儿童急性呼吸道感染病毒感染特点分析

目的分析儿童急性呼吸道感染患儿腺病毒(AdV)感染特点。方法 2009年5月至2009年6月北京儿童医院门诊急性呼吸道感染患儿共492例,入选患儿在就诊当日采集咽拭子标本1份,采用逆转录(RT)-PCR方法进行常见呼吸道病毒核酸检测,包括呼吸道合胞病毒(RSV),鼻病毒(RV),副流感病毒(PIV)1-4型,流感病毒甲型及乙型(IFA、IFB),腺病毒(AdV),肠道病毒(EV),人冠状病毒(HCoV),人偏肺病毒(HMPV)及人博卡病毒(HBoV)。AdV核酸扩增阳性片段进行克隆测序,对序列进行Blast和进化分析以对AdV进行分型。结果 492例急性呼吸道感染患儿的咽拭子标本中,165例检出至少1种病毒,总阳性检出率为33.5%。其中53份检出AdV,检出率为10.8%,在所有检出病毒中阳性率最高。53份AdV阳性标本中共检出3个亚组,7个血清型,以3型(23/53)为主,其次是7(8/53)型和1型(7/53)。结论 2009年春季北京地区AdV有多个血清型流行,以3型为主。AdV仍然是儿童呼吸道感染的重要病原。     

小儿急性白血病医院感染危险因素的非条件Logistic回归分析

目的：为探讨小儿急性白血病医院感染(NI)的危险因素,以利临床医师提高对其认识,降低治疗相关死亡率。方法：对306例急性白血病患儿进行了回顾性调查,其中87例为NI组,219例无任何感染者为非NI组,两组资料进行单因素卡方检验及t检验后,用非条件Logistic回归模型多元分析。结果：NI发生率28.43% (87/306例),感染部位以呼吸道、口腔为主。多因素分析结果筛选出住院天数,白细胞,中性粒细胞绝对计数及血小板是NI的独立危险因素。结论：住院天数延长、外周血白细胞减少、粒细胞减少及血小板减少是小儿急性白血病NI的危险因素。     

苏州地区呼吸道感染住院患儿腺病毒检测分析

目的 了解苏州地区呼吸道感染住院患儿腺病毒(ADV)感染特点.方法 选择2005年11月至2007年10月在苏州大学附属儿童医院住院的急性呼吸道感染患儿6227例,采用直接免疫荧光法(DFA)对患儿鼻咽部分泌物进行ADV等7种病毒抗原检测,同时进行痰细菌培养和测定患儿血清肺炎支原体(MP)抗体滴度(采用ELISA方法).结果 6227例标本中ADV抗原阳性64例,阳性率1.03%,1～7岁阳性检出数49例(76.56%),其中1～2岁14例(21.88%).每年3～9月份均有ADV检出,4～8月份检出率较高.64例腺病毒感染病例中,诊断为肺炎25例,扁桃体炎11例,咽结合膜热4例,支气管炎5例,咽炎2例.上呼吸道感染17例;高热60例(占93.75%),热退均表现为骤降;44例(68.75%)血常规检查白细胞升高;C反应蛋白(CRP)升高42例(65.63%);1例(1.56%)混合副流感病毒3型感染,13例(20.31%)混合细菌感染,30例(46.88%)混合肺炎支原体感染.结论 ADV感染在苏州地区每年春夏季高发,1～7岁是ADV感染的好发年龄,ADV感染后血白细胞、CRP升高多见,易混合肺炎支原体感染,混合病毒感染少见.     

