中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2008年
1期
22-25
,共4页
吴莉%张贤华%陈豪%印学蕾
吳莉%張賢華%陳豪%印學蕾
오리%장현화%진호%인학뢰
李斯特菌感染%李斯特菌,单核细胞增生%败血病%婴儿,新生
李斯特菌感染%李斯特菌,單覈細胞增生%敗血病%嬰兒,新生
리사특균감염%리사특균,단핵세포증생%패혈병%영인,신생
Listeria infections%Listeria monocytogenes%Septicemia%Infant,newborn
目的 分析6例由血培养证实的新生儿李斯特菌病临床特征、治疗方法与转归,提高临床对本病的识别.方法 调查2004年1月1日至2006年6月30日我院分娩活产婴儿12 538例,其中6例检出李斯特菌.比较此6例中的早产儿与足月儿在发病时间、临床表现、病情严重程度、实验室指标变化、治疗措施、预后的差异.结果 李斯特菌病检出率为4.8%.6例均为早发型感染,由母亲孕期宫内感染所致.3例早产儿生后即有败血症多样临床表现,反应低下,肤色苍灰,呼吸窘迫,肝脏增大,皮疹,四肢肌张力低下;实验室指标明显异常,WBC(21.6～33.8×109)/L,N0.77～0.83;PLT(102～59×109)/L;CRP＞(160～118)mg/L.3例早产儿合并有肺部病变,需机械通气辅助呼吸,死亡1例,痊愈2例.3例足月儿发病时间较晚,分别在生后62、63、165h,仅表现为发热,精神反应欠活跃;实验室指标轻度异常,WBC(4.8～40.7×109)/L,N 0.72～0.80;PLT(202～192×109)/L;CRP(22～33)mg/L.治疗后痊愈.确诊必须依赖于细菌培养.氨苄青霉素或青霉素治疗有效.结论 我国存在成人李斯特菌病散发病例,并导致母婴传播的发生.早期发现和检测,针对性选择敏感抗生素治疗可有效降低死亡率.对孕妇进行食品安全性宣传教育,避免孕期感染,是防止新生儿李斯特菌病的重要措施.
目的 分析6例由血培養證實的新生兒李斯特菌病臨床特徵、治療方法與轉歸,提高臨床對本病的識彆.方法 調查2004年1月1日至2006年6月30日我院分娩活產嬰兒12 538例,其中6例檢齣李斯特菌.比較此6例中的早產兒與足月兒在髮病時間、臨床錶現、病情嚴重程度、實驗室指標變化、治療措施、預後的差異.結果 李斯特菌病檢齣率為4.8%.6例均為早髮型感染,由母親孕期宮內感染所緻.3例早產兒生後即有敗血癥多樣臨床錶現,反應低下,膚色蒼灰,呼吸窘迫,肝髒增大,皮疹,四肢肌張力低下;實驗室指標明顯異常,WBC(21.6～33.8×109)/L,N0.77～0.83;PLT(102～59×109)/L;CRP＞(160～118)mg/L.3例早產兒閤併有肺部病變,需機械通氣輔助呼吸,死亡1例,痊愈2例.3例足月兒髮病時間較晚,分彆在生後62、63、165h,僅錶現為髮熱,精神反應欠活躍;實驗室指標輕度異常,WBC(4.8～40.7×109)/L,N 0.72～0.80;PLT(202～192×109)/L;CRP(22～33)mg/L.治療後痊愈.確診必鬚依賴于細菌培養.氨芐青黴素或青黴素治療有效.結論 我國存在成人李斯特菌病散髮病例,併導緻母嬰傳播的髮生.早期髮現和檢測,針對性選擇敏感抗生素治療可有效降低死亡率.對孕婦進行食品安全性宣傳教育,避免孕期感染,是防止新生兒李斯特菌病的重要措施.
