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[7名感染……的儿童的临床分析] (原文此处不完整)

[Clinical analysis of 7 children infected with ].

作者信息

Xie G, Chen J H, Sun L F, Wang W, Li Z C, Wang W J

机构信息

Department of Respiratory, Shenzhen Children's Hospital, Shenzhen 518038, China.

出版信息

Zhonghua Er Ke Za Zhi. 2022 Sep 2;60(9):925-929. doi: 10.3760/cma.j.cn112140-20220331-00260.

Abstract

To investigate the clinical manifestations, treatments, and prognosis of pediatric patients with infection. In this retrospective study, 7 children diagnosed with infection in Shenzhen Children's Hospital from July 2017 to October 2021 were recruited. The clinical features, radiology, pathogen detection, immunological evaluation, treatments, and prognosis were analyzed. In 7 cases, 5 were male, 2 were females. The age was from 0.75 to 8.75 years. The main clinical manifestations were fever in 7 cases, cough in 6 cases, malnutrition in 4 cases, papules in 2 cases and medical history of recurrent infection in 3 cases. Physical examination showed that all 7 patients had hepatosplenomegaly, 4 had superficial lymphadenopathy. Laboratory examination showed that 6 cases had decreased hemoglobin and 3 cases had decreased platelet. Chest CT showed that 4 cases had patchy shadows, pleural effusion, mediastinal or axillary lymph node enlargement, 3 had nodular shadows and 2 had cavities. The positive ratio of culture was 2/2 with tissue samples, 4/5 with bone marrow. The positive ratio was 3/4 by metagenomic next generation sequencing. The fungus was detected in 3 cases by smear microscopy of bone marrow and (or) peripheral blood. All patients were negative for human immunodeficiency virus by the immune function assay. However, 5 cases were confirmed as primary immunodeficiency disease, including 2 cases with high IgM syndrome, 2 with STAT1 gene variation, and the last with severe combined immunodeficiency (IL2RG gene variation). Exclude 1 case which gave up treatment due to acute intracranial infection, and the other patients received effective treatments along with amphotericin B, voriconazole, and itraconazole alone or in combination. Two cases relapsed after medication withdrawal, but 1 case got complete rehabilitation after hematopoietic stem cell transplantation. The clinical manifestations involve multisystem, the common charateristics are fever and cough. The chest CT imaging manifestations are diverse, it should be considered in differentiating tuberculosis. The amphotericin B, voriconazole and itraconazole are effective, but it will easily relapse when withdrawing those antifungal agents.

摘要

探讨小儿感染患者的临床表现、治疗方法及预后。在这项回顾性研究中,招募了2017年7月至2021年10月在深圳儿童医院确诊为感染的7例儿童患者。对其临床特征、影像学表现、病原体检测、免疫评估、治疗方法及预后进行分析。7例患者中,男性5例,女性2例。年龄为0.75至8.75岁。主要临床表现为发热7例、咳嗽6例、营养不良4例、丘疹2例、反复感染病史3例。体格检查显示,7例患者均有肝脾肿大,4例有浅表淋巴结肿大。实验室检查显示,6例血红蛋白降低,3例血小板降低。胸部CT显示,4例有斑片状阴影、胸腔积液、纵隔或腋窝淋巴结肿大,3例有结节状阴影,2例有空洞。组织样本培养阳性率为2/2,骨髓培养阳性率为4/5。宏基因组下一代测序阳性率为3/4。骨髓和(或)外周血涂片镜检3例检测到真菌。免疫功能检测所有患者人类免疫缺陷病毒均为阴性。然而,5例确诊为原发性免疫缺陷病,包括2例高IgM综合征、2例STAT1基因变异,最后1例为重症联合免疫缺陷(IL2RG基因变异)。排除1例因急性颅内感染放弃治疗的患者,其他患者接受了两性霉素B、伏立康唑和伊曲康唑单独或联合的有效治疗。2例停药后复发,但1例造血干细胞移植后完全康复。临床表现累及多系统,常见特征为发热和咳嗽。胸部CT影像学表现多样,鉴别诊断时应考虑结核病。两性霉素B、伏立康唑和伊曲康唑有效,但停用抗真菌药物后易复发。

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