登革熱登革出血熱，屈公病診斷與治療 - CDC · 2019-01-29 · – Plan: 轉內科並且安排腹超 • 內科醫師問診at 16:30 – fever onset on 8/19 (D1), also

登革熱登革出血熱屈公病診斷與治療

疾病管制署

洪敏南醫師

20140510

1

登革熱（Dengue fever）

bull 由蚊子傳播的急性病毒性熱疾

ndash 埃及斑蚊Aedes aegypti

ndash 白線斑蚊Aedes albopictus

bull 以高熱頭部肌肉骨頭關節的奇痛後眼窩痛以及發疹為主要症狀

2

登革熱通報定義

bull 突發發燒≧38且伴隨下列二（含）種以上症狀

1 頭痛

2 後眼窩痛

3 肌肉痛

4 關節痛

5 出疹

6 出血性癥候（hemorrhagic manifestations）

7 白血球減少（leukopenia）

3

屈公病通報定義

bull 臨床條件ndash 急性發燒≧38degC 且有嚴重關節炎或關節痛無法以其他醫學診斷解釋者

bull 流行病學條件 (具有下列任一個條件)ndash （一）住家或活動範圍附近有屈公病確定病例或有與屈公病確定病例接觸史

ndash （二）有屈公病流行地區相關旅遊史

bull 通報定義ndash 符合臨床條件及流行病學條件

4

5Clinical Infectious Diseases 2009 49942ndash8

6

Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever WHO 2011

7

8

9Handbook for clinical management of dengue WHO 2012

Potential Clinical Issues by Phase (days post fever onset)

bull Febrile phase ndash Dehydration

ndash Febrile seizures

ndash Neurologic manifestations

bull Critical phase ndash Prolonged shock

ndash Organs impaired

ndash Bleeding

bull Recovery phasendash Fluid overload

ndash Worsening effusions

ndash Acute pulmonary edema

10

11

整體評估

bull 鑑別診斷

bull 詢問居住地活動史與接觸史 (TOCC)

bull 要想到登革感染的可能性

bull 發燒初期的血比容值Hct可以當作此病患Hct的基礎值

bull 白血球與血小板下降暗示可能為登革感染

bull 利用止血帶試驗協助診斷

bull 完整的衛教(含回家後應注意事項)

12

WHO (1997) Dengue Haemorrhagic Fever Diagnosis Treatment Prevention and Control 2nd ed

13

The Atlas of Emergency Medicine gt Chapter 21

類似快篩

14

bull 具有以下特質的病患ndash 有警示徵象

ndash 有共病症 (如懷孕嬰幼兒老年人肥胖糖尿病高血壓心衰竭腎衰竭慢性溶血性疾病)

ndash 特定的社經因子

15

何謂 Vital signs ldquostable

bull 要養成親自接觸每個病患(無論是否為登革病人)並且評估病患週邊灌流的習慣

bull Level of consciousness (Use GCS) bull Capillary refill bull Skin temperature color and moisture level (normal

dry or clammy) bull Peripheral pulse volumebull Heart rate

ndash 發燒期心搏過速與肢體冰冷代表

bull Blood pressurendash Not match with the expectations ndash Definition of hypotension

bull Respiratory rate bull Urine output

16

登革病患出現腹痛

bull 腹痛是血漿滲出的早期徵象而且當低血容進展時腹痛也會惡化

bull 也許是上腹痛合併嘔吐因此常被誤診為單純的胃炎而只考慮給予抗腸痙攣劑或制酸劑

bull 如何鑑別ndash 要注意病史如之前有發燒但退燒後反而出現腸胃道症狀如噁心嘔吐腹瀉甚至解黑便等此時應該想到可能是登革感染的警示徵象甚至病患已經呈現休克

ndash 如果經過單純的輸液治療 (5minus10 mlkg over 1 hour)腹痛已減緩暗示外科急症的可能性不大

ndash 大量輸液治療24小時後仍有持續或惡化的腹痛表示是即將發生休克的危險徵兆嗎

17

Case studies

18

Case 1

bull 76歲女性

bull 高血壓病史

bull 居住地屏東市長春里號

bull 20131011早上被發現不省人事

bull At ER ndash TPR=36211820

ndash Lab CBC=68KHct=412PLT=25KASTALT=21796

ndash Brain CT severe SDH

19

Case 2

bull 40 歲女性於 2009130 (D1)至急診

bull 主述

ndash 130開始發燒

ndash 伴隨發冷咳白痰呼吸困難喉嚨痛頭痛頸部痠痛雙側膝關節腕關節與踝關節疼痛

ndash 痛到無法行走且背部出現疹子

bull 從馬來西亞回國 (122~130)

20

bull At ER (D1)

ndash TPR=3829720 BP=11055

ndash Lab Hct=393 WBC=4K Neu=86 PLT=139K ALTAST=1220

ndash PE conjunctivitis (+) tenderness over bil ankles and knees skin rash on back (+)

bull Admission

ndash Tentative Dx dengue Flu Chikungunya

ndash Give doxycycline

ndash fu lab WBC=138K PLT=111K afebrile 4 days later

21

Kaohsiung J Med Sci 201026256‐60

Case 3

bull 64 歲男性20111016凌晨4點至急診主述為自昨日起有發燒骨頭痠痛 (D1=1015) ndash 住在東港ndash 有慢性腎病與痛風史ndash BW=78Kg(IBW=60Kg)

bull At ERndash TPR=388319 BP=13886ndash Lab Hb=97 PLT=121K WBC WNL Seg=78 Cr=73ndash Give Keto 1 amp + NS 250ml

bull MBD (11 AM) ndash Dx URIpharyngitisndash Prescription panadal keflex and peace x 3 days

