摘要
目的介绍合并肺炎的4例地方性斑疹伤寒患儿的临床表现、治疗经过及预后。方法首都医科大学附属北京儿童医院2011年10月至2012年3月住院的4例合并肺炎的地方性斑疹伤寒患儿，年龄1岁3个月～7岁3个月，其中3例为农村患儿，1例为北京市郊区患儿，均为男性，4例患儿病程均较长，呼吸道症状不明显，头孢类抗生素治疗无效，细菌性、病毒性、真菌性等肺炎无法解释病情。均进行血常规、外斐反应、血涂片（Giemsa染色）、间接免疫荧光实验检测立克次体抗体等。回顾性分析其临床资料，进行总结。结果患儿临床表现均不典型，均无头痛，但均有发热、皮疹、程度不同的肺炎，1例伴有支气管塑形，3例患儿类似周期性发热。血涂片及立克次体抗体检测证实为地方性斑疹伤寒。体格检查均无焦痂，1例有皮肤抓痕，1例合并结膜出血，1例颈部淋巴结肿大。外周血白细胞明显升高者2例，且此2例均伴有丙氨酸转氨酶升高，1例c反应蛋白明显升高。血涂片（Giemsa染色）均提示胞内感染可能性大。4例患儿均给予多西环素联合大环内酯类抗生素治疗，预后较好。结论儿童地方性斑疹伤寒多发生于农村患儿，临床表现常不典型，本组4例患儿均有发热（常为周期性发热）、皮疹、程度不同的肺炎，经多西环素及大环内酯类抗生素治疗，预后均较好。
Objective To analyze clinical manifestations, treatment and prognosis of 4 cases with endemic typhus. Method The clinical data of four endemic typhus patients in prognosis were retrospectively analyzed. These four atypical cases of endemic typhus with pneumonia were treated in our department from October 2011 to March 2012. They were all male,with an age range of 15 months to 7 years. The four patients had long history, mild respiratory symptom and no improvement was found after treatment with cephalosporins. There were no evidences of bacterial, viral, or fungal infections and we thought they might have infection with other pathogen. Three were from rural areas. Routine blood tests, Well-Felix reaction, blood smear（ Giemsa staining） ,and indirect immunofluorescence assay were performed. Result Blood smear and IFA tests showed evidences for endemic typhus. The clinical presentations were atypical,the patients had no headache,but all had fever, rash, and pneumonia of varying severity. None of the patients had a severe cough, but bronchial casts were observed in one case. Recurrent fever was reported in three cases. Physical examinations showed no eschars, hut one patient had a subconjunctival hemorrhage, and one had skin scratches, cervical lymphadenopathy, pleural effusion, pericardial effusion, and cardiac dilatation. Two patients had remarkably increased peripheral blood leukocyte counts; both these patients also had high alanine aminotransferase （ALT） levels and one had a high C-reactive protein （CRP） level. Well-Felix testing was negative or the OX19 titer was low. The peripheral blood smear （Giemsa stain ） showed intraeellular pathogens in all four cases. After combined therapy with doxycycline and macrolide antibiotics, all four patients recovered well. Conclusion The endemic typhus children often come from rural areas. The clinical presentations were atypical, they usually have no headache, but have fever （often Periodic fever）, rash, and pneumonia of varying severity in these four cases. Combined therapy with doxycycline and macrolide antibiotics was effective in all four patients.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2013年第10期775-778,共4页
Chinese Journal of Pediatrics
关键词
立克次体感染
斑疹伤寒
地方性蚤传
中国人
Rickettsia infections
Typhus,endemic flea-borne
Chinese population