重庆单中心2009至2011年急性呼吸道感染住院患儿2种甲型流感病毒检出情况及临床特征分析

目的了解重庆地区急性呼吸道感染住院患儿新型甲型H1N1流感病毒（S-OIVs）与季节性甲型流感病毒（IVA）检出情况及临床特征。方法收集2009年6月至2011年5月重庆医科大学附属儿童医院呼吸科急性呼吸道感染住院患儿鼻咽抽吸物（NPA）,采用荧光定量PCR技术检测S-OIVs和季节性IVA基因组RNA,分析流行特点和临床特征,并采用Logistic回归分析急性呼吸道感染进展为重症肺炎的危险因素。 结果共收集NPA标本1 074份,经PCR检测IVA阳性105份(9.8%),其中1.4%（15/1 074）为S-OIVs,8.4%（90/1 074）为季节性IVA。2种病毒阳性病例男女比例、年龄分布和平均住院天数差异均无统计学意义（P>0.05）。①S-OIVs在2009年夏季高发(11/15,73.3%),季节性IVA在2009年夏季(26/95,27.4%)、2010年夏季(22/95,23.2%)和2011年春季(25/95,26.3%)检出率明显高于其他各季节。②2种病毒阳性患儿临床症状、外周血WBC计数、CRP水平相当,S-OIVs阳性患儿重症毛细支气管炎1例（6.7%）,季节性IVA阳性患儿重症肺炎14例（15.6％）。③15份S-OIVs阳性标本中,单纯S-OIVs感染3份,合并其他病毒感染9份,痰培养阳性7份。90份季节性IVA阳性标本中,单纯季节性IVA感染21份,合并其他病毒感染42份,痰培养阳性10份。④心脏基础疾病（OR=13.60）、发生喘息（OR=6.82）和合并腺病毒感染（OR=6.21）为季节性IVA感染患儿进展为重症肺炎的危险因素。 结论重庆单中心急性呼吸道感染住院患儿S-OIVs检出率低于季节性IVA。S-OIVs和季节性IVA感染患儿均以下呼吸道感染为主。心脏基础疾病、喘息症状和合并腺病毒感染有可能是季节性IVA感染患儿进展为重症肺炎的危险因素。     

急性呼吸道感染住院儿童人类博卡病毒感染的临床特征

目的 了解西安地区以急性呼吸道感染住院患儿的人类博卡病毒(HBoV)感染的临床特征.方法 将2008年1月-12月以急性呼吸道感染住院患儿的咽拭及痰液标本252例分成2份,1份应用直接免疫荧光法检测RSV,甲、乙型流感病毒,Ⅰ、Ⅱ、Ⅲ型副流感病毒和腺病毒常见的7种呼吸道病毒;另1份用于提取HBoV DNA,分析HBoV感染的临床特点及流行病学特征.随机抽取1份HBoV DNA阳性扩增产物进行序列测定,并通过Clustal W软件与GenBank中其他HBoV序列进行多序列比对分析.结果 252份标本共检测到15份(6.0%)HBoV PCR阳性扩增产物.HBoV感染全年均有发生,冬春季多发;73.3%HBoV感染患儿的年龄为6个月至3岁;53.3%的患儿诊断为支气管肺炎(包括毛细支气管炎);53.3%患儿合并有其他呼吸道病毒的感染.HBoV单独感染与合并其他呼吸道病毒感染在临床特征方面无明显差别.HBoV NS1测序的291 bp与GenBank中2个原型株HBoV Stockholm 1(stl,No.DQ00495)、HBoY Stockholm2(st2,No.DQ00496)和北京的2株(No.DQ988934.2及No.DQ988933.1)的同源性为99.0%.结论 HBoV在15例以急性呼吸道感染住院患儿的咽拭及痰液标本中检出,HBoV感染以下呼吸道感染为著,与其他呼吸道病毒有较高的合并感染,HBoV单独感染与合并其他呼吸道病毒感染在临床特征方面无明显差别.     

97例急性下呼吸道感染常见病原调查及临床意义

呼吸道感染性疾病在儿科发病占首位,我院年均收治下呼吸道感染(LRl)2000～2500例次。占内科住院患儿的1/3。其临床诊断及分型主要靠经X线特点、临床过程及外周血白细胞分类。由于缺少病原学诊断,抗生素应用逐年升级。为了更好地贯彻WHO关于小儿急性呼吸道感染(ARI)临床管理条例,减少抗生素应用的盲目性,我院呼吸组于1991年11月～     

