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Persevere in killing lice! Intermittent fever, fatigue, nausea, vomiting, occasional diarrhea, nosebleeds.
.
.
Xiao A is uncomfortable for several weeks.
Later, he developed a rash on his thighs, which gradually spread and affected his entire body.
Little A feels that he can no longer wait for self-healing and needs to see a doctor.
"Male, 22 years old, taxi driver.
He
has headache, sore throat, cough without sputum, and general malaise.
He has been in
good health before taking any drugs, denying drugs and food allergies.
.
.
" the emergency medical history wrote.
The emergency hospital admission evaluation showed that Xiao A had no fever, blood pressure 97/47mmHg, pulse 136 beats/min, and normal breathing 22 beats/min.
Physical examination revealed punctate rashes involving the trunk, upper limbs, and lower limbs.
No neck stiffness was seen.
No chest pain, no blood in the stool.
But the results of his laboratory tests were not good.
Sodium 126 mmol/L↓ (135-145 mmol/L) blood urea nitrogen 111 mg/dL↑ (7-23 mg/dL), creatinine 3.
14 mg/dL↑ (0.
60-1.
25 mg/dL) aspartate aminotransferase 421 U/L↑ (13-40 U/L), alanine aminotransferase 135 U/L↑ (9-51 U/L) alkaline phosphatase 158 U/L↑ (34-122 U/L) D- Dimer 17.
55μg/mL↑ (< 0.
41 μg/mL), fibrinogen 94 mg/dL↓ (214-470mg/dL) lactic acid 2.
34 mmol/L↑ (0.
50-2.
20 mmol/L) platelets 35×109/ L↓ (150-400×109/L), white blood cell 13.
83×109/L↑ (4.
3-10.
8×109/L) "I have pets, one cat and two dogs. Also, I have seen mice at home.
"Little A's self-report.
Differential diagnosis.
Little A was admitted to the intensive care unit, and the diagnosis was "severe sepsis with diffuse intravascular coagulation (DIC)", which was considered to be bacteremia caused by meningococcus.
The
doctor initiated vancomycin and Treatment of ceftriaxone.
Due to thrombocytopenia, the doctor did not perform a lumbar puncture on Little A.
On the
second day of admission, Little A was in stable condition.
The
doctor in charge invited the Department of Infectious Diseases for consultation, “The next step should be a differential diagnosis.
Greek body disease or other.
"Human Ehrlichia is caused by the transmission of Ehrlichia through ticks.
The
pathogen invades monocytes or neutrophils and forms mulberry-like inclusions in the cytoplasm.
Patients often develop sudden onsets with leukopenia.
, Thrombocytopenia, with liver cell damage and abnormal liver function.
Rare skin rash.
If there are serious complications, it can cause death.
Further laboratory tests showed: Epstein-Barr virus capsid antibody, IgM and IgG antibody detection, parvovirus serological examination (Including IgM and IgG antibodies), Ehrlichia DNA test: the results are all negative.
Rickettsia typhus IgM and IgG are positive.
The
flea flea A was quickly identified as "Rickettsia typhus" "Infection", the scientific name of the disease: murine typhus, which is transmitted to humans by fleas that parasitize cats and possums.
It is also called "endemic typhus" in China, which is a category C infectious disease.
Murine typhus.
It can manifest as a series of non-specific symptoms of different severity, including malaise, chills, myalgia, anorexia, arthralgia, nausea and vomiting.
These clinical features are similar to epidemic typhus, but the former is milder and shorter.
, The rash is rarely hemorrhagic.
The performance of small A belongs to the "typical triad": fever, headache and rash.
Approximately one-third of infected persons will have the above-mentioned manifestations.
In addition, 1/3 of patients can see macules or maculopapular rashes on their skin.
The rash usually spreads from the trunk to the limbs, involving the whole body (except palms and soles).
Laboratory examination may show abnormalities such as elevated liver enzymes, elevated lactate dehydrogenase, hypoalbuminemia, accelerated erythrocyte sedimentation rate, thrombocytopenia, elevated alkaline phosphatase, and hyponatremia.
Teenagers may also be infected with murine typhus.
But it is more likely to manifest as abdominal pain, diarrhea and sore throat, and the incidence of anemia is higher.
The incidence of hypoalbuminemia, hematuria and proteinuria is low, and the incidence of complications is significantly lower than that of adults.
Generally, people who have the above symptoms, especially those with animals around, or who have been exposed to fleas, have traveled along the coast, or live in epidemic areas, should consider murine typhus.
At the time of diagnosis, the indirect fluorescent antibody test is used to check the serum typhus rickettsiae IgG antibody.
