Multiple organ failure! The culprit turned out to be... The man had a rash all over his body and kidneys overnight | Mr. Li | The man
In the scorching summer, outdoor camping is often the first choice for holiday travel, but while enjoying outdoor fun, we must not ignore the hidden crises in nature. Recently, 49 year old Mr. Li, who had just returned from a trip to Shanghai, was admitted to the Emergency Department (EICU) of Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine due to being bitten by ticks in the wild.
In early May, Mr. Li went on a trip to another city. However, shortly after returning to Shanghai, he began to have a fever, reaching up to 39 ℃. After taking cold medicine on his own, Mr. Li's body temperature did not decrease and he became increasingly lethargic. What's even more terrifying is that, as if overnight, Mr. Li's body was covered in red papules, painless and not itchy, densely distributed in the corners of his body, with a terrifying appearance. His family quickly took him to Ruijin Hospital.
Preliminary assessment of the condition revealed that Mr. Li had high fever, chest tightness and asthma, as well as acute heart failure and acute renal insufficiency. More seriously, he was also accompanied by thrombocytopenia and coagulation dysfunction. The chief physician of the emergency department, Che, and Zheng Yanjun, considered his condition to be critical and critical, and urgently arranged for him to enter the intensive care unit for treatment.
After being admitted to the emergency intensive care unit, Zhao Bing, the deputy chief physician of the emergency department, suspected that Mr. Li had an atypical bacterial infection. While maintaining organ function and empirical anti infection measures, he urgently underwent pathogen identification. A day later, high-throughput sequencing results showed that Mr. Li had detected Japanese rickettsia in his blood.
"Japanese Rickettsia, also known as Tsutsugamushi disease Rickettsia, was first reported in Japan in 1983. The disease can be transmitted through the vectors of chigger mites and ticks or through contact with their feces. Clinical manifestations include fever and rash, with most patients having a good prognosis. However, a few patients may develop complications such as pneumonia, myocarditis, heart failure, meningoencephalitis, and septic shock due to endothelial damage and coagulation dysfunction. If not treated in time, it can lead to death," said Mao Enqiang, director of the emergency department.
Due to the severe damage to Mr. Li's heart and kidney function caused by this infection, Zhao Bing has carried out refined organ function maintenance and supportive treatment. During his hospitalization, Mr. Li underwent two rounds of bedside hemodialysis treatment. Later, due to multiple episodes of shortness of breath and decreased oxygen saturation caused by bilateral pleural effusion, timely thoracic puncture drainage and catheterization were performed to alleviate the symptoms. Finally, after more than 20 days of symptomatic treatment, Mr. Li's coagulation function, heart, kidney and other functional indicators, as well as infection indicators, all improved significantly in mid June. After the rash subsided, he was soon discharged from the hospital.
Summer is a great time for the public to travel and also a carnival for the "little bugs". Sheng Huiqiu, the deputy director of the emergency department, reminds that when avoiding summer in the suburbs, one should avoid sitting or lying down in the jungle or bushes to rest; It is best to close the screen window when going to bed to prevent wild insects from entering the room; When going out to play, it is best to choose to wear long sleeved pants. When entering areas with dense vegetation, the cuffs should be tightly tied to reduce skin exposure, especially for children; Prepare insect repellent when traveling, and spray on exposed areas before going out to reduce pest infestation; After returning home, one should change clothes and take a shower in a timely manner, with a focus on hidden areas such as armpits, back, and neck. "If unfortunately bitten by poisonous insects, it is necessary to closely observe whether there are blisters caused by infection in the local area, and whether there is high fever after being bitten. Once relevant situations occur, timely medical attention should be sought, and one must not be complacent."