Suppr超能文献

1例难治性川崎病合并假结核耶尔森菌感染经免疫抑制治疗后用头孢噻肟成功治愈的病例

A Case of Refractory Kawasaki Disease With Yersinia pseudotuberculosis Infection Successfully Treated With Cefotaxime Following Immunosuppressive Therapy.

作者信息

Yokoyama Koji, Sakabe Masahiko, Mamada Mitsukazu

机构信息

Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, JPN.

出版信息

Cureus. 2024 Nov 17;16(11):e73866. doi: 10.7759/cureus.73866. eCollection 2024 Nov.

Abstract

Kawasaki disease (KD) is a vasculitis mainly affecting children under five, with symptoms such as persistent fever, rash, red lips, strawberry tongue, conjunctivitis, and swollen hands and feet. Diagnosis is based on a fever lasting over five days plus at least four of these symptoms. Treatment includes intravenous immunoglobulin (IVIG) and aspirin to reduce complications, especially coronary artery issues.  infection is a gram-negative bacterium. In KD patients, the most prevalent gastrointestinal symptoms were vomiting (28.9%), abdominal pain (17.4%), and diarrhea (16.9%). By contrast, diarrhea is observed in over 50% of patients with  infection.  is a gram-negative bacterium reported to infect a wide variety of animal hosts and contact with these animals can serve as a potential clue in diagnosis.  infection can mimic KD with similar fever and rash symptoms, posing a diagnostic challenge. In practice, however, differentiation remains challenging. Differentiating between KD and  is essential, especially in cases resistant to typical KD treatment. Distinguishing KD from  infection in clinical practice is crucial to prevent misdiagnosis, avoid unnecessary immunosuppression, and minimize delays in effective treatment. Misinterpreting  infection as KD may lead to inappropriate treatment strategies that fail to address the underlying infection, potentially resulting in adverse patient outcomes. Accurate and timely diagnosis is therefore essential to initiate appropriate therapeutic interventions. A 16-month-old boy presented with fever and diarrhea and was initially treated for infectious gastroenteritis, with elevated inflammatory markers noted (C-reactive protein (CRP) 4.47 mg/dL, white blood cell (WBC) 8,200/μL). As his condition progressed, he developed symptoms consistent with KD, including a rash and mucous membrane changes, and was treated with IVIG and aspirin. However, the fever persisted, and elevated inflammatory markers continued (CRP 3.93 mg/dL, WBC 9,700/μL), prompting additional immunosuppressive therapies for refractory KD. Ultrasound revealed gastrointestinal and lymph node abnormalities suggestive of vasculitis. Eventually, infection was confirmed through serology, and antibiotic treatment was reintroduced, leading to defervescence. This case highlights the challenge of distinguishing KD from infection because they can coexist, complicating treatment decisions. Rapid diagnostic methods for , specifically through loop-mediated isothermal amplification-polymerase chain reaction (LAMP-PCR) testing, are crucial to guide timely treatment, particularly given the risk of coronary artery complications associated with both conditions.

摘要

川崎病(KD)是一种主要影响五岁以下儿童的血管炎,症状包括持续发热、皮疹、嘴唇发红、草莓舌、结膜炎以及手脚肿胀。诊断基于持续发热超过五天加上至少出现上述四种症状。治疗包括静脉注射免疫球蛋白(IVIG)和阿司匹林,以减少并发症,尤其是冠状动脉问题。 感染是一种革兰氏阴性菌。在KD患者中,最常见的胃肠道症状是呕吐(28.9%)、腹痛(17.4%)和腹泻(16.9%)。相比之下,超过50%的 感染患者会出现腹泻。 是一种革兰氏阴性菌,据报道可感染多种动物宿主,与这些动物接触可能是诊断的一个潜在线索。 感染可出现类似发热和皮疹的症状,酷似KD,这给诊断带来了挑战。然而在实际中,进行区分仍然具有挑战性。区分KD和 至关重要,尤其是在对典型KD治疗有抵抗的病例中。在临床实践中区分KD和 感染对于防止误诊、避免不必要的免疫抑制以及尽量减少有效治疗的延误至关重要。将 感染误诊为KD可能导致未能针对潜在感染的不恰当治疗策略,可能给患者带来不良后果。因此,准确及时的诊断对于启动适当的治疗干预至关重要。一名16个月大的男孩出现发热和腹泻,最初被诊断为感染性肠胃炎进行治疗,当时炎症指标升高(C反应蛋白(CRP)4.47mg/dL,白细胞(WBC)8200/μL)。随着病情进展,他出现了与KD相符的症状,包括皮疹和黏膜变化,并接受了IVIG和阿司匹林治疗。然而,发热持续,炎症指标持续升高(CRP 3.93mg/dL,WBC 9700/μL),促使对难治性KD采用额外的免疫抑制疗法。超声检查显示胃肠道和淋巴结异常,提示血管炎。最终,通过血清学确诊为 感染,并重新采用抗生素治疗,随后体温恢复正常。该病例凸显了区分KD和 感染的挑战,因为它们可能同时存在,使治疗决策变得复杂。针对 的快速诊断方法,特别是通过环介导等温扩增-聚合酶链反应(LAMP-PCR)检测,对于指导及时治疗至关重要,尤其是考虑到两种疾病都存在冠状动脉并发症的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5ac2/11652116/3963272552b4/cureus-0016-00000073866-i01.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验