객혈 없이 성인형 호흡 곤란 증후군을 동반한 렙토스피라증
Pulmonary Leptospirosis complicated by Acute Respiratory Distress Syndrome without Hemoptysis
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초록
국내에서 렙토스피라증은 쯔쯔가무시병, 신증후군 출혈열과 함께 여전히 가을철에 유행하는 대표적인 감염성 질환이며 최근 다시 증가 추세를 보이고 있다. 국내에서 발생되는 렙토스피라증은 외국의 경우와 달리 황달 없이 기침, 객혈등 호흡기 증상을 동반하는 경우가 흔하며 드물게 급성 호흡 부전증으로 치명적일 수도 있다. 가을철 발열성 감염 질환이 유행하는 시기에 고열, 두통, 의식 장애 등의 전신 증상과 함께 급성 호흡 곤란 증후군이 관찰될 경우 렙토스피라증의 감별진단이 필요하다.
Abstract
Leptospirosis is an acute febrile illness that is endemic in many tropical areas and considered the most common zoonosis worldwide. It is caused by the spirochete Leptospira interrogans. The clinical manifestations may be extremely variable, ranging from flu-like symptoms with mild constitutional complains like fever, headache, myalgias, and gastrointestinal complaints to a severe presentation with the complete Weil's syndrome and sometimes with acute respiratory distress syndrome (ARDS). In Korea, the more common clinical finding is pulmonary manifestation such as cough, hemoptysis and dyspnea. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary hemorrhage and/or acute respiratory distress syndrome (ARDS). A 67-year-old farmer was referred to the hospital with a history of fever, dyspnea, and confusion. She was found to have severe arterial hypoxemia but, denied blood-tinged sputum. Radiography showed widespread infiltrations over both lung fields, and hemodynamic features were consistent with ARDS. The patient recovered completely without mechanical ventilation.
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