近年北京儿科急性呼吸道感染患儿中腺病毒的型别监测

目的 了解近年北京地区儿科急性呼吸道感染患儿中人腺病毒(ADV)感染状况及ADV的型别.方法 2003年至2008年,连续6年通过病毒分离和(或)间接免疫荧光法,对收集的首都儿科研究所就诊的急性呼吸道感染患儿的17 941份标本进行ADV检测,对其中285份毒株或阳性标本提取DNA,通过3、7、11和21型4对分型引物的多重聚合酶链反应,确定3、7、11和21型ADV,对少数扩增阴性的标本或毒株,再使用2对可扩增所有ADV的通用引物对其DNA进行扩增,将PCR产物直接测序,结果与GenBank上的序列比较,确定其型别.结果 在17 941份呼吸道标本中,经病毒分离和(或)间接免疫荧光法确定为ADV阳性的标本304份,总阳性率为1.69%.对其中285份毒株或阳性标本的PCR分型结果:272例用3、7、11、21型分型引物扩增确定了型别:3型ADV 174例,占61.1%(174/285),7型ADV 92例,占32.3%,11型ADV 6例,占2.1%;有13例经分型引物扩增为阴性,经过通用引物扩增后的PCR产物测序确定为2型ADV 9例,占3.2%(9/285);6型ADV2例,占0.7%,1型和5型ADV各1例,各占0.4%.结论 本组ADV阳性检出率为1.69%.近年来北京地区ADV感染以3、7型为主,其次为2型和11型,1、5和6型较为少见,尚未发现其他型别.     

乌鲁木齐地区住院呼吸道感染患儿EB病毒感染的调查

目的探讨乌鲁木齐地区住院呼吸道感染患儿EB病毒(Epstein-Barr virus,EBV)感染率和临床特征。方法采用酶联免疫吸附试验法(ELISA),对2010年1月至12月收治住院的呼吸道感染患儿887例,进行血清EBV IgM抗体测定,调查EBV感染率;同时进行血清支原体、衣原体、腺病毒及合胞病毒IgM抗体检测;并对EBV感染的季节,感染患儿的性别、年龄、民族及临床表现进行分析。结果 2010年乌鲁木齐地区住院呼吸道感染患儿中,EBV感染率为33.48%(297/887);EBV IgM抗体全年都有检出,冬春季为高峰期;EBV感染以≤7岁患儿为主;EBV感染在性别及民族间差异均无统计学意义(P均>0.05)。EBV合并支原体感染为14.48%(43/297),合并腺病毒感染为10.77%(32/297),合并合胞病毒感染为9.43%(28/297),合并衣原体感染为2.69%(8/297)。患儿感染EBV后多以发热为主。结论 EBV感染是乌鲁木齐地区住院呼吸道感染患儿的重要致病病原之一,及时针对EBV感染作相应的实验室检查,明确病原诊断,及时治疗,可以缩短病程,提高治愈率。     

北京地区住院急性呼吸道感染患儿的病毒病原检测分析

目的了解北京地区住院急性呼吸道感染(ARI)患儿的病毒病原情况。方法取1260例年龄14岁以下住院ARI患儿的鼻咽深部分泌物,用间接免疫荧光及病毒分离法检测呼吸道合胞病毒(RSV)、流感病毒A、B型、副流感病毒1、2、3型及腺病毒等7种常见呼吸道病毒。用逆转录聚合酶链反应(RT-PCR)法对其中490例患儿标本进行肠道病毒(EV)检测。结果1.ARI1260例中,43.33%检测到了病毒病原,7种常见呼吸道病毒检出率36.19%,RSV阳性率最高(23.97%),以冬春季为著,88.08%的RSV阳性为3岁以下小儿。2.EV阳性率16.33%。3.19例存在2种病毒混合感染,均出现在冬春季,16例为RSV并EV感染。4.入选的510例急性呼气性喘息患儿中,3岁以下RSV阳性率最高(43.20%),3岁以上EV阳性率最高(36.11%)。结论1.RSV是北京地区冬春季婴幼儿ARI的主要病原。2.冬春季EV可并RSV等其他呼吸道病毒感染。3.RSV及EV是引起小儿急性喘息性疾病的主要病毒病原。     

