初期以急性腸胃炎表現的嗜伊紅性腦膜腦炎：一個案報告

Eosinophilic Meningoencephalitis Mimicking Acute Gastroenteritis in the Early Stage

嗜伊紅性腦炎可由多種不同的微生物引發，在東南亞及太平洋區域廣東住血線蟲是引起嗜伊紅性腦炎最常見的原因。人們可因為食入被感染的中間宿主（如未煮熟的軟體動物）而被感染，在嬰兒及孩童最常表現的臨床症狀為發燒、嘔吐、頭痛、食慾減少、頸部僵硬、四肢無力、躁動、感覺異常、抽搐及意識改變，有時只以腹痛、腹瀉及噁心表現，尤其是在疾病初期的時候，臨床醫師可能輕忽而以急性腸胃炎來處理而延誤疾病的診斷及治療。因此任何由東南亞返回的個案若診斷為急性腸胃炎的均需檢測血中的嗜伊紅性球及詳細詢問旅遊及是否曾食入未經煮熟的食物，當病人可能接觸到污染的食物或飲水時，醫師必需依據旅遊及飲食史做出進一步診斷。

Eosinophilic meningoencephalitis (EME) can be caused by a variety of microorganisms. In South East Asian and Pacific regions, Angiostrongylus cantonensis (A. cantonensis) is the most common cause of EME. People can be infected by ingestion of an infected intermediate host, such as raw mollusks. The most common clinical presentation in infants and young children are fever, vomiting, headache, anorexia, neck stiffness, weakness of extremities, irritability, paresthesia, convulsion, and consciousness change. Sometimes only abdominal pain, diarrhea, and nausea are present, especially in the early stage of the disease. The clinical doctor may consider easily and treat the patient as acute gastroenteritis and may delay the diagnosis and treatment with the disease. Travel and diet history should be taken before a doctor acknowledged that the patient had suspicious contact to contaminated food or water. If the patient with acute gastroenteritis has come back from Southeast Asia or has eaten raw or semicooked food contaminated by snails, their peripheral blood eosinophils should be checked.