22

Revisit ER 3 days later

bull Revisit ER on 7AM 1019 ( D5)

bull CC SOB and chest discomfort for 2 daysndash TPR=37410324 BP=11694

ndash Muscle soreness(+) low grade fever(+) abd pain (+) deny URI symptoms or rash

ndash Lab WBC=75K Hb=15 PLT=37K ALT=73BunCre=12110 ABG=73222263113INR=115 aPTT=394

bull Admission at 11 AMndash Abd echo ascites (+) CXR bil lower lung infiltrate(+) cardiomegaly(+)

ndash Impression DF + thrombocytopenia acute on CKD

23

24

Case 4

bull 70歲男性於2011115傍晚七點至急診bull 主述

ndash 發燒三天食慾不振解黑便ndash 住鳳山ndash HTN DM (+)

bull At ER ( D3=115)ndash TPR=36910320 BP=161103ndash Lab WBC=561KHb=166 Hct=494 PLT=44KBunCre=2511ALT=115

bull MBD at 11 PMndash Dx 1 fever cause 2 ro UGIB thrombocytopenia

25

Revisit ER next day

bull At ER 7 PM 116 (D4) due to generalized weaknessndash TPR=36813720 BP=9265ndash Lab WBC=614kHb=144Hct=434PLT=16KASTALT=353242Glu=418

ndash sp BT with PLT arrange PES

bull At ER (117)ndash 5AM BT=38 tarry stool BP=9363ndash 6AM WBC=767K Hb=107 Hct=322 PLT=17K sp BT with PRBC PLT FFP

ndash 12 AM SBP=40ndash 4AM skin rash (D5) noted notify denguendash 9PM AAD

26

27

Case 5

bull 24 歲女性 2012824 至急診因為ndash 發燒三天肌肉痛與虛弱 for 2 days and tea color urine 1 day

bull At ER ( 1500 )ndash BW=64Kg BH=158cm

ndash TPR=3611020 BP=10050

ndash Epigastric pain(+) Murphyrsquos sign (+)

bull GS re‐took Hx ndash epigastric pain for 5 days with worsening abd pain vomiting many times abd soft no guarding

28

bull 初步診斷 UTI acute cholecystitisndash Plan 轉內科並且安排腹超

bull 內科醫師問診 at 1630ndash fever onset on 819 (D1) also had vomiting malaise transient rash intense abd pain on 824 (D6)

ndash TP=36120 BP=10080ndash Petechiae over lower limbs(+) weak pulse ndash Revise Dx

29

Lesson learnt

bull It is not uncommon for dengue to be misdiagnosed at various phases of the disease coursendash Viral hepatitis vs jaundice in dengue

ndash ldquoAcute abdomenrdquo if fever bull an important warning sign of severe dengue

bull acalculous cholecystitis

ndash Polycythemia vs haemoconcentration

bull 仔細問診親自評估病患早期察覺休克

30

31

Take Home Message

bull 要想到登革感染

bull 要確認疾病進程

bull 要避免特定藥物

bull 要嚴密監控病況

bull 要補充適當輸液

bull 要考慮出血可能

32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90

WHO 10 facts on malaria

Yellow Book 2013 US CDC

1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3

Plasmodium falciparum P vivax P ovale P malariae

()

Dennis L Kasper 2005

2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze

Decerebrate rigidity

Management of severe malaria a practical handbook WHO 2000

A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine

Artemisinin-based combination therapy (ACT)

WHO

Artequin 6001500 Artesunate 3 tabs + mefloquine 6 tabs

quinine + (doxycyline tetracycline or clindamycin) x 7 days

P malariae hydroxychloroquine P vivax P ovale hydroxychloroquine

primaquine (025 mgkg) x 14 days

P vivax ACT + primaquine (

)

24

Artesunate (60mg) 24mgkg stat and q12h2 dose then qd 6 days (made in China)

Quinine (60mg) 20mgkg stat then 10mgkg q8h 7 days ( )

Quinine artemisinin

Primaquine for P vivax Usual adult oral dose is 15 mg base (025 mgkgday) In South-East Asia particularly Indonesia and in Oceania higher doses (05 mg basekgday) Primaquine contraindicated in pregnant women children lt 4 yo lactating woman

Effect 14 day-regimen gt 5 day

US CDC guideline Primaquine dose 05 mgkgday

Artemisinin

A potent and rapidly acting blood schizontocide Active against all Plasmodium species Safe and remarkably well tolerated

Reports mild gastrointestinal disturbances dizziness tinnitus reticulocytopenia neutropenia elevated liver enzyme values and electrocardiographic abnormalities including bradycardia and prolongation of the QT interval

not been evaluated in the first trimester

Artemisinin Resistance in the Greater Mekong subregion

2014 WHO Status Report on Artemisinin Resistance

Tier maps of the Grater Mekong

subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)

Mefloquine Doxycycline

Malarone 100

NEJM 2008359 603-612

2010

2011 Available at httppptccnLxk

Distribution of Chloroquine- Resistant P falciparum


Distribution of Mefloquine-

Resistant Malaria in the

Grater Mekong subregion

( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121

2009 9 50 FRIM Forest Research Institute Malaysia) 9

2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine

Schizont( ) progress

46 201045-418

(hydroxychloroquine) 425 428 429

428 hydroxychloroquine

-

THANK YOU FOR YOUR ATTENTION

日本腦炎恙蟲病之診斷與治療

高雄市立小港醫院

(委託高雄醫學大學經營) 感染管制室主任

張科

Figure 1 Global distribution pattern of Japanese encephalitis The areas shaded in yellow are Japanese encephalitis

risk-prone regions The areas encircled in red such as Karachi (Pakistan) and Torres Strait islands (Australia) and

parts of the northern Australian mainland are newer areas affected by Japanese encephalitis

