< Report of a Case>
¡@¡@A 77-year-old male patient, with a 10-year history of diabetes mellitus, was admitted because of acute onset of fever, chills, diarrhea and non-productive cough after returning from a cruise tour 4 days later. He was admitted to the emergency service at this hospital because of altered mental status. At the emergency service, the temperature was 39.5°C, the blood pressure 116/58 mmHg, the pulse rate 128 beats per minute, and the respiration rate 36 breaths per minute. Chest auscultation revealed crackles at the right upper and left lower lung fields. There were no lymphadenopathies, skin rashes, throat exudates, cardiac murmurs, peritoneal signs or legs edema. Neurological examination revealed that he was poorly oriented to persons, place, and time. There was no neck stiffness, meningeal signs, or focal neurological signs. The tendon reflex was normal. Lumbar puncture was performed and the results did not show pleocytosis. He was admitted to the intensive care unit for acute respiratory distress and confusion status. Endotracheal intubation was performed.
¡@¡@His family reported that the diabetes mellitus had been well controlled with diet and metformin. He was a retired senior high school teacher and had a habit of smoking for several decades. There was no history of recent operation, hospitalization, animal contact or family clustering of similar cases.
The results of laboratory studies were as follows.
1. CBC and differential count:
WBC
/£gl |
RBC
M/£gl |
Hb
g/dl |
Plt
K/£gl |
Hct
% |
MCV
fL |
Band
% |
Neutro
% |
Baso
% |
Eos
% |
Mon
% |
Lym
% |
17300 |
4.07 |
15.4 |
178 |
41.4 |
89.4 |
6 |
78 |
1 |
2 |
3 |
10 |
2. Biochemistry:
A/G
g/dl |
ALP
U/L |
AST
U/L |
ALT
U/L |
r-GT
U/L |
BUN
mg/dL |
Cre
mg/dL |
Na
mmol/L |
K
mmol/L |
Cl
mmol/L |
3.7/3.4 |
225 |
87 |
124 |
45 |
54.8 |
1.73 |
125 |
4.3 |
102 |
Ca
mmol/L |
P
mmol/L |
Mg
mmol/L |
Glu
mg/dL |
LDH
U/L |
TG
mg/dL |
T-CHO
mg/dL |
UA
mg/dL |
BilT/D mg/dL |
2.02 |
3.5 |
0.94 |
139 |
463 |
174 |
223 |
7.6 |
1.4/0.8 |
3. ABG (non-rebreather mask, FiO2 100%)
pH |
PCO2
(mmHg) |
PO2
(mmHg) |
HCO3-
(mEq/L) |
B.E
(mEq/L) |
7.41 |
18 |
72.9 |
11.3 |
-11.0 |
4. Sputum routine
Microscopy of an expectorated sputum specimen disclosed PMNs, 50-75/low power fields (LPF), few epithelial cells (<10/LPF), and no pathogens by Gram's stain.
5. CSF study
Open Pressure
(mmH2O) |
WBC |
Lymphocyte |
Neutrophil |
Glucose
(mg/dL) |
Protein
(mg/dL) |
101 |
4 |
4 |
0 |
58 |
40 |
6. Chest X ray
CXR revealed alveolar infiltrates in the left lower and right upper lobes.
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< °Ñ¦Ò¸ê®Æ >
- ½Ã¥Í¸p¯e¯fºÞ¨î§½¡G¶Ç¬V¯f¤¶²Ð - °h¥îx¤H¯g¡Chttp://www.cdc.gov.tw/professional/disease.aspx?treeid=beac9c103df952c4&nowtreeid=6b7f57aafde15f54. (accessed on July 31, 2012)
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