2009—2010年苏州地区博卡病毒感染住院患儿临床特征分析

目的探讨苏州地区因急性呼吸道感染住院患儿中人类博卡病毒(human bocavirus,HBoV)感染的临床特征。方法收集2009年1月—2010年12月因急性呼吸道感染住院的3 826例患儿的痰标本,应用实时PCR检测HBoV DNA,直接免疫荧光法检测呼吸道合胞病毒、流感病毒(A、B)、副流感病毒(1～3)和腺病毒,同时采用逆转录PCR检测人偏肺病毒RNA,并进行细菌培养及荧光定量PCR检测支原体DNA,分析HBoV感染的临床特点及流行病学特征,并与呼吸道合胞病毒(RSV)进行比较。结果 3 816份标本共检测到HBoV 272例(7.13%),仅次于RSV;HBoV单独感染率为32.7%,与其他呼吸道病毒的合并感染率为18.38%,高于RSV和其他病毒的合并感染率(P<0.05)。HBoV感染全年均有发生,夏季最多;6～18月龄婴幼儿检出率最高,占48.17%。在住院患儿中,HBoV主要引起支气管肺炎(85.39%),临床症状主要表现为咳嗽(96.63%)、喘息(46.07%)、发热(56.18%)。与RSV相比,HBoV感染患儿的白细胞、中性粒细胞比例、CRP均高于RSV,差异有统计学意义(P<0.05)。结论 HBoV是苏州地区小儿呼吸道感染的重要病原体之一,有单独的致病性,与RSV相比,在年龄、季节分布、临床症状、实验室指标等方面有明显差异。     

Mycoplasma pneumoniae infection in children with acute respiratory infection

A prospective study was performed on 93 children admitted to Kasturba Medical College Hospital, Manipal and TMA Pai Rotary Hospital of Udupi and Karkala. Blood samples from 93 children admitted to the ward with no respiratory illness were taken as age-matched controls for the inpatients, IgM antibody against Mycoplasma pneumoniae was detected using a commercial kit (Virion-Serion ELISA, Germany) following the manufacturer's instructions. 23.96% of the inpatients with respiratory tract symptoms had IgM antibodies against Mycoplasma pneumoniae. The highest infection rate was found to be in the 2-5 and 5-10 year age group. The most common mode of presentation was an upper respiratory focus of infection with cervical lymphadenopathy. Bronchial breathing signifying pneumonic consolidation was significantly less in the Mycoplasma positive group (p = 0.006). There was no statistically significant difference in the radiological findings in the Mycoplasma positive and Mycoplasma negative groups.     

儿童急性呼吸道感染肺炎衣原体感染状况的研究

目的了解急性呼吸道感染儿童肺炎衣原体(CPn)感染状况及特点.方法采用敏感性较好的培养方法对83例各年龄组呼吸道感染住院儿童进行了鼻咽拭子和咽拭子的培养分离.结果共发现CPn阳性21例,总感染率25.3%.其中49例肺炎中,CPn阳性13例(26.5%),10例毛细支气管炎中CPn阳性2例(20%),6例喘息性支气管炎中CPn阳性1例(16.7%),12例上呼吸道感染中有CPn阳性5例(41.7%),6例支气管炎中未分离到CPn.结论CPn是我国儿童急性呼吸道感染的重要病原,其在儿童急性上呼吸道感染中占有主要地位,在毛细支气管炎、喘息性支气管炎中的作用值得重视.     

Chikungunya infection in children

Chikungunya fever is caused by Chikungunya virus (CHIK) and spread by Aedes aegypti and Aedes albopictus. The median incubation period is 2 to 4 days. Vertical transmission of disease from mother to child has also been documented. Clinical manifestations are very variable, from asymptomatic illness to severe debilitating disease. Children are among the group at maximum risk for severe manifestations of the disease and some clinical features in this group are distinct from those seen in adults. Common clinical features include: abrupt onset high grade fever, skin rashes, minor hemorrhagic manifestations, arthralgia/ arthritis, lymphadenopathy, conjunctival injection, swelling of eyelids and pharyngitis. Unusual clinical features include: neurological manifestations including seizures, altered level of consciousness, blindness due to retrobulbar neuritis and acute flaccid paralysis. Watery stools may be seen in infants. Treatment is symptomatic. Generally non- steroidal anti-inflammatory drugs are avoided. Paracetamol may be used for pain and fever. However, NSAIDS may be required for relief of severe arthralgia during convalescent phase.     