Kaushik Bharati httpwwwantimicrobeorgmid

Year Incident

1871 First recorded clinical case of JE reported from Japan

1924 Large outbreak of JE in Japan with gt6000 cases and a fatality rate

of 60 Isolation of JEV from human brain

1933 First cases of JE reported from the Korean peninsula

1935 Isolation of Nakayama strain of JEV

1938 Isolation of JEV from Culex tritaeniorhynchus mosquitoes

1940 First cases of JE reported from the Chinese Mainland

1950 First cases of JE reported from the Philippines

1950s Elucidation of transmission cycle of JEV with pigs and ardeid birds

identified as amplifying hosts and Culex tritaeniorhynchus as

primary vector species

1955 First cases of JE reported from Vellore India

1965 Major epidemic in northern Vietnam

1969 and 1970 Major epidemic in Chiang Mai Valley Thailand

1973 First epidemic in India in the state of West Bengal

1978 Major epidemic in Terai region of Nepal

1983 JE reaches Pakistan the furthest geographical extension to the West

1985-86 and

1987

Major epidemics in Sri Lanka

1995 JE reaches Papua New Guinea and Torres Strait islands (Australia)

the furthest geographical extension to the South

2005 Major epidemic in Gorakhpur Uttar Pradesh state of India 5737

cases with 1344 deaths

India imports live-attenuated SA 14-14-2 vaccine from China

Table 1 Japanese Encephalitis An Historical Timeline

日本腦炎

bull 1924年在日本爆發大流行

bull 1938年日本學者

得知經由蚊蟲為媒介

而傳染

bull 1956年發展出不活性的

疫苗

bull 臺灣地區每年都

有日本腦炎病例發生

流行地區遍部全省

日本腦炎

bull All world

bull Approximately 35000-50000 people

suffer from JE every year with a

mortality rate of 10000-15000 people

per year China still accounts for 50 of

the reported JE cases worldwide

bull Zheng Y Rev Med Virol 2012 Mar 8

0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43

Japanese encephalitis cases

from 1998 to Feb2013 in Taiwan

httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月

bull 高雄市出現首例本土型日本腦炎病例籲請市民提高警覺

bull 高雄市出現今年(2011)首例本土型日本腦炎確定病例個案為64歲男性美國人居住於高雄市大寮區患者於5月16日開始出現頭痛發燒全身無力等症狀5月19日出現行動及反應遲緩5月20日因意識混亂由友人護送至市立聯合醫院急診求治並由醫院通報為日本腦炎疑似個案採檢送驗6月5日經行政院衛生署疾病管制局綜合研判結果為陽性該患者於5月26日因出現呼吸急促等危急症狀已由醫師給予插管呼吸器輔助呼吸目前意識狀況呈現昏迷昏迷指數約7分持續於加護病房加強照護中

疫情調查

bull 經環境調查該名個案居住地點周邊有大量雜草叢生的空地防疫人員在空地內側隱密處查獲民眾飼養豬支豬圈舍前方即為水池現場亦捕獲數隻斑蚊與家蚊整體衛生環境條件不良是十分有利傳播日本腦炎的病媒蚊-三斑家蚊孳生的環境

大寮戰區防治作為

本府衛生局已依傳染病防治法對國防部總政治作戰局及國有財產局權管之影劇七新村病媒蚊孳生源開出舉發通知書

臨床症狀

bull 患者通常在經過5~15天的潛伏期後出現臨床症狀其典型的病程演進可分為四個時期 ndash 前驅期 (2~3天)

