抗金黄色葡萄球菌及溶血性链球菌鸡卵黄IgG喷剂治疗慢性咽炎

目的 探讨抗金黄色葡萄球菌及溶血性链球菌鸡卵黄IgG喷剂治疗慢性咽炎的临床疗效。方法 将100例慢性咽炎患者随机分为两组：治疗组50例和对照组50例。治疗组采用抗金黄色葡萄球菌及溶血性链球菌鸡卵黄IgG喷剂口腔喷雾治疗30d；对照组采用口腔喷雾安慰剂30d。结果治疗组治愈率36．0％（18／50）、显效率42．0％（21／50）、有效率8．0％（4／50）、无效率14．0％（7／50），总有效率86．0％（43／50）；对照组显效率4．0％（2／50）、有效率16．0％（8／50）、无效率80．0％（40／50），总有效率20．0％（10／50），两组总有效率比较，差异有显著性（χ^2=58．2，P〈0．005）。结论 0．2％抗金黄色葡萄球菌及溶血性链球菌鸡卵黄IgG喷剂治疗慢性咽炎疗效显著，安全、无毒副作用，值得临床应用。     

婴幼儿肺炎链球菌肺炎患儿潮气呼吸肺功能的改变

目的 探讨肺炎链球菌(SP)肺炎患儿肺功能的变化.方法 应用V26max肺功能仪测定35例0～3岁SP肺炎患儿的潮气呼吸流速容量环和肺功能各项指标,以36名同龄健康体检儿童作对照,并和37例同龄呼吸道合胞病毒(RSV)肺炎患儿作对比.结果 SP肺炎组患儿与正常对照组相比,呼吸频率(RR)增快,呼气峰流速/呼气达峰时间(PTEF/tPTEF)升高,每公斤潮气量(VT/kg)、达峰时间比(tPTEF/tE)、剩余25%潮气量时的呼气流速(TEF25%)、达峰容积比(%V-PF)、剩余25%潮气量时的呼气流速/呼气峰流速(25/PF)、平均呼气流速(MEF)、平均吸气流速(MIF)下降,差异均有统计学意义(均P<0.05).SP肺炎组与RSV肺炎组相比,RR增快,MEF、MIF及TEF25%下降,差异均有统计学意义(均P<0.05).结论 SP肺炎患儿大小气道均有损害,通气功能障碍,肺功能下降,且较RSV肺炎患儿为重.使用V26max肺功能仪来测定潮气呼吸流速容量环和肺功能各项指标,可用来判断患儿支气管肺炎的严重程度,并为各种病原感染提供诊断及治疗帮助.     

Additional antibiotic use and preterm birth among bacteriuric and nonbacteriuric pregnant women

OBJECTIVES: To determine the magnitude of and factors associated with spousal abuse during pregnancy in women presenting to tertiary care hospitals in Karachi, Pakistan. METHODS: Five hundred women who delivered a live singleton baby were interviewed. Physical and/or emotional abuse during pregnancy (PEAP) was the primary outcome measure as determined by the World Health Organization's domestic violence module. Frequencies of different forms of abuse were measured and the relationship between PEAP and the risk factors was determined using multiple logistic regression. RESULTS: Of the women interviewed, 44% reported abuse during the index pregnancy; and of these, 43% experienced emotional abuse and 12.6% reported physical abuse. Factors independently associated with PEAP were number of living children (adjusted odds ratio [AOR] 1.34; CI, 1.08-1.65), interfamilial conflicts (AOR 3.03; CI, 1.85-4.96), husband's exposure to maternal abuse (AOR, 2.38; CI, 1.41-4.02), and husband's use of tobacco (AOR 1.59; CI, 1.05-2.42). Women who had adequate social support were less likely to be abused by their husbands (AOR 0.65; CI, 0.51-0.82). CONCLUSIONS: Almost half of the pregnant women interviewed were either physically or emotionally abused. Strong social support helps protect against abuse.     

