Pediatric Nephrology, Ministry of Health Diskapi Children's Hospital, Ankara, Turkey.
Eur J Pediatr. 2010 Jan;169(1):73-6. doi: 10.1007/s00431-009-0989-x. Epub 2009 May 9.
Primary peritonitis is a well-described infectious complication of nephrotic syndrome. Current data on the true incidence of peritonitis and efficacy of preventive pneumococcal vaccination are not clear in this group of children. In this nationwide study, among a total of 268 patients with an initial diagnosis of steroid sensitive nephrotic syndrome, eight episodes of primary peritonitis were detected in seven patients during 5 years. All eight attacks of peritonitis occurred in the relapse period. Seven of these peritonitis episodes occurred in the first 2 years of nephrotic syndrome, three of them during the first attack. One patient had two attacks with a 6-month interval. Only two of the patients were steroid sensitive, while four of them were steroid dependent, and one was steroid resistant at the diagnosis of peritonitis. The causing microorganism was identified in three patients (Streptococcus hemolyticus, Streptococcus pneumoniae, and alpha-hemolytic Streptococcus). Incidence of peritonitis (2.6%) in our series was not high when compared with previous reports. None of the patients had been immunized against pneumococcus before or after the peritonitis attack. It raises the question if the vaccine is necessary for every child with steroid sensitive nephrotic syndrome. However, we suggest that immunization against pneumococcus is not indicated in children with steroid-responsive nephrotic syndrome (NS) and should be reserved for the small number of children who have steroid-dependent or steroid-resistant NS.
原发性腹膜炎是肾病综合征一种常见的感染性并发症。目前,对于这组儿童中腹膜炎的真实发生率和预防性接种肺炎球菌疫苗的疗效的数据尚不清楚。在这项全国性研究中,在总共 268 名最初诊断为激素敏感型肾病综合征的患者中,7 名患者在 5 年内发生了 8 次原发性腹膜炎。所有 8 次腹膜炎发作均发生在复发期。这 7 次腹膜炎中有 3 次发生在肾病综合征的前 2 年内,且均发生在首次发作期间。1 名患者有两次发作,间隔 6 个月。仅有 2 名患者为激素敏感型,4 名患者为激素依赖型,1 名患者在诊断为腹膜炎时为激素耐药型。3 名患者的致病微生物得到了鉴定(溶血性链球菌、肺炎链球菌和甲型溶血性链球菌)。与以往的报告相比,我们的系列中腹膜炎的发生率(2.6%)并不高。在腹膜炎发作之前或之后,没有患者接种过肺炎球菌疫苗。这引发了一个问题,即对于每一个患有激素敏感型肾病综合征的儿童,是否都需要接种疫苗。然而,我们建议对于激素反应性肾病综合征(NS)的儿童,接种肺炎球菌疫苗是不必要的,而应保留给少数患有激素依赖性或激素耐药性 NS 的儿童。