bull 前驅症狀發作快主要出現頭痛噁心嘔吐食慾不振精神不安發燒或輕微呼吸道感染症狀

ndash 急性期 (3~4天) bull 高燒部份兒童呈現抽筋症狀頸部僵硬四肢僵硬深部及淺部反射異常震顫言語困難神智不清對人時地不能辨別甚至昏迷或死亡

ndash 亞急性期 (7~10天) bull 中樞神經的侵犯較緩部分病例仍有生命危險

ndash 恢復期 (4~7週) bull 大部分存活病例的神經功能缺損仍存在其中包括四肢僵硬無力腦神經及錐體外徑路的異常

病媒蚊在台灣傳播日本腦炎之病媒蚊

bull 三斑家蚊環紋家蚊

孳生於

ndash 水稻田

ndash 灌溉溝渠

ndash 地上小水池

ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流

ndash 臨時性積水漥地

潛伏期與可傳染期

bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期

ndash 人不會經由人直接傳染給人

ndash 蚊子一旦被感染則終生具感染力

ndash 豬及鳥類的病毒血症期通常為2~5天

bull 感染性及抵抗力

ndash 通常小孩及老人感染後較容易發生臨床症狀其他年齡層則較多不顯性感染

病例定義

bull 臨床病例

ndash 出現下列急性神經症狀發燒意識障礙嘔吐頸部僵硬抽筋肌張力異常頭痛腦膜刺激症狀及精神症狀（譫妄意識不清等）

檢體採檢送驗事項

實驗室診斷

ndash 符合下列檢驗結果之任一項者定義為檢驗結果陽性臨床檢體（組織腦脊髓液或其他體液）分離並鑑定出日本腦炎病毒

臨床檢體分子生物學核酸檢測陽性腦脊髓液中日本腦炎病毒特異性之IgM抗體陽性

急性期（或初次採檢）血清中日本腦炎病毒特異性IgM或IgG抗體為陽性者

在最近未接受預防注射及排除其他黃病毒交叉反應的情形下成對血清（恢復期及急性期）中日本腦炎病毒特異性IgM或IgG抗體（二者任一）有陽轉或≧4倍上升

疾病分類

bull 極可能病例

ndash 符合臨床條件及檢驗結果陽性定義之第三項

bull 確定病例

ndash 符合檢驗結果陽性定義之第一二四項之任一項

法定傳染病規範

bull 疾病分類

ndash 屬第三類傳染病

bull 通報定義

ndash 具有下列任一個條件

ndash符合臨床條件

ndash醫師高度懷疑與確定病例具有流行病學上相關

bull 通報期限

ndash 於1週內進行通報

bull 白血球上升嗜中性白血球增加輕微貧血

bull 腦脊髓液蛋白質約 50個案會上升

bull 腦脊髓液早期會以嗜中性白血球為主

bull 腦脊髓液晚期為淋巴球為主

實驗室檢查

KMHKH bull Case presentation

bull 23 male

bull consciousness change and

bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240

Chief Complaint and Present

Illness

bull 43 yrs old Car repair workers

bull Admission Date20091011

bull Chief Complaint

Sudden onset of left lower limb weakness for one day

Present Illness

suffered from fever muscle soreness since 2 days ago

sudden onset of progressive left proximal lower limb

weakness noted 1 day before admission

bull headache dizziness general malaise vomiting intermittent

left thigh numbness and neck pain

bull visited LMD but in vain then visited our ER (1011)

Physical Exam bull Consciousness Alert E4V5M6

BP113 68 mmHg PR109 bpm RR18cpm BT379

Lower limbs left lower limb weakness

free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot

Biceps reflex + + + +

Triceps + + + +

Brachiaradia is + + + +

Knee jerk + + -

Ankle jerk + + + +

Differential diagnosis

bull Cranial nerve intact

bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)

bull Bradykinesia (-)

bull Bilateral upper limbs postural Tremor (+)

bull DD

bull L2~L3 level (no sensory level)

bull Suspect drug related (EPS)

bull L-spine radiculopathy

bull Myopathy

bull Femoral nerve lesion

bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011

bull Fever up to 39 (1930)

bull Give stin and Blood culture

bull Intermittent bilateral upper limbs tremor and spasm (2030) left predominant tonic ndashflexor posture suspect seizure 30 seconds~1 min

bull Suspect novamin induced EPS

Clinical Course

1012

bull Generalized skin rash (0040) and fever suspect stin allergy

bull Drowsy consciousness generalized skin rash + fever suspect stin allergy

bull WBC = 1253 10^3ul Segament Neutro = 886 CRP = 694 mgl

bull Highly suspect meningoencephalitis

bull Focal seizure

Consult Infection check HIV TB JBE

Clinical Course

1013

Course

bull Drowsy consciousness E3V3M5

bull Lumbar puncture for suspected CNS infection (open pressure 218mmHg)

Transfer to KMU- NICU

Lab

bull Cell count = 177X119 mm^3 [0~5]

bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]

bull Glu = 59 [120~200] Smear CSF negative

bull Pathology Increased leukocytes and lots of neutrophils suggest meningitis

Medication

bull Ceftriaxone 2g IV Q12H + Vancomycin 1g IVD Q8H + Acyclovir 750mg IVD Q8H

bull Doxycycline 100mg PO QD

1017-1024 at KMUH

bull 1017 respiratory failure Intubation Right lower lobe pneumonia

bull EEG no seizure wave was found

bull lumbar puncture again due to consciousness not improved

CNS infection was partial relieved WBC was lymphocyte dominent stop using Vancomycin Consciousness was improved

bull 1024 consciousness and pneumonia improved gradually Extubation

1030

bull Pneumonia relieved gradually

bull Pre-renal acute renal failure was impressed so we increased fulid amount of hydration Following renal function improved gradually

bull transferred to general ward on 1028

bull JBE confirmed by positive IgG and IgM (981013)

治療及預後

bull 治療方式

ndash 無針對日本腦炎病毒之抗病毒藥物

ndash 依病情給予支持療法

ndash 嚴重時要加護病房照護

bull 併發症

ndash 神經性後遺症

bull 不正常肌張力

bull 語言障礙

bull 運動肌無力等

ndash 精神性後遺症

bull 脾氣暴躁

bull 性格不正常

bull 智力不足

ndash 常發生在年輕的小孩

日本腦炎防治策略

bull早期診斷早期治療

bull病媒蚊防治

A)降低幼蟲 B)病媒蚊控制

bull 預防施打疫苗

bull 國內自民國57年起新生兒全面施打日本腦炎疫苗之前出生的人多半都沒有接種過疫苗

疫苗接種條件及限制

bull 接種對象

ndash 年滿15個月的幼兒應接受2劑注射其間相隔2週隔年再接種一劑小學一年級時再追加接種一劑

ndash 工作或生活中有感染之虞且有意願接種的成人可前往全國26家署立醫院或分院自費接種

bull 接種時程

ndash 每年3至5月

bull 禁忌

ndash 發高燒

ndash 患有嚴重疾病者


bull 保護力

ndash 疫苗的有效性約85

bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身

發燒惡寒頭痛倦怠感

ndash 通常2~3天內消失

避免病媒蚊叮咬

bull 盡量避免於病媒蚊活動的高峰期(黃昏)在豬舍其他動物畜舍或病媒蚊孳生地點附近活動

bull 請穿著長袖長褲身體裸露處塗抹防蚊藥劑避免蚊蟲叮咬以降低感染風險

bull 居家環境管理疏通水溝清除雜草處理積水及家中需設置紗門紗窗以消滅病媒蚊及其幼蟲

Rickettsial Infection

1 Gram (-) obligate intracellular bacteria

2 Vectorborne ( tick mite fleashellip)

3 Spotted fever and typhus groups

vasculitis

rickettsiae proliferate in the endothelial lining cells of small arteries capillaries and veins

