A patient with Japanese spotted fever complicated by meningoencephalitis.
A patient with Japanese spotted fever complicated by meningoencephalitis.
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一名日本斑疹热并发脑膜脑炎的患者。
DOI：
10.11150/kansenshogakuzasshi1970.75.812
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
H. Fujita
中科院分区：
文献类型：
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作者：
K. Kodama;T. Senba;H. Yamauchi;Y. Chikahira;H. Fujita
一名77岁男子于2000年8月14日入院，有2天的尖峰热病史。由于怀疑胆管炎，给予头孢美唑，但发热未消退，出现意识障碍和惊厥。Encephaly被怀疑，他于8月17日被转移到我们部门。体格检查时，他处于半昏迷状态（日本昏迷量表III-100）。胸腹部正常，浅表淋巴结未触及。观察到左肩皮肤上的全身斑丘疹性红斑和焦痂。实验室检查结果如下：WBC计数11，180 μl（中性粒细胞81%，单核细胞3.9%，淋巴细胞14.0%），RBC 372×10 μl，Hb 11.2 g dl，Ht 33.5%，血小板13.7×10 μl，BUN 21.4mg dl，肌酐0.95mg dl，GOT 122 IU l，GPT 56 IU l，LDH 720 IU l，AlP 339 IU l，γ-GTP 306 IU/l，总胆红素0.8 mg/dl，胆碱酯酶0.35 μ g/ml，C反应蛋白7.1 mg/dl，纤维蛋白降解产物（FDP）9 μg/ml，氨20 μg/dl，动脉血气pH7.398，脑脊液（CSF）;蛋白质52 mg dl，葡萄糖68 mg dl（血糖132 mg dl），细胞103 3（中性粒细胞64%，淋巴细胞27%），腺苷脱氨酶（ADA）2.5 IU l，EEG显示3 - 4 Hz慢波，提示脑病（图）。从抗癫痫药物治疗惊厥开始，开始静脉注射米诺环素200 mg/天，根据发热、外显和焦痂考虑立克次体病。2天后意识逐渐好转，发热减轻。他因脑炎引致的轻微发烧于九月初消失，并于九月五日出院。用免疫过氧化物酶反应检测日本立克次体青木株的特异性抗体。住院17天恢复期血清IgG效价×2,560，IgM效价×2,560，显示一例日本斑点热合并脑膜脑炎患者
A 77-year-old man was admitted August 14, 2000, for a 2-day history of spiking fever. Cefmetazole was administered, because of suspected cholangitis, but the fever did not subside, and disturbance of consciousness and convulsions appeared. Encephalitis was suspected, and he was transferred to our department August 17. On physical examination, he was in a semicoma(Japan coma scale III-100). The thoracoabdominal region appeared normal and superficial lymphonodes were not palpable. Generalized maculopapular erythema and an eschar on the left shoulder skin were noted. Laboratory results were as follows : WBC count 11,180 μl(neutrophil 81% monocyte 3.9% lymphocyte 14.0%), RBC 372×10 μl, Hb 11.2 g dl, Ht 33.5%, Platelet 13.7×10 μl, BUN 21.4mg dl, Creatinine 0.95mg dl, GOT 122 IU l , GPT 56 IU l , LDH 720 IU l , AlP 339 IU l , γ-GTP 306 IU l , Total bilirubin 0.8 mg dl, Cholinesterase 0.35 ∆pH, CRP 7.1mg dl, Fibrin degradation product(FDP)9 μg ml, NH3 20 μg dl, Arterial blood gas pH 7.398, Cerebrospinal fluids(CSF); protein 52 mg dl, glucose 68 mg dl(blood glucose 132 mg dl), Cell 103 3(Neutrophil 64%, Lymphocyte 27%), Adenosine deaminase(ADA)2.5 IU l , EEG showed 3―4 Hz slow waves, suggesting encephalopathy(Figure). Starting with an antiepileptic drug for treating convulsions, intravenous administration of minocycline 200mg day was begun, considering rickettsiosis based on the fever, exanthema, and eschar. His conscious gradually improved and fever decreased after 2 days. Slight fever due to encephalitis disappeared in early September and he was discharged on September 5. Specific antibodies were detected by immunoperoxidase reaction using Rickettsia japonica Aoki strain. Serum IgG titer was ×2,560 and IgM titer was ×2,560 on hospital day 17 during recovery, showing A Patient with Japanese Spotted Fever Complicated by Meningoencephalitis