CAJ | 학술논문

目的介绍合并肺炎的4例地方性斑疹伤寒患儿的临床表现、治疗经过及预后.方法首都医科大学附属北京儿童医院2011年10月至2012年3月住院的4例合并肺炎的地方性斑疹伤寒患儿,年龄1岁3个月～7岁3个月,其中3例为农村患儿,1例为北京市郊区患儿,均为男性,4例患儿病程均较长,呼吸道症状不明显,头孢类抗生素治疗无效,细菌性、病毒性、真菌性等肺炎无法解释病情.均进行血常规、外斐反应、血涂片(Giemsa染色)、间接免疫荧光实验检测立克次体抗体等.回顾性分析其临床资料,进行总结.结果患儿临床表现均不典型,均无头痛,但均有发热、皮疹、程度不同的肺炎,1例伴有支气管塑形,3例患儿类似周期性发热.血涂片及立克次体抗体检测证实为地方性斑疹伤寒.体格检查均无焦痂,1例有皮肤抓痕,1例合并结膜出血,1例颈部淋巴结肿大.外周血白细胞明显升高者2例,且此2例均伴有内氨酸转氨酶升高,1例C反应蛋白明显升高.血涂片(Giemsa染色)均提示胞内感染可能性大.4例患儿均给予多西环素联合大环内酯类抗生素治疗,预后较好.结论儿童地方性斑疹伤寒多发生于农村患儿,临床表现常不典型,本组4例患儿均有发热(常为周期性发热)、皮疹、程度不同的肺炎,经多西环素及大环内酯类抗生素治疗,预后均较好.
목적 개소합병폐염적4례지방성반진상한환인적림상표현、치료경과급예후.방법 수도의과대학부속북경인동의원2011년10월지2012년3월주원적4례합병폐염적지방성반진상한환인,년령1세3개월～7세3개월,기중3례위농촌환인,1례위북경시교구환인,균위남성,4례환인병정균교장,호흡도증상불명현,두포류항생소치료무효,세균성、병독성、진균성등폐염무법해석병정.균진행혈상규、외비반응、혈도편(Giemsa염색)、간접면역형광실험검측립극차체항체등.회고성분석기림상자료,진행총결.결과 환인림상표현균불전형,균무두통,단균유발열、피진、정도불동적폐염,1례반유지기관소형,3례환인유사주기성발열.혈도편급립극차체항체검측증실위지방성반진상한.체격검사균무초가,1례유피부조흔,1례합병결막출혈,1례경부림파결종대.외주혈백세포명현승고자2례,차차2례균반유내안산전안매승고,1례C반응단백명현승고.혈도편(Giemsa염색)균제시포내감염가능성대.4례환인균급여다서배소연합대배내지류항생소치료,예후교호.결론 인동지방성반진상한다발생우농촌환인,림상표현상불전형,본조4례환인균유발열(상위주기성발열)、피진、정도불동적폐염,경다서배소급대배내지류항생소치료,예후균교호.
Objective To analyze clinical manifestations,treatment and prognosis of 4 cases with endemic typhus.Method The clinical data of four endemic typhus patients in prognosis were retrospectively analyzed.These four atypical cases of endemic typhus with pneumonia were treated in our department from October 2011 to March 2012.They were all male,with an age range of 15 months to 7 years.The four patients had long history,mild respiratory symptom and no improvement was found after treatment with cephalosporins.There were no evidences of bacterial,viral,or fungal infections and we thought they might have infection with other pathogen.Three were from rural areas.Routine blood tests,Weil-Felix reaction,blood smear(Giemsa staining),and indirect immunofluorescence assay were performed.Result Blood smear and IFA tests showed evidences for endemic typhus.The clinical presentations were atypical,the patients had no headache,but all had fever,rash,and pneumonia of varying severity.None of the patients had a severe cough,but bronchial casts were observed in one case.Recurrent fever was reported in three cases.Physical examinations showed no eschars,but one patient had a subconjunctival hemorrhage,and one had skin scratches,cervical lymphadenopathy,pleural effusion,pericardial effusion,and cardiac dilatation.Two patients had remarkably increased peripheral blood leukocyte counts; both these patients also had high alanine aminotransferase (ALT) levels and one had a high C-reactive protein (CRP) level.Weil-Felix testing was negative or the OX19 titer was low.The peripheral blood smear (Giemsa stain) showed intracellular pathogens in all four cases.After combined therapy with doxycycline and macrolide antibiotics,all four patients recovered well.Conclusion The endemic typhus children often come from rural areas.The clinical presentations were atypical,they usually have no headache,but have fever(often Periodic fever),rash,and pneumonia of varying severity in these four cases.Combined therapy with doxycycline and macrolide antibiotics was effective in all four patients.