목적 분석6례유혈배양증실적신생인리사특균병림상특정、치료방법여전귀,제고림상대본병적식별.방법 조사2004년1월1일지2006년6월30일아원분면활산영인12 538례,기중6례검출리사특균.비교차6례중적조산인여족월인재발병시간、림상표현、병정엄중정도、실험실지표변화、치료조시、예후적차이.결과 리사특균병검출솔위4.8%.6례균위조발형감염,유모친잉기궁내감염소치.3례조산인생후즉유패혈증다양림상표현,반응저하,부색창회,호흡군박,간장증대,피진,사지기장력저하;실험실지표명현이상,WBC(21.6～33.8×109)/L,N0.77～0.83;PLT(102～59×109)/L;CRP＞(160～118)mg/L.3례조산인합병유폐부병변,수궤계통기보조호흡,사망1례,전유2례.3례족월인발병시간교만,분별재생후62、63、165h,부표현위발열,정신반응흠활약;실험실지표경도이상,WBC(4.8～40.7×109)/L,N 0.72～0.80;PLT(202～192×109)/L;CRP(22～33)mg/L.치료후전유.학진필수의뢰우세균배양.안변청매소혹청매소치료유효.결론 아국존재성인리사특균병산발병례,병도치모영전파적발생.조기발현화검측,침대성선택민감항생소치료가유효강저사망솔.대잉부진행식품안전성선전교육,피면잉기감염,시방지신생인리사특균병적중요조시.
Objective Neonatal listeriosis is a relatively rare but serious disease with a high mortality rate.This study was conducted to analyze the clinical features.treatment.and outcome of 6 cases with Listeria monocytogenes septicemia confirmed by positive blood cultures.Methods Totally 12 538 live births delivered in the hospital from January 1,2004 to June 30.2006 were investigated.Differences in the time of onset of the disease,clinical presentation,illness severity,laboratory data,management,and prognosis were compared between preterm and full-term infants.Results The incidence of neonatal listeriosis was 4.8%in this study.All the cases with listeriosis were found to have early onset and the disease was transmitted from the mother to the fetus.4 of the cases were delivered via cesarean section,2were born via normal spontaneous vaginal delivery.Maternal infection before parturition presented with fever in 4,diarrhea in 1;5 had abnormal white blood cell counts and total neutrophil counts:1 had positive result of Listeria monocytogenes in intrauterine contents culture.Three premature infants showed signs and symptoms of severe bacterial septicemia at birth,such as reduced activity,respiratory distress,poor skin color and poor peripheral perfusion;the enlarged liver was palpable 2-3 cm below the right costal margin and 5 cm below the xiphoid in one;congestive rashes over the body and muscular hypotonia.Abnormal results of laboratorv tests included peripheral blood white cell count(21.6-33.8×109)/L,total neutrophil count 0.77-0.83;platelet count(102-59×109)/L;C-reactive protein(CRP)＞(160-118)mg/L(24-72 h after birth).Three preterm infants who received intensive care,accompanied by pathological changes of lungs indicated by chest X ray required assisted mechanical ventilation and 2 of them survived without sequelae but the other one died at 51 h of life.The initial clinical signs of septicemia in 3 full-term infants appeared later than preterm newborn within 62 h.63 h and 165 h.respectively after birth.They only had fever,T 38-39℃.with lower activity in contrast to normal newborn and without other signs and symptoms of septicemia.Accurate diagnosis of listeriosis was established by positive bacterial blood cultures.Intravenous treatment of neonatal listeriosis with ampicillin or penicillins for 1-2 weeks was more effective.but cephalosporins were not effective.Conclusions There are sporadic cases with Listeria monocytogenes infection among pregnant women in this country.resulting in severe illness of their newborn infants.Early differential diagnosis.earlydetection of causative organisms.especially in newborn infants infected with Listeria monocytogenes,early treatment with sensitive antibiotics can decrease the mortality rate and improve neonatal outcome. It is necessary to enhace nationwide surveillance for listeriosis.
