Lee Han Sang, Sunwoo Jun-Sang, Ahn Seon-Jae, Moon Jangsup, Lim Jung-Ah, Jun Jin-Sun, Lee Woo-Jin, Lee Soon-Tae, Jung Keun-Hwa, Park Kyung-Il, Jung Ki-Young, Lee Sang Kun, Chu Kon
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea.
Am J Trop Med Hyg. 2017 Oct;97(4):1094-1098. doi: 10.4269/ajtmh.17-0077. Epub 2017 Aug 18.
is a major cause of vector-borne infection in Asia. Prompt recognition and appropriate treatment are crucial because of its potentially fatal complications and lack of response to beta-lactam antibiotics. The present study retrospectively evaluated the clinical characteristics and laboratory findings of 16 patients with scrub typhus-related central nervous system (CNS) infections. Single titers ≥ 1:40 of total serum antibodies against detected by an indirect immunofluorescent assay were considered as positive results. The median age was 35.5 (range, 14-72) years, and 10 (62.5%) patients were female. The most common symptoms were headache (81.3%) and fever (81.3%). Eschar formation was found in three (18.8%) patients. Among patients with encephalitis, seizures and altered consciousness occurred in five (83.3%) and four (66.7%) patients, respectively. An abnormal liver function was noted in seven (43.8%) patients. The median antibody titer was 1:120 (range, 1:40-1:2,560). Typical cerebrospinal fluid profiles were lymphocytic pleocytosis, mild protein elevations, and normal glucose levels. All patients received an empirical treatment with doxycycline and most (93.8%) of them recovered without neurological sequelae. None of the patients reported side effects of the doxycycline treatment. An empirical treatment with doxycycline is needed in patients with CNS infections in scrub typhus endemic areas.
是亚洲媒介传播感染的主要原因。由于其潜在的致命并发症以及对β-内酰胺类抗生素无反应，迅速识别和恰当治疗至关重要。本研究回顾性评估了16例恙虫病相关中枢神经系统（CNS）感染患者的临床特征和实验室检查结果。间接免疫荧光法检测到的抗 总血清抗体单滴度≥1:40被视为阳性结果。中位年龄为35.5岁（范围14 - 72岁），10例（62.5%）患者为女性。最常见的症状是头痛（81.3%）和发热（81.3%）。3例（18.8%）患者发现有焦痂形成。在脑炎患者中，分别有5例（83.3%）和4例（66.7%）出现癫痫发作和意识改变。7例（43.8%）患者肝功能异常。抗体滴度中位数为1:120（范围1:40 - 1:2560）。典型的脑脊液特征为淋巴细胞增多、蛋白轻度升高和葡萄糖水平正常。所有患者均接受了多西环素经验性治疗，大多数（93.8%）患者康复且无神经后遗症。所有患者均未报告多西环素治疗的副作用。在恙虫病流行地区，CNS感染患者需要多西环素经验性治疗。
