《日本 6 岁以下儿童出疹性疾病的临床与实验室诊断（麻疹-风疹疫苗后时代）》
Clinical and Laboratory Diagnosis of Exanthems Among Japanese Children Younger Than 6 Years Old in the Post-Measles-Rubella Vaccine Era.
机构信息
From the Division of Emergency and Transport Services, Department of General Pediatrics and Interdisciplinary Medicine.
Division of Infectious Diseases, Department of Medical Subspecialties.
出版信息
Pediatr Infect Dis J. 2024 Feb 1;43(2):e44-e48. doi: 10.1097/INF.0000000000004175. Epub 2023 Nov 13.
BACKGROUND
Exanthems are a common reason for visits to the pediatric emergency department. However, epidemiological data in the post-measles-rubella vaccine era is limited.
OBJECTIVE
We sought to determine the recent causes of exanthems in children younger than 6 years old in the pediatric emergency department.
METHODS
A prospective single-center study was conducted in Japan from August 2019 to March 2020. Children younger than 6 years old with exanthems were enrolled. Exanthems were classified into 7 morphological patterns. Varicella, herpes zoster, impetigo, urticaria and Kawasaki disease were diagnosed clinically. Nasopharyngeal swab specimens were collected from patients with nonspecific exanthems and evaluated by polymerase chain reaction (PCR) assays capable of detecting 24 pathogens. The final diagnosis was made by discussion of 3 physicians based on clinical course and microbiology.
RESULTS
There were 9705 pediatric visits, of which 296 (3%) had exanthems and were younger than 6 years old. Clinical diagnosis was possible for 160 (54%), including urticaria in 110 (37%), Kawasaki disease in 29 (10%), impetigo in 10 (3%), varicella or herpes zoster in 7 (2%) and group A Streptococcus in 4 (1%). Among the remaining 136 (46%) children, 75 (25%) underwent testing by PCR. One or more pathogens were detected in 49 (65%), specifically enterovirus in 14 (19%), cytomegalovirus in 13 (17%), human herpesvirus type-6 in 12 (16%), adenovirus in 11 (15%) and human herpesvirus type-7 in 8 (11%). Final infectious disease diagnoses were roseola infantum in 11 (15%), enterovirus in 9 (12%), adenovirus in 6 (8%), mixed virus infection in 5 (7%), group A Streptococcus in 3 (4%), parechovirus-A in 3 (4%) and influenza in 3 (4%).
CONCLUSIONS
The most common causes of pediatric exanthems were noninfectious diseases and viral exanthema. PCR assay was instrumental for etiological diagnosis of nonspecific exanthems.
背景
出疹是儿童急诊科就诊的常见原因。然而，在麻疹-风疹疫苗时代之后，有关出疹的流行病学数据有限。
目的
我们旨在确定日本儿科急诊科 6 岁以下儿童近期出疹的病因。
方法
2019 年 8 月至 2020 年 3 月，在日本进行了一项前瞻性单中心研究。纳入患有出疹的 6 岁以下儿童。将出疹分为 7 种形态类型。水痘、带状疱疹、脓疱疮、荨麻疹和川崎病均经临床诊断。对非特异性出疹患者采集鼻咽拭子标本，并用聚合酶链反应（PCR）检测 24 种病原体。根据临床病程和微生物学，由 3 名医生进行讨论来确定最终诊断。
结果
共有 9705 例儿科就诊，其中 296 例（3%）有出疹且年龄小于 6 岁。160 例（54%）可明确临床诊断，包括 110 例（37%）荨麻疹、29 例（10%）川崎病、10 例（3%）脓疱疮、7 例（2%）水痘或带状疱疹、4 例（1%）A 组链球菌。在其余 136 例（46%）儿童中，75 例（25%）接受了 PCR 检测。49 例（65%）检测到一种或多种病原体，具体为 14 例（19%）肠道病毒、13 例（17%）巨细胞病毒、12 例（16%）人类疱疹病毒 6 型、11 例（15%）腺病毒、8 例（11%）人类疱疹病毒 7 型。最终传染病诊断为幼儿急疹 11 例（15%）、肠道病毒 9 例（12%）、腺病毒 6 例（8%）、混合病毒感染 5 例（7%）、A 组链球菌 3 例（4%）、A 组肠道病毒 3 例（4%）和流感 3 例（4%）。
结论
儿科出疹最常见的原因是非传染性疾病和病毒性出疹。PCR 检测对非特异性出疹的病因诊断很有帮助。
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