It is worth noting that antibodies have not yet been produced in the first week of illness.
The antibody titer of serum specimens during the recovery period increased by 4 times, which is of diagnostic value.
Adjusting the treatment Murine typhus can be a self-limiting disease.
Fever can last for 12-21 days in untreated patients.
Treatment with tetracycline drugs can significantly shorten the course of the disease, and the fever can be relieved after 1.
5-4 days of use.
Xiao A's anti-infection regimen was quickly adjusted from vancomycin to oral doxycycline 100 mg twice a day.
Soon, his fever subsided.
On the third day of hospitalization, hemodynamics were stable and he was transferred out of the intensive care unit smoothly.
On the 5th day of hospitalization, follow-up serology showed that the serum antibody titer of residual rickettsiae was high, and the examination of other pathogens was negative.
In addition, for coagulation dysfunction, after the hematology consultation, cryoprecipitate was started, and the target fibrinogen level was >150 mg/dL.
The peripheral blood smear showed no red blood cell fragments (split red blood cells), which ruled out the previous diagnosis of DIC.
After 5 days of monotherapy, Xiao A's symptoms were fully improved and he was allowed to be discharged from the hospital.
He kept wondering: When did he get bitten by a flea? At present, murine typhus has a global distribution.
In China, it mainly exists in sporadic form, with small outbreaks in some areas.
However, all provinces (cities, districts) have reported cases.
To cut off the transmission route, preventing and killing lice is the key.
With the development of eco-tourism and the continuous development of the original environment, people are going to more "unknown corners", opportunities for people to come into contact with disease host animals and transmission media are increasing, and the risk and scope of infection with Rickettsia typhus are both Increasing.
Reference materials: 1.
.
gov/salmonella/reporting-timeline.
html4.
Epidemiological status of murine typhus and its influencing factors.
Chinese Journal of Tropical Medicine.
2019,Vol.
19 Issue(8):790-793.
DOI:10.
13604/j.
cnki.
46 -1064 / r.
2019.
08.
195 endemic typhus centers for disease control and prevention in Heilongjiang Province source: medical author: blue whale Xiaohu proof: Zangheng Jia Editor: Xu Li Yan to the group of wonderful review See also "humidifier pneumonia occur "! What kind of medicine can make people smarter? The first batch of post-90s livers collapsed.
.
.
.
.
Xiao A is uncomfortable for several weeks.
Later, he developed a rash on his thighs, which gradually spread and affected his entire body.
Little A feels that he can no longer wait for self-healing and needs to see a doctor.
"Male, 22 years old, taxi driver.
He
has headache, sore throat, cough without sputum, and general malaise.
He has been in
good health before taking any drugs, denying drugs and food allergies.
.
.
" the emergency medical history wrote.
The emergency hospital admission evaluation showed that Xiao A had no fever, blood pressure 97/47mmHg, pulse 136 beats/min, and normal breathing 22 beats/min.
Physical examination revealed punctate rashes involving the trunk, upper limbs, and lower limbs.
No neck stiffness was seen.
No chest pain, no blood in the stool.
But the results of his laboratory tests were not good.
Sodium 126 mmol/L↓ (135-145 mmol/L) blood urea nitrogen 111 mg/dL↑ (7-23 mg/dL), creatinine 3.
14 mg/dL↑ (0.
60-1.
25 mg/dL) aspartate aminotransferase 421 U/L↑ (13-40 U/L), alanine aminotransferase 135 U/L↑ (9-51 U/L) alkaline phosphatase 158 U/L↑ (34-122 U/L) D- Dimer 17.
55μg/mL↑ (< 0.
41 μg/mL), fibrinogen 94 mg/dL↓ (214-470mg/dL) lactic acid 2.
34 mmol/L↑ (0.
50-2.
20 mmol/L) platelets 35×109/ L↓ (150-400×109/L), white blood cell 13.
83×109/L↑ (4.
3-10.
8×109/L) "I have pets, one cat and two dogs. Also, I have seen mice at home.
"Little A's self-report.
Differential diagnosis.
Little A was admitted to the intensive care unit, and the diagnosis was "severe sepsis with diffuse intravascular coagulation (DIC)", which was considered to be bacteremia caused by meningococcus.
The
doctor initiated vancomycin and Treatment of ceftriaxone.
Due to thrombocytopenia, the doctor did not perform a lumbar puncture on Little A.
On the
second day of admission, Little A was in stable condition.
The
doctor in charge invited the Department of Infectious Diseases for consultation, “The next step should be a differential diagnosis.
