上海熱──社區型感染綠膿桿菌腸炎併敗血症

Shanghai Fever Community Acquired Pseudomonas aeruginosa Enteritis and Sepsis

社區型感染綠膿桿菌腸炎併敗血症，起初俗稱為「上海熱」，在東南亞以及世界各地陸續報導，嬰幼兒是最常報告的族群，這群嬰幼兒通常沒有潛在疾病。剛開始表現可能不具特異性，如發燒、嘔吐、腹瀉、活動力低下等，若沒有早期治療，病情會很快進展到敗血症、壞死性腸炎、與壞死性膿瘡，處置不當會有相當高的併發症與致死率。因此在一歲以下嬰幼兒敗血症，合併有腹瀉、皮膚膿皰、白血球低下，需要先經驗性使用抗綠膿桿菌抗生素，積極輸液、升壓劑治療，並注意可能的腸壞死、腸穿孔、皮膚壞死等併發症，及早手術介入，才能提升存活率。雖然大部份病患沒有發現潛在疾病，不過檢驗可能的中性球低下、免疫球蛋白低下原因仍有其必要性。未來若能找出更多危險因子與可能的感染源，將有助進一步改善治療的成效。

Community-acquired Pseudomonas aeruginosa enteritis and sepsis, originally called as ''Shanghai fever,'' has been reported in Southeast Asia and worldwide. Infants are the most frequently reported group, and they usually do not have any underlying diseases. Initially, the symptoms may be nonspecific, such as fever, vomiting, diarrhea, and decreased activity. If not treated early, the condition quickly deteriorates to septicemia, necrotizing enteritis, and ecthyma gangrenosum. Improper treatment can lead to significant complications and high mortality rates. Thus, in infants under the age of one year with septicemia accompanied by diarrhea, pustules, and leukopenia, the empirical use of anti-Pseudomonas antibiotics, aggressive fluid resuscitation, inotropic agent administration, and attention to possible complications, such as intestinal necrosis, intestinal perforation, and skin necrosis, are necessary. Early surgical intervention is necessary to improve patient survival rates. Although most patients do not have underlying diseases, it is necessary to examine the possible etiologies of neutropenia and hypogammaglobulinemia. In the future, the identification of additional risk factors and possible sources of infection will help further improve the effectiveness of treatment.