一个患有登革热休克综合征,呈现急性脑膜炎的患者的诊断挑战
Kaiho Hirata1, Takuyo Chiba1, Harumi Gomi2,3
1Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba 286-8520, Japan.
IDCases
|April 22, 2024
概括
登革热病毒可以导致严重的神经并发症,如脑膜炎,即使没有典型的登革热症状. 在患有来自特有病区的发烧和改变意识的患者中,对登革热的早期考虑对诊断至关重要.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 病毒学 病毒学
背景情况:
- 登革热是一种广泛的系统性病毒感染,具有广泛的临床表现,从轻微到危及生命.
- 严重登革热的早期诊断对患者的结果至关重要,但症状的变化和严重程度可能会使诊断复杂化.
- 据估计,全球每年有3.90亿名登革热感染者,这凸显了该疾病对公共卫生的影响.
研究的目的:
- 报告一例带有脑膜炎的登革热休克综合征.
- 突出非典型登革热呈现所带来的诊断挑战.
- 强调在发烧性脑病的差异诊断中考虑登革热的重要性.
主要方法:
- 病例报告是一名24岁的男性患者,出现发烧和精神状态变化.
- 大脑磁共振成像 (MRI) 来识别神经系统的异常.
- 对脑脊液 (CSF),血清和尿液进行聚合酶链反应 (PCR) 测试,以检测登革热病毒.
主要成果:
- 大脑MRI揭示了T2在双边丘脑和脑干的超强度.
- 通过PCR检测证实了CSF,血清和尿液中存在登革热病毒2型血清,诊断出登革热脑炎.
- 患者康复了,但有持续的神经缺陷,包括眼睛运动受损和尿液保留.
结论:
- 登革热应该被纳入来自特有地区的患者的差异诊断中,即使没有典型的登革热症状,也会出现发烧和意识受损的患者.
- 登革热的非典型表现,如脑膜炎,强调需要广泛的诊断考虑.
- 对于患有严重登革热和神经系统并发症的患者来说,早期诊断和管理至关重要.
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