個案報告：恙蟲病
 
賴芳宇

 
個案為26歲台灣女性，就診2週前曾至蘭嶼遊玩，於3天前開始有間斷性高燒，伴隨寒顫、關節疼痛、頭痛、倦怠和左耳後淋巴結腫大。另外，在右前臂內側有焦痂。血液檢驗顯示白血球數下降和肝指數上升。診斷為恙蟲病和急性肝炎，以口服doxycycline治療（每12小時服用100 mg，共7天）。在通報衛生福利部疾病管制署後採檢個案血液，血清中針對恙蟲病的抗體呈陽性反應。
恙蟲病(scrub typhus)致病原為Orientia tsutsugamushi，主要宿主––齧齒類和人類––通常是被具傳染性的恙蟎幼蟲叮咬而感染，病例多發生於韓國、中國、台灣、日本、印度、東南亞和澳洲北部農村。台灣則以東部、南部、山區及離島病例數較多，常見症狀為發燒、寒顫、頭痛、倦怠、肌肉痠痛、淋巴結腫大和紅疹，在恙蟎幼蟲叮咬處出現焦痂是極具代表性的診斷依據。恙蟲病引發的症狀嚴重程度可從輕微表現到多重器官衰竭，甚至死亡，而得到適當治療的病人通常可順利恢復。
（台灣家醫誌2021; 31: 67-76）DOI: 10.3966/168232812021033101008
 
關鍵詞：恙蟲病、Orientia tsutsugamushi、恙蟎、焦痂
 

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二林基督教醫院家庭醫學科
受理日期：109年8月18日　　修改日期：109年9月17日　　同意刊登：109年10月5日
通訊作者：賴芳宇　　　　 通訊地址：彰化縣二林鎮大成路一段558號

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Case Report: Scrub Typhus
 
Fang-Yu Lai

 
Our patient was a 26-year-old Taiwanese woman, who presented with intermittent spiking fever with chills, joint pain, headache, malaise, and a swollen postauricular lymph node on the left side. There was an eschar on the medial side of her right forearm. She went to Orchid Island two weeks before the visit. Blood examination revealed leukopenia and impaired liver function; scrub typhus and acute hepatitis were therefore suspected. She was treated with oral doxycycline 100 mg twice a day for seven days, and we reported the case to Taiwan Centers for Disease Control. The result of an indirect fluorescent antibody test was positive for antibodies to Orientia tsutsugamushi.
Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, and usually spreads to rodents and humans by bites of infected chiggers (larval mites). The disease is prevalent in rural areas of Korea, China, Taiwan, Japan, India, Southeast Asia, and northern Australia. In Taiwan, most cases occur in the southeastern regions and mountain areas, as well as the Pescadores, Kinmen, and Matsu Islands. Common symptoms include fever, chills, headache, malaise, muscle pain, lymphadenopathy, and sometimes rashes. A dark region at the site of the chigger bite (eschar) is useful for making the diagnosis. The severity of infection can range from mild symptoms to multiorgan failure and death. Patients treated early with appropriate antibiotics usually recover quickly.
(Taiwan J Fam Med 2021; 31: 67-76) DOI: 10.3966/168232812021033101008
 
Key words: chiggers, eschar, Orientia tsutsugamushi, scrub typhus
 

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Department of Family Medicine, Erlin Christian Hospital, Changhua, Taiwan.
Received: August 18, 2020; Revised: September 17, 2020; Accepted: Ocotber 5, 2020.