Life-Threatening Scrub Typhus Complicated with Acute
Respiratory Distress Syndrome and Hemophagocytic
Lymphohistiocytosis in a Teenager
 
Kuo-Shen Chou and Chien-Lin Wu

Scrub typhus is a rickettsial disease and caused by Orientia tsutsugamushi. It is transmitted via the bites of mite and is one of the most important and non-negligible infectious disease in the Asia Pacific countries. We present a case of a 10-year girl with scrub typhus, associated with hemophagocytic lymphohistiocytosis (HLH). Rapidly deteriorated clinical course of the patient is complicated by the development of acute respiratory distress syndrome (ARDS). She recovered after intravenous immunoglobulin and doxycycline therapy and intensive supportive care. Although it is rare, Scrub typhus can be life-threatening. Physicians in endemic countries, for instance in Taiwan, should aware of this disease with early recognition and prompt treatment.
(Taiwan J Fam Med 2020; 30: 107-114) DOI: 10.3966/168232812020063002006
 
Key words:acute respiratory distress syndrome, hemophagocytic lymphohistiocytosis, Orientia tsutsugamushi, scrub typhus
 

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Department of Family Medicine, Saint Mary’s Hospital Luo Dong, Yilan County, Taiwan
Received: December 23, 2019; Revised: February 11, 2020; Accepted: April 9, 2020.
Corresponding author: Dr. Chien-Lin Wu, Department of Family Medicine, Saint Mary’s Hospital, Number 160, Zhong-zheng South Road, Luo Dong 256, Yilan County, Taiwan. E-mail: smh06225@smh.org.tw (C.-L. Wu).
 

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青少年罹患恙蟲病併發急性呼吸窘迫症及噬血症候群
 
周國燊　吳建林

恙蟲病(scrub typhus)是由恙蟲東方體(Orientia tsutsugamushi)感染所引起的一種克次體疾病(rickettsial disease)。文是藉由蟲叮咬而傳播，是亞太國家中最主要且不可忽略的傳染病之一。我們報告一位10歲女孩罹患恙蟲病，因延期投藥，病情迅速惡化，併發有急性呼吸窘迫症(acute respiratory distress syndrome)及其後的噬血症候群(hemophagocytic lymphohistiocytosis)，需要靜脈注射免疫球蛋白(intravenous immunoglobulin)，口服強力黴素(doxycycline)及插管併重症支持性治療，經治療後康復出院。雖然恙蟲病併發重症個案不多，但由此病例了解到，流行地區（如台灣）的臨床醫師應格外謹慎，對這種疾病及其後續進展要有所了解，提高警覺，以便及早發現並迅速投藥治療，以免危及生命。
（台灣家醫誌2020; 30: 107-114）DOI: 10.3966/168232812020063002006
 
關鍵詞：急性呼吸窘迫綜合症、噬血症候群、恙蟲病、恙蟲東方體
 

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羅東聖母醫院家庭醫學科
受理日期：108年12月23日　　修改日期：109年2月11日　　同意刊登：109年4月9日