碱性成纤维细胞生长因子在肺炎链球菌脑膜炎大鼠室管膜下区表达的动态变化

目的探讨肺炎链球菌脑膜炎大鼠碱性成纤维细胞生长因子(bFGF)在脑组织神经发生区域室管膜下区(SVZ)表达的特点。方法取3周龄SD大鼠36只,随机分为感染组和对照组,感染组用肺炎链球菌Ⅲ型菌悬液脑池内注射,对照组用等量9g/L盐水脑池内注射,建立肺炎链球菌脑膜炎模型和正常对照模型,分别于接种肺炎链球菌Ⅲ型菌悬液或注射9g/L盐水24、72h和第6天经多聚甲醛灌流内固定后取脑,采用免疫组织化学染色技术和图像分析,观察不同时间点bFGF在SVZ表达的变化。结果肺炎链球菌感染后24h,SVZ区bFGF表达明显增加,表现为bFGF阳性细胞着色较深,数量明显增加,与对照组比较有显著性差异(P<0.01);感染后72h表达逐渐下降,与24h比较差异有显著性(P<0.01),但仍高于对照组。感染第6天bFGF降至正常水平,与对照组比较无显著性差异(P>0.05)。感染组大鼠侧脑室脉络丛、蛛网膜下腔渗出的中性粒细胞和巨噬细胞也有bFGF表达,对照组未见炎性渗出。结论肺炎链球菌脑膜炎病程中,SVZ区bFGF表达升高可能对促进神经前体细胞增殖、SVZ区神经发生发挥重要作用,有利于脑神经元的再生和修复,可能是脑膜炎脑损伤后机体的自我保护机制之一。     

Perianal cellulitis in children caused by group A streptococcus

The diagnosis of perianal cellulitis caused by group A streptococcus is often missed because of lack of awareness of this clinical entity. Over an 8-year period 20 children were treated for this condition. Their symptoms had all followed a protracted course because of a failure to identify the underlying pathology. The diagnosis should be suspected when there is perianal cellulitis, often accompanied by an anal fissure or superficial cracking of the skin, which goes on to follow a chronic course. All children responded to penicillin V, but a 3-week course was required in most, and in one-third of the patients a second course was necessary. In light of this experience, co-amoxiclav would be a more appropriate antibiotic. Correspondence to: G. A. MacKinlay     

The importance of serum creatine phosphokinase level in the early diagnosis and microbiological evaluation of necrotizing fasciitis

BACKGROUND: Necrotizing fasciitis (NF) due to group A beta-haemolytic streptococci (GAS) is a rare but still life-threatening soft-tissue infection characterized by rapidly spreading necrosis of the muscle fascia and of the surrounding tissues. NF other than that due to GAS involves the participation of one or more anaerobes and/or of non-group A streptococci, Staphylococcus aureus, enteric organisms, and may be associated with a better outcome. Early diagnosis and treatment, consisting of surgical debridement along with appropriate antibiotic therapy, are required to reduce morbidity and mortality rates. OBJECTIVES: The aim of the study was to analyse the clinical and laboratory findings of patients with GAS NF and with non-GAS NF, and to identify which characteristics could help to diagnose NF in the early stages of infection. METHODS: We retrospectively analysed the clinical and laboratory findings of 43 cases of GAS and non-GAS NF that occurred in Belgium (n = 32) and at Saga Medical School (Japan) (n = 11) between May 1984 and December 2001. RESULTS: GAS NF more frequently occurred in previously healthy individuals than NF due to other pathogens (P < 0.05) but was associated with a poorer prognosis. Both for patients with GAS NF and with non-GAS NF, the first clinical manifestations often suggested a diagnosis of erysipelas or cellulitis and rarely evoked the correct diagnosis (12% and 15% of the cases, respectively). However, we found that creatine phosphokinase (CPK) values were far higher in patients with GAS NF than in those with non-GAS NF. CONCLUSIONS: Our data suggest that GAS may exert particular tropism and/or toxicity for muscle, responsible for early muscle necrosis. This indicates that elevated levels of CPK in a patient with erysipelas or cellulitis-like symptoms should clearly prompt the clinician to exclude the diagnosis of GAS NF.     