Topic1Scrub typhus-history bull AD 313 晉朝rdquo葛洪rdquoldquo人行經草處沙地被依微小沙虱叮咬即發生紅疹三日後發熱叮咬局部潰瘍節痂rdquo

bull 1810 Hakuju Hashimoto Japanese first described this disease

bull 1927緒方規雄(Ogata norio) patient serum injected into the rabbitrsquos testis-repeat this procedure 5 times-gall bladder swelling -isolated Rickettsia orientia

bull 1931 Formal name Rickettsia tsutsugamushi

bull 範圍西至巴基斯坦阿富汗

東至日本本州北端南到整個東南亞至

澳洲東北部及西南太平洋群島

Scrub typhus-pathogen bull 1恙蟲病 (Tsutsugamushi disease

tsutsu是惡疾之意而mushi是指恙蟲)

又名叢林型斑疹傷寒〈Scrub typhus〉

bull pathogen Orientia tsutsugamushi

( Rickettsia tsutsugamushi)

vector Leptotrombidium deliense

bull 2Transmitted by a bite of chigger

(a larval stage mite) through the

chiggerrsquos saliva

bull Endemic in Asia Australia New Guinea

Pacific Islands

Host

bull Orientia tsutsugamushi

in mites will be vertical

transmission in every

stages including ovarylarvadeutonymphadult permanent

infection

bull Animal host rodentsmammals (sheeppigdogcat)avian (birdchicken) Rodents are

the major host

38 Jerome Goddard Infect Med 17(4)236-239 2000

bull Incubation period

- 1~2 weeksusually 9~12

days not human to human

bull Immunity protection

- One man got secondary infection of scrub typhus he may have long term immunity for protection if the strain of scrub typhus is same as previous but only short term immunity for protection if the strain of scrub typhus is different from previous

- Second or third infection of scrub typhus in endemic area may occur but the symptoms and signs will be mild

httpwwwcdcgovtw

Transmission method

Scrub typhus 1996~20132

台北區合計 1636 No1

北區合計 230

中區合計 640

南區合計 216

高屏區合計 1277 No3

東區合計 1481 No2

合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12

Scrub typhus cases from 1996 to Feb2013 in Taiwan

httpwwwcdcgovtw

bull Seasons all year in Taiwan the peak period May~December

bull Location scrub typhus favor high temperature and high humidity outsides grass

bull occur in Taiwan high prevalence in Kingman Matsu Penghu Lanyu Hualien Taitung Kaohsiung

Epidemioloy

bull genotype Karp Gilliam Kato

Kawasaki Boryong Taguchi

KandaKawasaki

Clinical Manifestation (1) bull Fever chills headache muscle pain

lymphadenopathy

bull Rash ndash 5 days after insect bite

9-10 days later subsided

ndash from trunk to extremities

ndash maculerarrpapule

Eschar (about 50-80 in scrub

typhus patients painless)

bull Splenomegaly may be seen

bull Complication ndash Pneumonia ARDS myocarditis renal failure septic shock

ndash After two weeks incubation central nervous system occur meningoencephalitis acute transverse myelitis

httpwwwcdcgovtw

SCRUB TYPHUS IN JAPAN EPIDEMIOLOGY AND

CLINICAL FEATURES OF CASES

REPORTED IN 1998

bull A total of 462 cases

bull Seventy-six percent of the patients were more than 51 years old and 36 and 16 of the patients were engaged in farm work and forestry respectively

bull Fever rash and eschar were detected in 98 93 and 97 of

bull the patients respectively

bull Elevated levels of C-reactive protein aspartate transaminase and alanine transaminase were detected in 96 87 and 77 of the patients respectively

bull Disseminated intravascular coagulation developed in 34

bull cases and had a unique regional distribution Am J Trop Med Hyg 67(2) 2002 pp 162ndash165

Acute respiratory distress

syndrome in scrub typhus

bull 72 patients with scrub typhus from 19981 to 20068 in KCGMH in Taiwan

bull Eight of 72 scrub typhus patients with ARDS included in the study the other patients without ARDS were used as controls The mortality rate for the scrub typhus patients with ARDS was 25

bull Initial presentations of dyspnea and cough white blood cell count hematocrit total bilirubin and delayed used of appropriate antibiotics use were significant predictors of ARDS

bull Multivariate analysis showed that albumin prothrombin time and delayed use of appropriate antibiotics were independent predictors of ARDS

Am J Trop Med Hyg 2007 Jun76(6)1148-52

Scrub typhus complication bull Be aware of the potential for complications scrub

typhus are older (ge 60 years) presents without eschar or WBC counts gt 10 000mm3 and serum albumin level le 30 gdL Close observation and intensive care for scrub typhus patients with the potential for complications reduction in its mortality rate Kim et al BMC Infectious Diseases 201010108

bull Bilateral simultaneous facial palsy following scrub typhus meningitis a case report and literature review

LinWL Kaohsiung J Med Sci 2011Dec27(12)573-6

Diagnosis bull 1 PCR amplification of O tsutsugamushi DNA from blood of febrile

patients or eschar lesion

2 IFA (indirect fluorescent antibody) acute stage IgM Ab ≧180

and IgG Ab ≧1320

3 IFA (acute stage amp recovery stage）

IgM or IgG Ab seroconversion or ≧4x elevation

bull Weil-Felix slide agglutination test lower sensitivity and specificity

half patients have antibody reaction to

Proteus spp OX-K

Weil-Felix slide agglutination test is not specific

sensitive or specificity is not high

Proteus spphave similar antigen with rickettsial antigen When human got rickettsial infection human body will induce anti-rickettsial antibody which will be cross reaction with Proteus spp

