Tseng H W, Liu C C, Wang S M, Yang Y J, Huang Y S
Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan, ROC.
J Microbiol Immunol Infect. 2000 Dec;33(4):248-52.
A review of medical records at a tertiary hospital in southern Taiwan from June 1988 through May 1998 identified 136 children who had been hospitalized for varicella-related complications. Of the children, 83% (113/136) were healthy before the onset of varicella and 17% (23/136) had underlying illnesses. The mean age was 4.7 years (ranged from 1 day to 18 years) with a male predominance (1.7:1). The mean hospital stay was 5.5 days (ranged from 1 to 22 days). Secondary bacterial skin or soft tissue infections were the most common complications (44%), followed by central nervous system (CNS) involvement (23%), pneumonia (18%), thrombocytopenia (12%), and liver function impairment (10%). Among the 60 patients with secondary bacterial cutaneous infection, 16 (27%) had positive isolates, including 12 isolates of Staphylococcus aureus and four Streptococcus pyogenes. Age above 8 years was significantly associated with the development of varicella-associated CNS complications (p = 0.019). Of the 23 immunocompromised hosts, the most common underlying conditions were hematological diseases (11 patients, 48%), followed by neonatal varicella (7 patients, 30%) and chronic illness with steroid treatment (5 patients, 22%). All of the subjects in this study had a favorable outcome except for three lethal cases, resulting in a case-fatality rate of 2.2%. The cause of death was S. aureus septicemia in one patient, streptococcal toxic shock syndrome in one patient, and encephalitis with brain herniation in one patient. Our results demonstrate that varicella continues to be a serious disease that occasionally results in life-threatening complications in healthy and immunocompromised children. Routine immunization of all healthy children against varicella is recommended.
对台湾南部一家三级医院1988年6月至1998年5月期间的病历进行回顾，确定了136名因水痘相关并发症住院的儿童。在这些儿童中，83%（113/136）在水痘发病前身体健康，17%（23/136）有基础疾病。平均年龄为4.7岁（范围从1天至18岁），男性居多（1.7:1）。平均住院时间为5.5天（范围从1至22天）。继发性细菌性皮肤或软组织感染是最常见的并发症（44%），其次是中枢神经系统（CNS）受累（23%）、肺炎（18%）、血小板减少症（12%）和肝功能损害（10%）。在60例继发性细菌性皮肤感染患者中，16例（27%）分离培养结果呈阳性，包括12株金黄色葡萄球菌和4株化脓性链球菌。8岁以上年龄与水痘相关的CNS并发症的发生显著相关（p = 0.019）。在23名免疫功能低下宿主中，最常见的基础疾病是血液系统疾病（11例患者，48%），其次是新生儿水痘（7例患者，30%）和接受类固醇治疗的慢性病（5例患者，22%）。除3例致命病例外，本研究所有受试者预后良好，病死率为2.2%。死亡原因分别为1例金黄色葡萄球菌败血症、1例链球菌中毒性休克综合征和1例脑炎伴脑疝形成。我们的结果表明，水痘仍然是一种严重疾病，偶尔会在健康和免疫功能低下的儿童中导致危及生命的并发症。建议对所有健康儿童常规接种水痘疫苗。
