你我不可不知的傳染病——類鼻疽之治療與預防照護

Knowledge of Melioidosis for You and Me—Treatment and Prevention with Care

類鼻疽是一種由Burkholderia pseudomallei引起的嚴重細菌感染，主要在熱帶和亞熱帶地區流行。其臨床症狀多樣性，包含肺炎、皮膚膿瘡、關節疼痛等，嚴重時可導致敗血症和多器官衰竭。診斷類鼻疽需要結合病史、臨床表現以及實驗室檢查，如血液、痰液、尿液、傷口培養和聚合酶連鎖反應檢測等，影像學檢查如胸部X光、超音波及電腦斷層檢查等，則有助於確認感染的範圍和性質。類鼻疽的治療分為急性期和維持期，急性期通常使用強效抗生素如頭孢他啶（ceftazidime）或美羅培南（meropenem），治療時間為10至14天或更長時間，急性治療後的維持期，則由靜脈輸液改為口服抗生素，如磺胺類藥物（trimethoprim-sulfamethoxazole）、四環黴素（doxycycline），並持續20週以上以防止復發。此外，對重症患者提供支持性照護，如監測生命徵象、補充輸液和營養支持也是必要措施。
類鼻疽在台灣並非常見的傳染病，但數據顯示會有週期性或於颱風之後，產生為數不少的類鼻疽案例爆發甚至造成死亡案例發生，對於臨床醫護人員更值得需要注意並早期診斷早期投藥，以減少重症及死亡風險發生，故冀望本文能夠提供給第一線人員最新國內外文獻彙整之照護參考。

Melioidosis is a severe bacterial infection caused by Burkholderia pseudomallei, which is primarily endemic to tropical and subtropical regions. The clinical manifestations of melioidosis are diverse, including pneumonia, skin abscesses, and joint pain, with severe cases leading to sepsis and multiple organ failure. Diagnosis requires a comprehensive approach integrating patient history, clinical presentation, and laboratory investigations, including blood, sputum, urine, wound cultures, and polymerase chain reaction testing. Imaging modalities, such as chest radiography, ultrasound, and computed tomography, are instrumental in determining the extent and nature of the infection.
Melioidosis treatment consists of an intensive phase followed by a maintenance phase. The intensive phase typically involves the administration of potent intravenous antibiotics, such as ceftazidime or meropenem, for 10–14 days or longer, depending on the severity of the infection. Following the intensive phase, the maintenance phase consists of oral antibiotic therapy, including trimethoprim-sulfamethoxazole and doxycycline, for at least 20 weeks to prevent relapse. In critically ill patients, supportive care, such as monitoring vital signs, fluid resuscitation, and nutritional support, is essential for improving outcomes.
Although melioidosis is not a common infectious disease in Taiwan, epidemiological data indicate periodic outbreaks, particularly after typhoons, that sometimes result in significant morbidity and mortality. This underscores the importance of early recognition and prompt antibiotic administration by healthcare professionals to reduce the risk of severe complications and fatalities. This article aims to provide frontline healthcare providers with an updated synthesis of domestic and international literature to support clinical decision-making and patient care.