Proteus OX-K (+) ---may be associated with scrub typhus infection

Proteus OX19 (+) -- may be associated with murine typhus infection

Proteus OX-K(-) OX19(-) OX2(-)mdashQ fever

Treatment and prophylaxis

bull 1 inadequate treatment (insufficient treatment course) induce

high relapse tendency all patient need two weeks treatment

course doxycycline 100 mg bid po for 7-14 days

tetracycline minocycline

bull 2ciprofloxacin levofloxacin

chloramphenicol rifampicin

3 oral azithromycin was administered in a 500mg dose on

the first day followed by 250 mg daily on days 2 to 5

( in children and pregnant women)

Prophylaxis doxycycline 200 mg every week keep 3-4 weeks wearing long-sleeve clothes and trousers bootleg use insect repellent

Prognosis treatment-mortality less than 5

第四類法定傳染病一週內通報

Scrub typhus prevention Personal prevention

bull wearing long-sleeve clothes and trousers

bootleg while in adventure travel

bull use insect repellent Diethyltoluamide

(DEET) for prevention mite bite

bull After leaving an endemic area take a bath

and wear the clean dress

Environment improve

grass cutting nearby a residence house for decreasing the possibility of mite contact

Deratization- decresae the numbers of mites

httpwwwcdcgovtw

Patient profile amp

Chief complaint

bull Age58 yo female

bull Occupation housewife

bull Residence 高雄縣大寮鄉

bull Admission date 941114 via ER

bull CC sudden onset fever up to 392

degrees on and off for 2-3 days

Present illness

bull This 58 female a case with

hypertension with diet and activity

control without other major systemic

diseases

bull About 7 days ago she came back from

澎湖娘家 and then felt general malaise

headache since last W2(118)

Present illness

bull Due persistent symptoms she went

LMD for help and medications was

prescibed on last W6(1112) for

tonsillitis

bull However after LMD visit fever on and

off was noted for 2-3 days and chillness

dizziness sore throat persisted

Present illness

bull she came to our ER for help

bull Other associated symptomssigns

- Fever(+) chillness(+) general malaise(+) headache(+) myalgia(-) arthralgia(-) retro-orbital pain(-) night sweating(-) rash(-)

- Neck stiffness(-) conscious change(-) facial muscle weakness(-) photophobia(-) seizure(-) limb weakness(-)

- Sorethroat(+) cough(-) rhinorrhea(-)dyspnea(-)

- Abdominal pain(-) diarrhea(-) nauseavomiting(-)

- Painful urination(+) low back soreness(+) frequency(-) urgency(-)

Physical examination

bull Consciousness alert oriented

bull Vital signs BT 378 BP 13080 PR 84

RR 20

bull HEENT

Sclera mildly pink but not icteric

Oral cavity swelling of injected bil

Tonsils discharge(-)


bull Neck

-Lymphadenopathy (+) over left side of neck 2 lymph nodes size 1x1 cm tenderness(-) movable

-Jugular vein engorgement(-)

-Kernigrsquos sign(-) Brudzinskirsquos sign(-)

Chest

-Heart sound regular heart beat no murmur no S3S4 normal S1S2

-Breath sound bil clear No crackles No wheezing


bull Abdomen

-Soft flat tenderness(-) Murphyrsquos sign(-)

-Liverspleen impalpable

-RUQ knocking pain(+)

-Rrsquot flank knocking(+)

-Normoactive bowel sound


bull Extremities

-Lower legs pitting edema(-)

bull Skin

-Erythematous maculopapules(+) over lower abdomen itching(-) pain(-)

-Black-central scared wound (+) with erythematous base over rrsquot inguinal area itching(-) pain(-) discharge(-) Eschar

Clinical impresison

bull Fever

Acute tonsillitis

(sore throat swelling tonsils)

susp APN rrsquot

( kocking pain)

susp Viral infections

Reckettsia infection (scrub typhus)

Dengue fever

( hx eschar regional lymphadenopathy rash)

susp Liver disease

( RUQ knocking pain)

Plans

bull General survey CBCDC CRP electrolytes liver function renal function coagulation profile GOTGPT bilirubin AC sugar

bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo

bull Chest X-ray 12-lead EKG

bull Well-Felix test LDH

bull IFA PCR

bull Antibiotics Cefazolin 1g IV q8h

Doxycyclin 100mg bid

Laboratory surveys CBC 1114 ER 1116 1118

WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64

Laboratory surveys Urine 1114 ER Urine 1114

GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2

SG =lt1005 Crystal -

OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal

Laboratory surveys Blood

chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo

Finding Liver cyst at S2 single lt5 cm

Splenomegaly(-) hepatic parenchyma change(-)

normal kidney size parenchyma hydronephrosis(-)

Tentative Diagnosis

bull Atypical infection suspect scrub typhus

(thrombocytopenia normal or low WBC impaired liver function eschar relative bradycardia rash lymphadenopathy travel history)