Family infection in enterobiasis

In this collaborative study four clinicians, one each from Jaipur, Imphal, Madras and Varanasi, surveyed a total of 100 consecutive families of patients with enterobiasis. Perianal cellophane patch smears were taken on 4 consecutive mornings for diagnosis using a special Japanese device. All members of the patients’s family were persuaded to take the test. If one or more of other members were infected, the family was labelled an “infected family”. From this, Family Infection Raie (FIR) was calculated as :(number of infected familiesl total number of families) xl00. In addition Family Infection Extent (FIE) was calculated as :(number of infected members/total number of members) x 100. FIR was 80% and FIE ranged from 50 to 75%. These findings indicate that in 80% of the families of patients with enterobiasis one or more of other members are infected.     

早产儿霉菌感染分析

目的通过对我院新生儿科住院的既往霉菌感染病例作回顾性分析,了解霉菌感染的特征。方法选取2005年4月至2008年1月在我院新生儿科住院的所有早产儿1716例为研究现象,结合临床及实验室检查进行感染判定。并予氟康唑6mg／ks静脉滴注治疗,如治疗效果反应欠佳则改用两性霉素B联合静脉内丙种球蛋白治疗。结果所有早产儿中,共有11例确诊为霉菌感染,另有26例拟诊为霉菌感染,共37例,占早产儿总数的2．16％;死亡3例,感染病死率为8．1％;平均胎龄（30．7±2．3）周,其中小于32周31例,占83．78％;平均感染日龄（19．21±8．02）d;100％患儿使用过两种或以上抗生素、使用过部分或全静脉营养,曾进行过侵入性操作的患儿共29例,占78．38％。结论广泛的广谱抗生素应用、多种抗生素的联合应用、侵入性治疗手段的增加,是早产儿院内霉菌感染的主要因素,胎龄越小,其发生霉菌感染的可能性越大。氟康唑是对新生儿霉菌感染有效的药物,可以考虑作为一线药物使用。对于早产儿,较长期（14d或以上）的抗真菌药物使用或许是比较适宜的治疗周期。     

Risk of cytomegalovirus infection in nurses and congenital infection in their offspring

The risk of contracting cytomegalovirus (CMV) infection in nursing of infants and of congenital CMV infection in infants born to such nursing personnel were investigated. The investigation comprised 292 women working in paediatric clinics or day nurseries and a control group of 163 women who had no professional contact with infants. Among the women younger than 25, those who had tended infants for more than six months were significantly (p less than 0.001) more often seropositive for CMV than were those--mainly student nurses--with less than six months' infant nursing service, but ot more often than control women. At ages above 25 there was no demonstrable difference between the groups. In a separate study the occupation of 36 mothers of infants with congenital CMV infection was investigated. Compared to a control group no overrepresentation of nurses was found. All six congenitally infected infants born to nurses developed normally.     

早产儿霉菌感染分析

Objective To stuay the features of fungal infection by analyzing the preterm inpatient in our departrment retrospectively.Methods All preterm(1716 babies)inpatient in our department were ealtrolled between April 2005 to January 2008,and the assessment ofinfection was taken by elinical symptom and laratory examillation.The infected babies were give.flueonazol 6mg/(kg·d)by intravenous drip,and amphoteriein B and ganmla globulin would be used for those babies who were still sick.Results A total of 11 cases were diagnod as fungus infection.and another 26 cases of suspected fungus infecdon for a total of37 cases.accounting forthe total number of premature infants 2.16 percents;the death ofthree cases Qfinfection case-fatality rate was 8.1%.The average gestational age was(30.7±2.3)weeks,and 31 cases were less than 32 weeks,aceoundng or 83.78%.The average age ofinfecdon was(19.21±8.02)days;All babies were given two ormoire anubiodes,and used in part ortotal parenteral nutrition,and the number of babies had been conducted with invasive operation was 29.accounting for 78.38%.Conclusion Applicadon of a wide range of broad-spectnlm antibiotie,combined with a variety of antiNodes,invasive treatment in premature infants are nosoeomial fungal infection of the main faetors,the smaller gestational age,the more possibility fungal infoetion.Fluconazole is effective for fungal infection of newborns,and can be comidered as first.line drug.For premature infants,the longer-term(14 days or above)use of antifungal agents may be more appropriate treatment cycle.