Shamir R, Garty B Z, Rachmel A, Kivity S, Alpert G
Pediatric Department A, Beilinson Medical Center, Tel Aviv, Israel.
Pediatr Infect Dis J. 1993 Nov;12(11):913-6. doi: 10.1097/00006454-199311000-00004.
We reviewed the clinical features and laboratory findings of 27 infants with infantile spasms treated with adrenocorticotropic hormone or prednisone during febrile episodes in order to evaluate the incidence of bacteremia, the risk of serious infection, determination of whether serious infections can be identified at presentation and the outcome of febrile episodes. There were 75 febrile episodes including 4 episodes of identified bacteremia (5.3%). Three children who were treated with adrenocorticotropic hormone dosage larger than recommended died. Leukocytosis and a differential count with many immature granulocytes predicted bacteremia in this population. Chest radiography was useful in identifying the cause of fever. The pathogens isolated were similar to those found in this age range. We conclude that the frequency of bacteremia in our patient population is similar to that observed in infants of the same age; however, the outcome is frequently fatal. In addition this increased mortality may be associated with the use of a larger dosage of adrenocorticotropic hormone than recommended.
我们回顾了27例在发热期接受促肾上腺皮质激素或泼尼松治疗的婴儿痉挛症婴儿的临床特征和实验室检查结果，以评估菌血症的发生率、严重感染的风险、确定在就诊时是否能识别出严重感染以及发热期的结局。共有75次发热发作，其中4次确诊为菌血症（5.3%）。3例接受高于推荐剂量促肾上腺皮质激素治疗的儿童死亡。白细胞增多以及伴有许多未成熟粒细胞的分类计数可预测该人群中的菌血症。胸部X线检查有助于确定发热原因。分离出的病原体与该年龄范围内发现的病原体相似。我们得出结论，我们患者群体中菌血症的发生率与同年龄婴儿中观察到的相似；然而，结局往往是致命的。此外，这种死亡率的增加可能与使用高于推荐剂量的促肾上腺皮质激素有关。
