[Sero-negative tsutsugamushi disease (scrub typhus) diagnosed by polymerase chain reaction].

Nihon Kyobu Shikkan Gakkai zasshi Pub Date : 1997-12-01
M Sugita, M Shigeta, Y Miyake, T Sakamoto, S Aoki, R Matsuoka, T Nagayama, S Aoki, R Matsuoka
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Abstract

We report a case of sero-negative tsutsugamushi disease diagnosed by polymerase chain reaction (PCR). A 54-year-old man who worked in Nagano prefecture presented with flu-like symptoms that did not respond to cephalosporin therapy. On admission to another hospital, chest roentgenography revealed abnormal shadows; liver dysfunction was also present. Despite therapy, the patient's condition gradually worsened and he was transferred to our intensive care unit. Erythema on all extremities and scabs on the right medial femoral region and the dorsum of the left foot suggested a diagnosis of tsutsugamushi disease. We administered minocycline and gave percutaneous cardiopulmonary support for adult respiratory distress syndrome. Despite all efforts, the patient died. Although serologic tests were not positive, Karp strains of R. tsutsugamuschi were identified on PCR amplification. Autopsy revealed evidence of acute hemorrhagic pancreatitis, which has not been reported previously in tsutsugamushi disease. We conclude that PCR techniques may be useful in confirming a diagnosis of early tsutsugamushi disease.

聚合酶链反应诊断血清阴性恙虫病(恙虫病)。
我们报告一例经聚合酶链反应(PCR)诊断为血清阴性的恙虫病。一名在长野县工作的54岁男子出现流感样症状,头孢菌素治疗无效。在另一家医院入院时,胸部x线摄影显示异常阴影;肝功能障碍也存在。尽管治疗,病人的病情逐渐恶化,他被转移到我们的重症监护室。四肢红斑、右股内侧及左脚背结痂提示恙虫病诊断。我们给予米诺环素并给予经皮心肺支持治疗成人呼吸窘迫综合征。尽管做了一切努力,病人还是死了。虽然血清学试验未见阳性,但经PCR扩增鉴定出恙虫体r - Karp菌株。尸检显示急性出血性胰腺炎的证据,这在恙虫病中以前没有报道过。我们得出结论,PCR技术可能有助于确认早期恙虫病的诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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