Differentials Dengue fever typhoid fever leptospirosis other viral infections

bull Acute tonsillitis

Cefazolin and Doxycyclin use

Watch out CNS pulmonary renal complications

Dx Confirmation

Progression

bull Fever(+) but decreased gradually under

treatment with Cefazolin and Doxycyclin

bull No complications occurred during

admission

bull Fever subsides on 1119 (day 6) and

due to stable condition MBD arranged

with OPD FU and oral antibiotics

prescribed

bull Her husband

Fever with headache without obvious focus

1Endemic areasouth-east asia

2headachemuscle painjoint painretrobulbar painback painrash

3Laboratory

WBC＜5000ul or normal

PLT＜100000ul

GOTGPT elevation and GOT ＞ GPT

aPTT prologationPT normal

initial 3 days Segment elevation

the 4th ~6th day after infected

monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items

compatible but not very

likely

Inform

CDC

May inform

CDC

DD Dengue fever and Rickettsial diseases

Relative bradycardia No Yes

Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

登革熱通報定義

bull 突發發燒≧38且伴隨下列二（含）種以上症狀

1 頭痛

2 後眼窩痛

3 肌肉痛

4 關節痛

5 出疹

6 出血性癥候（hemorrhagic manifestations）

7 白血球減少（leukopenia）

3

屈公病通報定義

bull 臨床條件ndash 急性發燒≧38degC 且有嚴重關節炎或關節痛無法以其他醫學診斷解釋者

bull 流行病學條件 (具有下列任一個條件)ndash （一）住家或活動範圍附近有屈公病確定病例或有與屈公病確定病例接觸史

ndash （二）有屈公病流行地區相關旅遊史

bull 通報定義ndash 符合臨床條件及流行病學條件

4


6


7

8








ndash Bleeding




10

11

整體評估

bull 鑑別診斷







12


13


類似快篩

14




15








16







17

Case studies

18

Case 1

bull 76歲女性







19

Case 2


bull 主述





20

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


6


7

8








ndash Bleeding




10

11

整體評估

bull 鑑別診斷







12


13


類似快篩

14




15








16







17

Case studies

18

Case 1

bull 76歲女性







19

Case 2


bull 主述





20

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

7

8








ndash Bleeding




10

11

整體評估

bull 鑑別診斷







12


13


類似快篩

14




15








16







17

Case studies

18

Case 1

bull 76歲女性







19

Case 2


bull 主述





20

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus








ndash Bleeding




10

11

整體評估

bull 鑑別診斷







12


13


類似快篩

14




15








16







17

Case studies

18

Case 1

bull 76歲女性







19

Case 2


bull 主述





20

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

11

整體評估

bull 鑑別診斷







12


13


類似快篩

14




15








16







17

Case studies

18

Case 1

bull 76歲女性







19

Case 2


bull 主述





20

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


13


類似快篩

14




15








16







17

Case studies

18

Case 1

bull 76歲女性







19

Case 2


bull 主述





20

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




15








16







17

Case studies

18

Case 1

bull 76歲女性







19

Case 2


bull 主述





20

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus







17

Case studies

18

Case 1

bull 76歲女性







19

Case 2


bull 主述





20

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Case 1

bull 76歲女性







19

Case 2


bull 主述





20

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

bull At ER (D1)

ndash TPR=3829720 BP=11055



bull Admission




21


Case 3




22








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus








23

24

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Case 4





25

Revisit ER next day





26

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

27

Case 5



ndash TPR=3611020 BP=10050



28




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




29

Lesson learnt






30

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

31

Take Home Message







32

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

謝謝聆聽

敬請指教

33

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

20140510

2013-2-21 OO

OO OO

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Outline

90



1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

1945 120 600 1946 DDT 1965 WHO 1972 1995

2003

1965-2013

0

10

20

30

40

50

60

70

80

90

100

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013

1965

1974

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

2009-2013

2009 2010 2011 2012 2013 6 15 9 8 7 45

2 3 2 7 2 4 6 1 3 2 6 1 1 2 4

2 2 1 1 2

1 1 1 1

11 21 17 12 13 74

2009-2013 2009 2010 2011 2012 2013

2 5 3 1 11 1 2 2 2 3 10 1 4 1 1 7

2 1 1 1 1 6 1 1 3 1 6 1 1 1 1 4 1 1 1 3

1 1 1 3 3 3


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


()


2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

2009-2013

+

2009 2010 2011 2012 2013

4 10 12 6 7 39 (52)

1 4 0 5 2 12 (17)

6 7 5 1 4 23 (31)

11 21 17 12 13 74

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

5-6 8 9 13

48 48 49-50 72

12 13-17 13-17 28-30

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

420 40

(Anopheles minimus)

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

7-30 2 3

( 6 10 )

(15 1 )

(2 6 ) (2 4 )

1

2 3

4

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

( )

11

Severe malaria

10

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Disconjugate gaze



A B C


A

C

B


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


Gold Standard

10-15 100

PCR

5

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

4-6

( )

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

2010

hydroxychloroquine


WHO






)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




)

24



Quinine artemisinin




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




Artemisinin







subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




subregion


48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

48 25

(recrudescence) ( )

(wwwcdcgovtw)


Malarone 100

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

NEJM 2008359 603-612

2010







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus







( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

( 30-50 DEET)

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

29

2010222-223 223-226 227

315

318

PCR ( + )

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

38 93

66

2008823-1015 2008915-1030

20081015 1031

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

49

2008117-128

2008417

619 1121


2009123 P vivax

- 56 yo

2009 3

Mefloquine

hydroxychloroquine


46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

46 201045-418



-





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus





張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




張科





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus





Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Year Incident


















1985-86 and

1987








日本腦炎




而傳染


疫苗




日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

日本腦炎

bull All world







0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12

male

female

Male 239 cases

Female153 cases

台北區合計

55

北區合計 34

中區合計 91

南區合計 89

高屏區合計

80

東區合計 43



httpwwwcdcgovtw

0

10

20

30

40

50

60

70

80

90

100

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

2012年5月



疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

疫情調查




臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus



臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

臨床症狀








孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus



孳生於

ndash 水稻田

ndash 灌溉溝渠


ndash 牛足印

ndash 水泥槽

ndash 池塘

ndash 溪流

ndash 濕地

ndash 人工容器

bull 白頭家蚊

孳生於

ndash 濕地

ndash 溪流



bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


bull 潛伏期

ndash 5 ~ 15天

bull 可傳染期






病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

病例定義

bull 臨床病例



實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

實驗室診斷





疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

疾病分類



bull 確定病例



bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


bull 疾病分類


bull 通報定義




bull 通報期限






實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus





實驗室檢查


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


bull 23 male


bull irritable mood

bull CSF Glu60

TP 32

Lactate11

Appearclear

cell count0

PMNMN0

VDRL(-)

