医护人员暴发肺炎衣原体肺炎12例临床特征分析

目的总结肺炎衣原体(CP)肺炎暴发流行的临床特征及治疗方法。方法收集2009-01-04—2009-03-01中国医科大学附属第四医院暴发流行的12例医护人员CP肺炎咽试纸标本,应用聚合酶联反应(PCR)检测DNA,使用微量免疫荧光技术检测CP的IgG和IgM抗体,同时对肺高分辨CT结果进行分析,并评价疗效。结果本组暴发流行的CP肺炎其病原学介于CP与鹦鹉热衣原体之间的一种变异的衣原体种,且更倾向于鹦鹉热衣原体。临床表现为乏力10例,周身酸痛10例,发热6例,咳嗽、咳少量白痰2例,心悸、气短2例,皮疹1例,稀水样便1例,12例均无咯血、胸痛、呼吸困难及精神症状,肺部体征均为阴性。所有患者肺部高分辨CT均有改变,表现为多发或单发以小叶为中心阴影和腺泡状结节影3例,病变可发生在两肺各个叶段,多以外、中带分布;以小叶分布的气腔实变和磨玻璃样阴影分别为4例和1例,伴有支气管血管束增厚3例;球形影1例;结节影与实变影混合存在3例。结论医护人员CP肺炎的暴发流行具有群体发病,早期高分辨CT检查更能真实地反映病变大小、多少和分布范围。对氟喹诺酮类联合大环内酯类药物治疗有效。诊断时应与严重急性呼吸综合征、禽流感、支原体肺炎等进行鉴别。     

Orofacial manifestations in patients with inflammatory rheumatic diseases

The main orofacial manifestation of the inflammatory rheumatic diseases is that of Sjögren's syndrome. In addition, there is a constellation of orofacial manifestations of the inflammatory rheumatic diseases, many of which are extra-articular with some constituting presenting signs of the underlying rheumatic disease. This review will discuss the orofacial manifestations in a variety of connective tissue diseases and will also allude to the oral adverse drug reactions that may occur as a consequence of therapy.     

Arthritis associated with Mycoplasma pneumoniae in a pediatric patient: A case report

Introduction:Mycoplasma pneumoniae (MP) infection in infants is usually overlooked and it might result in important complications if left untreated. MP-induced arthritis is probably the least common extrapulmonary manifestation and frequently leads to delays in the diagnosis.Patient concerns:We report the case of a 2-year-old female child admitted in our clinic for prolonged fever (onset 2 weeks before the admission), for which the general practitioner established the diagnosis of acute pharyngitis and recommended antibiotics. But the fever persisted and the patient was referred to a pediatrician.Diagnosis:The laboratory tests revealed leukocytosis with neutrophilia, elevated C-reactive protein and liver cytolysis. The blood and urine cultures, as well as the serological hepatitis B and C, toxoplasmosis, Epstein Barr virus, Rubella, Herpes virus, and cytomegalovirus were negative. The chest X-ray established the diagnosis of pneumonia. The fever persisted for approximately 2 weeks after admission. On the 2nd week of admission, the patient began to experience gait difficulties complaining of pain in the right hip and ankle. The cardiology and pneumology consults revealed no pathological findings. The evolution was favorable after the initiation of Levofloxacin and MP infection was detected as we suspected. Moreover, the ultrasound of the hip revealed a mild joint effusion, while the ankle joint appeared to be normal at ultrasound. Thus, we established the diagnosis of hip and ankle arthritis based on the clinical and ultrasound findings.Interventions:Levofloxacin by vein was continued for 5 days, replaced afterwards with clarithromycin orally for 2 weeks.Outcomes:The gait difficulties persisted for approximately 5 months from the initial diagnosis, and improved once the titer of immunoglobulin M anti-MP antibodies lowered considerably. After more than 8 months, the patient was completely asymptomatic and the immunoglobulin M anti-MP was close to the normal range.Conclusion:The awareness of MP-induced arthritis in children represents the cornerstone in preventing diagnostic delays and initiating the proper treatment.     

Influenza vaccination in children with neurologic or neurodevelopmental disorders

BackgroundChildren with neurologic or neurodevelopmental disorders (NNDDs) are at increased risk of complications from influenza. Although the Advisory Committee on Immunization Practices (ACIP) has recognized NNDDs as high-risk conditions for influenza complications since 2005, little is known about influenza vaccination practices in this population.MethodsCDC collaborated with Family Voices, a national advocacy group for children with special healthcare needs, to recruit parents of children with chronic medical conditions. Parents were surveyed about their knowledge, attitudes, and practices surrounding influenza vaccination. The primary outcome of interest was parental report of vaccination, or intent to vaccinate, at the time of survey participation. CDC also collaborated with the American Academy of Pediatrics to recruit primary care and specialty physicians who provide care for high-risk children, specifically those with neurologic conditions. The primary outcome was physician recognition of ACIP high-risk influenza conditions.Results2138 surveys were completed by parents of children with high-risk conditions, including 1143 with at least one NNDD. Overall, 50% of children with an NNDD were vaccinated, or their parents planned to have them vaccinated against influenza. Among all 2138 children, in multivariable analysis, the presence of a respiratory condition and prior seasonal influenza vaccination was significantly associated with receipt or planned current season influenza vaccination, but the presence of an NNDD was not. 412 pediatricians completed the provider survey. Cerebral palsy was recognized as a high-risk influenza condition by 74% of physician respondents, but epilepsy (51%) and intellectual disability (46%) were less commonly identified.ConclusionsOur estimates of influenza vaccination in children with NNDDs are comparable to published reports of vaccination in healthy children, which continue to be suboptimal. Education of parents of children with NNDDs and healthcare providers about influenza and the benefit of annual influenza vaccination is needed.     

