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A组链球菌菌血症患儿临床疾病模式的变化

Changing pattern of clinical illness in children with group A streptococcal bacteremia.

作者信息

Burrows K J, Halperin S A, Swift M, Bortolussi R

机构信息

Department of Pediatrics and Microbiology, Dalhousie University; and the Izaak Walton Killam Hospital for Children, Halifax, Nova Scotia.

出版信息

Can J Infect Dis. 1993 Nov;4(6):341-6. doi: 10.1155/1993/916470.

Abstract

OBJECTIVE

To test the hypothesis that bacteremia caused by group A streptococci (gas) has become more common and the presentation of the infection more severe in the Izaak Walton Killam Hospital for Children during the past decade.

DESIGN

Retrospective analysis by laboratory log and chart review.

SETTING

A pediatric teaching hospital providing primary and tertiary care.

RESULTS

There was no difference in the frequency of detection of gas bacteremia between the two periods studied (1980 to 1988 and 1988 to 1991). However, severe gas infection with deep tissue invasion was more common in the last three-year period (77% versus 11%, P=0.01). Severity, as measured by length of hospital stay, was also greater in the recent group (17.9 days versus 3.3 days, P=0.03). A recent group of four children was identified with a unique clinical syndrome of rash, severe myalgias, hyperesthesia, and refusal to bear weight.

CONCLUSION

The number of cases of severe gas disease has increased in the past several years, and gas infection should be included in the differential diagnosis of seriously ill children, gas infection must be managed aggressively with vigilance for additional deep tissue involvement, even while on appropriate antimicrobial therapy.

摘要

目的

检验以下假设,即在过去十年中,伊萨克·沃尔顿·基拉姆儿童医院里,由A组链球菌(GAS)引起的菌血症变得更加常见,且感染表现更为严重。

设计

通过实验室日志和病历回顾进行回顾性分析。

地点

一家提供初级和三级护理的儿科教学医院。

结果

在两个研究时间段(1980年至1988年和1988年至1991年)之间,GAS菌血症的检测频率没有差异。然而,在最近三年期间,伴有深部组织侵袭的严重GAS感染更为常见(77%对11%,P=0.01)。以住院时间衡量的严重程度在近期组中也更高(17.9天对3.3天,P=0.03)。近期发现一组四名儿童患有独特的临床综合征,包括皮疹、严重肌痛、感觉过敏和拒绝负重。

结论

在过去几年中,严重GAS疾病的病例数有所增加,GAS感染应纳入重症儿童的鉴别诊断中。即使在接受适当的抗菌治疗时,也必须积极处理GAS感染,并警惕是否有额外的深部组织受累。

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