Greek body disease or other.
"Human Ehrlichia is caused by the transmission of Ehrlichia through ticks.
The
pathogen invades monocytes or neutrophils and forms mulberry-like inclusions in the cytoplasm.
Patients often develop sudden onsets with leukopenia.
, Thrombocytopenia, with liver cell damage and abnormal liver function.
Rare skin rash.
If there are serious complications, it can cause death.
Further laboratory tests showed: Epstein-Barr virus capsid antibody, IgM and IgG antibody detection, parvovirus serological examination (Including IgM and IgG antibodies), Ehrlichia DNA test: the results are all negative.
Rickettsia typhus IgM and IgG are positive.
The
flea flea A was quickly identified as "Rickettsia typhus" "Infection", the scientific name of the disease: murine typhus, which is transmitted to humans by fleas that parasitize cats and possums.
It is also called "endemic typhus" in China, which is a category C infectious disease.
Murine typhus.
It can manifest as a series of non-specific symptoms of different severity, including malaise, chills, myalgia, anorexia, arthralgia, nausea and vomiting.
These clinical features are similar to epidemic typhus, but the former is milder and shorter.
, The rash is rarely hemorrhagic.
The performance of small A belongs to the "typical triad": fever, headache and rash.
Approximately one-third of infected persons will have the above-mentioned manifestations.
In addition, 1/3 of patients can see macules or maculopapular rashes on their skin.
The rash usually spreads from the trunk to the limbs, involving the whole body (except palms and soles).
Laboratory examination may show abnormalities such as elevated liver enzymes, elevated lactate dehydrogenase, hypoalbuminemia, accelerated erythrocyte sedimentation rate, thrombocytopenia, elevated alkaline phosphatase, and hyponatremia.
Teenagers may also be infected with murine typhus.
But it is more likely to manifest as abdominal pain, diarrhea and sore throat, and the incidence of anemia is higher.
The incidence of hypoalbuminemia, hematuria and proteinuria is low, and the incidence of complications is significantly lower than that of adults.
Generally, people who have the above symptoms, especially those with animals around, or who have been exposed to fleas, have traveled along the coast, or live in epidemic areas, should consider murine typhus.
At the time of diagnosis, the indirect fluorescent antibody test is used to check the serum typhus rickettsiae IgG antibody.
It is worth noting that antibodies have not yet been produced in the first week of illness.
The antibody titer of serum specimens during the recovery period increased by 4 times, which is of diagnostic value.
Adjusting the treatment Murine typhus can be a self-limiting disease.
Fever can last for 12-21 days in untreated patients.
Treatment with tetracycline drugs can significantly shorten the course of the disease, and the fever can be relieved after 1.
5-4 days of use.
Xiao A's anti-infection regimen was quickly adjusted from vancomycin to oral doxycycline 100 mg twice a day.
Soon, his fever subsided.
On the third day of hospitalization, hemodynamics were stable and he was transferred out of the intensive care unit smoothly.
On the 5th day of hospitalization, follow-up serology showed that the serum antibody titer of residual rickettsiae was high, and the examination of other pathogens was negative.
In addition, for coagulation dysfunction, after the hematology consultation, cryoprecipitate was started, and the target fibrinogen level was >150 mg/dL.
The peripheral blood smear showed no red blood cell fragments (split red blood cells), which ruled out the previous diagnosis of DIC.
After 5 days of monotherapy, Xiao A's symptoms were fully improved and he was allowed to be discharged from the hospital.
He kept wondering: When did he get bitten by a flea? At present, murine typhus has a global distribution.
In China, it mainly exists in sporadic form, with small outbreaks in some areas.
However, all provinces (cities, districts) have reported cases.
To cut off the transmission route, preventing and killing lice is the key.
With the development of eco-tourism and the continuous development of the original environment, people are going to more "unknown corners", opportunities for people to come into contact with disease host animals and transmission media are increasing, and the risk and scope of infection with Rickettsia typhus are both Increasing.
Reference materials: 1.
.
gov/salmonella/reporting-timeline.
html4.
Epidemiological status of murine typhus and its influencing factors.
Chinese Journal of Tropical Medicine.
2019,Vol.
19 Issue(8):790-793.
DOI:10.
13604/j.
cnki.
46 -1064 / r.
2019.
08.
195 endemic typhus centers for disease control and prevention in Heilongjiang Province source: medical author: blue whale Xiaohu proof: Zangheng Jia Editor: Xu Li Yan to the group of wonderful review See also "humidifier pneumonia occur "! What kind of medicine can make people smarter? The first batch of post-90s livers collapsed.
.
.
