Huang M X, Ye B, Jiang Y, Tang L F, Chen Z M
Department of Pulmonology, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
Zhonghua Er Ke Za Zhi. 2021 Jan 2;59(1):33-36. doi: 10.3760/cma.j.cn112140-20200430-00453.
To summarize the clinical characteristics, imaging features, diagnosis, treatment and prognosis of pulmonary actinomycosis in children. The clinical data of a child with pulmonary actinomycosis who was hospitalized in Children's Hospital, Zhejiang University School of Medicine in December 2019 was retrospectively analyzed. The related literature published from January 1975 to January 2020 was retrieved from Wanfang, CNKI and PubMed databases with "pulmonary" or "thoracic" and "actinomycosis" and "pediatric" or "children" or "child" as the keywords. And the characteristics of pediatric pulmonary actinomycosis were summarized based on the literature review. The patient was a boy aged 12 years and 6 months. He was admitted due to cough and chest pain for more than 20 days, with fever on the first three days. The chest CT scan in local hospital found inflammatory lesions in the right middle lobe, which was also suspected to be cavitation. The flexible bronchoscopy showed congestion and edema of bronchial mucosa in the right middle lobe, and bronchoalveolar lavage fluid smear was positive for acid-fast bacilli DNA, although both purfied protein derivatives tuberculin test and T-spot were negative. During the hospitalization, the child had persistent cough and chest pain, but no fever. Pathogen metagene sequencing of the bronchoalveolar lavage fluid detected Actinomyces (sequence number: 222) and Grevini Actinomycetes (sequence number: 185). The boy received intravenous cefoperazone sulbactam sodium for 2 weeks followed by oral amoxicillin clavulanate potassium for 6 weeks. Until April 2020, his clinical symptoms completely relieved, and the pulmonary lesions were significantly absorbed on the latest chest CT scan. Eight articles and 62 children with pulmonary actinomycosis were reported, but no related reports were retrieved from CNKI and Wanfang databases. The youngest case was 27 months old. The clinical presentations of this disease were nonspecific. The main symptoms included chest wall masses (8 cases), cough (23 cases), pain (chest, back, shoulders and armpits) (24 cases), fever (25 cases), weight loss (26 cases), etc. The clinical manifestations and imaging features of pediatric pulmonary actinomycosis are nonspecific, therefore it could easily be misdiagnosed. For children with pneumonia of unknown etiology and failing to respond to routine antibiotics, the pathogen metagene sequencing of the bronchoalveolar lavage fluid will be helpful for diagnosis. With appropriate course of antibiotic treatment, the prognosis is good in most cases.
总结儿童肺放线菌病的临床特征、影像学特点、诊断、治疗及预后。回顾性分析2019年12月在浙江大学医学院附属儿童医院住院的1例儿童肺放线菌病患者的临床资料。以“pulmonary”或“thoracic”、“actinomycosis”、“pediatric”或“children”或“child”为关键词，从万方、知网和PubMed数据库检索1975年1月至2020年1月发表的相关文献，并结合文献复习总结儿童肺放线菌病的特点。患者为12岁6个月男孩，因咳嗽、胸痛20余天入院，起病前3天有发热。当地医院胸部CT检查发现右中叶炎性病变，也怀疑有空洞形成。纤维支气管镜检查显示右中叶支气管黏膜充血水肿，支气管肺泡灌洗液涂片抗酸杆菌DNA阳性，但结核菌素纯蛋白衍生物试验和T-spot均为阴性。住院期间，患儿持续咳嗽、胸痛，但无发热。支气管肺泡灌洗液病原体宏基因测序检测到放线菌（序列编号：222）和格氏放线菌（序列编号：185）。该男孩静脉滴注头孢哌酮舒巴坦钠2周，随后口服阿莫西林克拉维酸钾6周。至2020年4月，其临床症状完全缓解，最新胸部CT检查显示肺部病变明显吸收。共检索到8篇文献报道62例儿童肺放线菌病，知网和万方数据库未检索到相关报道。最小病例为27个月龄。本病临床表现无特异性，主要症状包括胸壁肿块（8例）、咳嗽（23例）、疼痛（胸部、背部、肩部和腋窝）（24例）、发热（25例）、体重减轻（26例）等。儿童肺放线菌病的临床表现及影像学特点无特异性，易误诊。对于病因不明且常规抗生素治疗无效的肺炎患儿，支气管肺泡灌洗液病原体宏基因测序有助于诊断。经适当疗程的抗生素治疗，多数患儿预后良好。