Cryptococcus (-)

HSV IgM(-)

blood Glu85

Lactate18

IgG1240


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


Illness





Present Illness










free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




free activity

Rrsquot

Lrsquot

upper limbs

proximal

5 4

distal 5 4+

lower limbs

proximal

5 2

distal 5 3-4

Muscle Power

DTR(0-

+ + + +)

Rrsquot Lrsquot


Triceps + + + +


Knee jerk + + -

Ankle jerk + + + +



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus



bull MP

ndash R L

ndash 5 5

ndash 5 2

ndash 5 4-

bull DTR

bull R L

bull 2 2

bull 2 2

bull EPS

bull Rigidity (-)



bull DD




bull Myopathy


bull Plan

bull GOTGPT

bull CK lactate

bull T3T4 TSH

bull influenza

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Admitted on 1011

1011





Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Clinical Course

1012





bull Focal seizure


Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Clinical Course

1013

Course




Lab


bull PMNMN = 8614 [298~595]

bull TP = 019 gdl [660~852]



Medication



1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

1017-1024 at KMUH






1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

1030





治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

治療及預後

bull 治療方式




bull 併發症



bull 語言障礙



bull 脾氣暴躁


bull 智力不足




bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus



bull病媒蚊防治





bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


bull 接種對象



bull 接種時程


bull 禁忌

ndash 發高燒



bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


bull 保護力


bull 副作用

ndash 局部

紅腫腫脹疼痛

ndash 全身











vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus









vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus





vasculitis



















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


















Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus











Pacific Islands

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Host





infection


the major host








httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus







httpwwwcdcgovtw

Transmission method



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus



北區合計 230

中區合計 640

南區合計 216



合計 5480

0

200

400

600

800

1000

1200

lt14 15-19 20-29 30-39 40-49 50-59 60-69 gt70

female

male

male

female

male3515 cases

Female1915 cases

0

100

200

300

400

500

600

700

800

900

1000

1 2 3 4 5 6 7 8 9 10 11 12


httpwwwcdcgovtw




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




Epidemioloy



KandaKawasaki


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


lymphadenopathy










httpwwwcdcgovtw



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus



REPORTED IN 1998






















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus















and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus








and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




and IgG Ab ≧1320





Proteus spp OX-K



























Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus





















Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus








Environment improve



httpwwwcdcgovtw

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Patient profile amp

Chief complaint







Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Present illness




diseases




Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Present illness




tonsillitis




Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Present illness











RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




RR 20

bull HEENT





bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


bull Neck




Chest




bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


bull Abdomen







bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


bull Extremities


bull Skin



Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Clinical impresison

bull Fever

Acute tonsillitis


susp APN rrsquot

( kocking pain)



Dengue fever


susp Liver disease


Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Plans


bull HBsAg anti-HCV

bull Urine routine

bull Abdominal echo



bull IFA PCR




WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


WBC x1000ul 403 467 699

RBC x10^6ul 409 388 392

HGB gdl 117 112 106

HCT 345 326 329

MCV fl 848 84 839

PLT x1000ul 94 105 182

SEGEMENT BAND

282

LYMPH 1794 44

EOSIN 024 1

MONO 5

BASO 074

RDW-CV

RDW-SD fl

CRP ugml 64


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


GLU - RBC HPF 2-5

BIL - WBC HPF 0-2

KET - Epith HPF 0-2


OB + Cast -

PH 70

PRO -

URO 01

NIT -

WBC -

Color YellowClear

normal


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus


chemistry

1114 ER 1115 1116

T-BIL mgdl 047

D-BIL mgdl 013

GOT IUL 56

GPT IUL 46

PRO mgdl 602

ALB mgdl 328

GGT UL 23

ALK-P IUL 145

LDH 1207

Cholestreol 147

TG 185

PT p second 119

PT c second 108

PT(INR) 107

PTT P 357

PTT C 282

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Laboratory surveys

1114 ER 1118

BUN mgdl 58

CREA mgdl 076

NA m molL 129 133

K m molL 41 38

Sugar(AC) mgdl 108

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Abdominal echo




Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Tentative Diagnosis







Dx Confirmation

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Progression




admission




prescribed

bull Her husband




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus




3Laboratory


PLT＜100000ul





monocytosis

Endemic + 2 kind

clinical symptoms +

laboratory

One or two items


likely

Inform

CDC

May inform

CDC



Eschar

Yes No

mountains

Climbing

Taitung or

Hualien

travel

history

suspect

Q fever

suspect

Murine typhus

WBC＜5000ul

or normal

PLT lower

GOTGPT

elevated and GOT

lt GPT

aPTT

prolongation

PT normal

Animal contact

Anticardiolipin Ab

elevation

WBC＜5000ul or

normal

PLT lower

GOTGPT

elevated andor

GOT gt GPT

aPTT

prolongation

PT abnormal

OX 19 (+)

suspect scrub

typhus

Documents

登革熱 登革出血熱，屈公病 診斷與治療 - CDC · 2019-01-29 · – Plan: 轉內科並且安排腹超 • 內科醫師問診at 16:30 – fever onset on 8/19 (D1), also

登革熱登革出血熱，屈公病診斷與治療 - CDC · 2019-01-29 · – Plan: 轉內科並且安排腹超 • 內科醫師問診at 16:30 – fever onset on 8/19 (D1), also