一位67歲男性以反覆發燒為表現

Abstract

發燒是相當普遍的症狀表現，但後續評估釐清原因，並盡早確認診斷治療更是臨床一大考驗。本案是一位67歲男性，因兩週前反覆發燒合併寒顫、腹痛、全身痠痛，外院診斷泌尿道感染口服抗生素治療無效，因兩天前併發呼吸喘及頭痛就醫，本院急診初步診斷敗血性休克合併多重器官衰竭入院治療。筆者為感染科專師，照護期間為2019 年11月12日至12月10日，經詳細病史詢問及身體評估，因個案有猴子咬傷接觸史，醫療團隊初步疑似恙蟲病合併鉤端螺旋體感染，立即開立恙蟲病及鉤端螺旋體檢驗並同步給予兩種抗生素治療，於2019 年11月27日確診恙蟲病，治療後感染及敗血性休克得以控制，呼吸、腸胃、肝腎功能逐漸恢復改善，個案順利健康出院。針對反覆發燒為表現之患者，必須仔細詢問職業史、旅遊史、接觸史及群聚史，當個案屬於恙蟲病高風險感染族群時，即使未發現焦痂，在流行區仍須將恙蟲病列為鑑別診斷，以免錯失治療時機。  Fever is a common clinical symptom and it is crucial to assess the etiology for appropriate treatment.This article describes the nursing experience of a 67-Year-Old male patient with recurrent fever, ac-companied by chills, abdominal pain, and general soreness. Septic shock and multiple organ failure further developed. A thorough history was performed by the author as a nurse practitioner. Physical assessments, and primary care were conducted between 12th November and 10th December 2019. Ac-cording to the history, the patient was bitten by a monkey prior to the episode. Scrub typhus and/or leptospirosis co-infection were highly suspected. Immediately after the blood tests for scrub typhus and leptospirosis, empirical antibiotic treatment was applied. Scrub typhus was confirmed on 27th November, 2019. Septic shock, respiratory failure, gastrointestinal tract symptoms, hepatitis and renal failure gradually resolved after the treatments. The patient fully recovered and was discharged without sequelae. Thorough history taking including travel, occupation, contact, and cluster (TOCC) is very important to identify febrile diseases. For timely treatment, including scrub typhus into differential diagnosis for the patients with high risk is suggested, despite no eschar was found.