Risk factors for pediatric invasive group A streptococcal disease

Invasive group A Streptococcus (GAS) infections can be fatal and can occur in healthy children. A case-control study identified factors associated with pediatric disease. Case-patients were identified when Streptococcus pyogenes was isolated from a normally sterile site, and matched controls (>or=2) were identified by using sequential-digit dialing. All participants were noninstitutionalized surveillance-area residents <18 years of age. Conditional regression identified factors associated with invasive disease: other children living in the home (odds ratio [OR]=16.85, p=0.0002) and new use of nonsteroidal antiinflammatory drugs (OR=10.64, p=0.005) were associated with increased risk. More rooms in the home (OR=0.67, p=0.03) and household member(s) with runny nose (OR=0.09, p=0.002) were associated with decreased risk. Among children, household-level characteristics that influence exposure to GAS most affect development of invasive disease.     

Streptococcal toxic shock syndrome in children without skin and soft tissue infection: report of four cases

Streptococcal toxic shock syndrome is a fulminant, highly fatal disease characterized by evidence of group A beta-haemolytic streptococcus infection and early shock with consecutive organ failure. In adults, affected individuals usually have preceding skin or soft tissue infection. However, in paediatric patients, except for varicella, the background focus is usually respiratory tract infection, and early diagnosis of streptococcal toxic shock syndrome in such patients is difficult. We report four previously healthy children with streptococcal toxic shock syndrome. Pharyngitis was identified in three cases. All of them had constitutional symptoms such as fever, vomiting, diarrhoea, abdominal pain and physical findings of tachycardia and diffuse abdominal tenderness, but no concomitant skin infection. CONCLUSION: Streptococcal toxic shock syndrome should be considered in paediatric patients with fever, vomiting, diarrhoea, abdominal pain and early shock. Early diagnosis, prompt initiation of antibiotics and aggressive fluid therapy are lifesaving for such patients.     

Reduction in pediatric hospitalizations for varicella-related invasive group A streptococcal infections in the varicella vaccine era

OBJECTIVES: To assess changes in hospitalization rates for invasive group A streptococcal (IGAS) and varicella-associated IGAS (VA-IGAS) infections at a pediatric hospital over a period of 9 years, to characterize clinical features of patients with IGAS infections, and to assess frequency of macrolide-resistant IGAS isolates.Study design Medical records of all hospitalized patients with group A streptococcus isolated from a normally sterile site from 1993 to 2001 were reviewed. Data collected included demographics, clinical course, microbiologic features, outcome, and presence of streptococcal toxic shock syndrome (STSS) or necrotizing fasciitis (NF). Annual hospitalization rates for IGAS were determined. RESULTS: There were 144 patients with IGAS infections, including 11 (8%) with STSS or NF. Overall mortality rate was 2% (3/144) but 18% (2/11) among patients with STSS or NF. Preexisting varicella was present in 16% (23/144); 4 of 23 VA-IGAS cases had STSS or NF. Although there was no change in annual hospitalization rates for IGAS infections during the study period, the percentage of VA-IGAS hospitalizations decreased from 27% in the prevaccine era (1993 to 1995), to 16% during vaccine implementation (1996 to 1998) and 2% during widespread vaccine use (1999 to 2001) (linear-by-linear association, P=.001). Macrolide resistance was low in 1993 to 1995 (5%, 1/19) and 1996 to 1998 (0%, 0/42) among tested IGAS isolates and increased significantly in 1999 to 2001 (13%, 5/38) (Fisher exact, P=.035). CONCLUSIONS: A decline in pediatric varicella-related IGAS hospitalizations was temporally associated with utilization of varicella vaccine. These data reinforce the importance of universal varicella vaccination for children. Increasing macrolide resistance among IGAS isolates indicates a need for continued surveillance.     

Splenic abscess caused by group A beta-haemolytic streptococcus

A case of a pyoderma complicated with splenic abscess and bacteraemia caused by group A streptococcus was treated successfully with antibiotics alone for 4 weeks. To our knowledge, this is the first reported case of splenic abscess associated with group A streptococcal bacteraemia. Advances in antibiotic therapy and imaging techniques have improved the management and outcomes of splenic abscesses. Clinicians should be aware of the possibility of splenic abscess after a pyoderma or a sepsis-like episode. CONCLUSION: Splenic abscesses can be diagnosed by serial ultrasound or CT scan examinations and should be treated with antibiotics for 4-6 weeks.