死亡病例。顯示出這項傳染病在國內可能被嚴重低估。衛生署於89年3月開始將鉤端螺旋體菌感染症列為「新興傳染病」。本文報告一位二十六歲男性，入院前三天出現發燒、右下肢輕微紅、痛、熱現象。入院後出現漸行性黃膽、急性腎衰竭併發肺水腫，經過檢查。結果證實是鉤端螺旋體感染。在使用青黴素治療後病人症狀很快的改善。二週後腎功能及黃膽指數皆已完全恢復。本文目的主要是提醒醫師在臺灣對於發燒、肢體疼痛(尤其是腓腸肌)合併黃膽及急性腎衰竭的病人，鉤端螺旋體感染應該列入考慮。
並列摘要
Leptospirosis is a zoonotic disease with higher incidence of human infection occurring in the tropics. Though cases of Leptospirosis appeared globally, most were reported in China, Korea and Southeast Asia. The clinical symptoms of infected patients include high fever, myalgia, weakness, conjunctival suffusion, lymphadenopathy and calf muscle tenderness. Severe cases can cause pulmonary hemorrhage, jaundice, pleuritis, renal failure and even death. The mortality rate is as high as 5-10%. Leptospirosis is rare, and can easily be neglected. In Taiwan, various cases of leptospirosis were reported in recent years. Some of these cases were expired as a result of diagnosis delay. This disease is still potentially underestimated in Taiwan due to difficult early diagnosis. Our patient was a twenty-six year old male suffering with fever, right lower leg swelling, pain and local heat for three days prior to admission. Jaundice, acute renal failure and pulmonary edema developed progressively after admission. Leptospirosis was diagnosed by serologic examination. Symptoms improved soon after penicillin treatment. Renal function and bilirubin recovered completely. We present this case to remind clinicians that if fever, limb pain (especially lowr legs), jaundice and acute renal failure are present in patients, leptospirosis should be on the list of differential diagnosis.