Effect of regional cerebral oximetry to estimate neurologic prognostic outcomes in patients administered targeted temperature management

Purpose

The aim of our study is to research the role and efficacy of cerebral oximetry in predicting neurologic prognosis when applied during TTM to patients experiencing coma after CA.

云南省儿童恙虫病50例临床特征分析

目的了解儿童恙虫病的临床特征,避免漏诊和误诊。方法回顾性分析2018年1月—2019年12月,在昆明市儿童医院住院的50例恙虫病患儿的流行病学资料、临床表现及辅助检查结果。结果50例恙虫病患儿中,男29例、女21例,年龄10个月~13岁,平均年龄5.73岁、年龄中位数5岁;发病月份集中在6—11月,78.0%的患儿在7—9月发病;病例来源于云南省14个地(州、市),均有发热症状;96.0%的患儿来自农村,所有患儿均有草地游玩史,94.0%的有焦痂;患儿存在多脏器损害,其中肝功能损伤41例(82.0%)、呼吸系统受累22例(44.0%)、神经系统受累18例(53.0%)和血液系统受累(血细胞下降、低纤维蛋白血症)46例(92.0%)。结论临床上发现儿童持续反复发热、表现多样和多脏器损害症状应警惕恙虫病,及时询问其流行病学史、仔细查体寻找焦痂、完善相关检查,避免漏诊和误诊。     

Neurological manifestations of hepatitis E virus infection: An overview

Hepatitis E virus (HEV) is an important cause of repeated waterborne outbreaks of acute hepatitis. Recently, several extrahepatic manifestations (EHMs) have been described in patients with HEV infection. Of these, neurological disorders are the most common EHM associated with HEV. The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation. Patients can present with normal liver function tests, which can often be misleading for physicians. There is a paucity of data on HEV-related neurological manifestations; and these data are mostly described as case reports and case series. In this review, we analyzed data of 163 reported cases of HEV-related neurological disorders. The mechanisms of pathogenesis, clinico-demographic profile, and outcomes of the HEV-related neurological disorders are described in this article. Nerve root and plexus disorder were found to be the most commonly reported disease, followed by meningoencephalitis.     

Manifestations cliniques des infections à Chlamydia pneumoniae

Chlamydia pneumoniae is a newly described and ubiquitous bacterium. Most infections are asymptomatic as shown by a high worldwide séroprévalence (> 50% of cases). It is a common cause of acute respiratory infections, mainly pneumonia (> 50% of cases) and other acute respiratory tract infections (25% of acute bronchitis, < 5% of sinusitis, otitis and pharyngitis). About 10% of the community acquired pneumonia cases have been associated with Chlamydia pneumoniae infection. This incidence depends on a cyclic epidemiology with a high incidence for 2 to 3 years-followed by a low prevalence for 3 to 4 years. Most chlamydial infections are mild but occasionnaly severe with death especially in old people. Mostly acute infections are reccurent infections. The seroprevalence is higher in asthmatic patients, its role in acute exacerbation of chronic bronchitis is not definitely established. Extra-respiratory acute infections are less frequent, either fever alone, or cardiovascular diseases (acute myocarditis, pericarditis and endocarditis) or neurological (encephalitis, meningitis or Gudlain-Barré syndrome). In addition, seroepidemiology studies have shown an association with coronary artery disease, Chlamydia pneumoniae was detected in coronary atheroma by immunochemistry, polymerase chain reaction and by electron microscopy. Chlamydia pneumoniae may be involved in the atherosclerotc process. To define the clinical spectrum of infection requires precise laboratory diagnosis, the most efficient tests (PCR, direct immunofluorescence and culture) are done in specialized laboratories, serological tests are less reliable. Macrolides, cyclines and fluoroquinolones are the most potent antibiotics but with differences in vitro within and between these families of antibiotics. Bacteriological failures are described despite the in vitro activity. A lot of questions on clinical aspects, epidemiology and treatement are unanswered, we need more studies.     

Extraintestinal manifestations of granulomatous enterocolitis induced in rabbits by long-term submucosal administration of muramyl dipeptide emulsified with Freund's incomplete adjuvant

We examined whether extraintestinal manifestations of granulomatous enterocolitis in rabbits might be produced by the long-term administration of muramyl dipeptide which represents the basic fragment of the bacterial cell wall, emulsified with Freund's incomplete adjuvant. Muramyl dipeptide emulsion was injected submucosally at six sites in the rectum and colon, 10 cm proximal to the anus, each time with a flexible endoscope. Seven rabbits were injected nine times or more every month, and all were sacrificed 1 month after the last injection. The histological changes in the colon in the seven rabbits were mononuclear cell infiltration, epithelioid granulomas, granulomatous lesion, and denuded and regenerative epithelia, although the changes differed in degree. In five of the seven rabbits, histological examination of the liver showed pericholangitis and periductal fibrosis, findings analogous to sclerosing cholangitis in patients with inflammatory bowel disease. In four of the seven rabbits, fibrosis bridging mainly between portal and portal veins, and, in places, between portal and central veins, was seen. Two of the seven rabbits developed polyarthritis. The histological changes in our model suggest that continuous stimulation with bacterial cell wall fragments may be involved in the extraintestinal manifestations of chronic intestinal inflammation such as that seen in inflammatory bowel disease.