严重钩端螺旋体病合并赫氏反应致呼吸衰竭 1 例
A case of severe leptospirosis with Jarisch-Herxheimer reaction presenting as respiratory failure.
机构信息
Department of Infectious Diseases, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
出版信息
Front Public Health. 2023 Feb 10;11:1125306. doi: 10.3389/fpubh.2023.1125306. eCollection 2023.
BACKGROUND
Leptospirosis is a widespread zoonotic disease caused by pathogenic spp. The treatment of penicillin or tetracycline can cause a Jarisch-Herxheimer reaction (JHR), which can lead to acute respiratory distress syndrome (ARDS) and multi-organ failure in severe cases. The overall course of evolution and imaging features of a JHR exacerbation of leptospirosis have rarely been reported.
CASE PRESENTATION
We present a case of leptospirosis complicated by pulmonary alveolar hemorrhage and a Jarisch-Herxheimer reaction (JHR) that required respiratory and vasopressor support. This case demonstrates a well-defined course of evolution of JHR and the imaging features.
CONCLUSIONS
Leptospirosis is easily misdiagnosed in some sporadic areas, and JHR complicates its management. Early diagnosis and appropriate treatment can reduce the mortality of severe leptospirosis with JHR.
背景
钩端螺旋体病是一种由致病性 spp. 引起的广泛流行的人畜共患病。青霉素或四环素的治疗可能会引起赫氏反应（Jarisch-Herxheimer reaction，JHR），在严重的情况下，可能导致急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）和多器官衰竭。钩端螺旋体病 JHR 加重的整体病程和影像学特征很少有报道。
病例介绍
我们报告了一例并发肺肺泡出血和赫氏反应（Jarisch-Herxheimer reaction，JHR）的钩端螺旋体病，需要呼吸和血管加压支持。该病例展示了 JHR 的明确病程和影像学特征。
结论
在一些散发地区，钩端螺旋体病容易被误诊，JHR 使其治疗复杂化。早期诊断和适当的治疗可以降低伴有 JHR 的严重钩端螺旋体病的死亡率。
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