更昔洛韦治疗小儿水痘合并脑炎

我院2001年5月～2004年8月应用更昔洛韦治疗小儿水痘合并脑炎32例，取得较好疗效，现总结报告如下。     

更昔洛韦治疗流行性腮腺炎合并脑炎临床观察

1999年4月至2001年3月我科收治小儿流行性腮腺炎合并脑膜脑炎共42例。年龄3～14岁,平均8.5岁;男25例,女17例。入选标准:①发热,首诊体温在38 5℃以上;②单侧或双侧腮腺肿胀、触痛,张口或咀嚼时疼痛,腮腺管口红肿;③伴头痛、呕吐、嗜睡、颈抗等神经系统表现;④外周血白细胞在(4.0～8.0)×10~9/L,淋巴细胞相对增高;CRP阴性。其     

更昔洛韦治疗小儿巨细胞病毒性肝炎

目的　了解更昔洛韦对小儿巨细胞病毒性肝炎 (CMV肝炎 )的疗效。方法　将巨细胞病毒性肝炎患儿 47例分为更昔洛韦治疗组 2 7例及病毒唑对照组 2 0例进行比较。结果　治疗组和对照组血CMV -IgM或尿CMV -DNA转阴率分别为 81.5 %和 35 % ,P <0 .0 1;总有效率分别为 88.9%和 2 5 % ,P <0 .0 1。且治疗组血清胆红素 (SB)复常时间及谷丙转氨酶 (ALT)复常时间均较对照组明显缩短。两组治疗过程中部分病例有消化道反应 ,但不严重 ,未观察到对肾脏的毒性反应。结论　更昔洛韦治疗小儿CMV肝炎疗效较好 ,值得在临床进一步推广应用。     

伐昔洛韦治疗水痘40例

目的观察伐昔洛韦治疗水痘的疗效及安全性。方法采用随机开放、平行对照方法,以伐昔洛韦治疗水痘40例为治疗组,与利巴韦林治疗水痘40例为对照组进行疗效比较。结果治疗组d5痊愈率为82.5%,d6痊愈率为95.0%;d4总有效率为100%,与对照组比较差异有显著意义(P<0.01)。结论伐昔洛韦治疗水痘疗效好,安全可靠。     

更昔洛韦治疗小儿轮状病毒肠炎疗效观察

目的探讨更昔洛韦治疗小儿轮状病毒肠炎患儿的发热、腹泻、呕吐等临床表现的疗效及安全性。方法65例8个月至3岁患轮状病毒感染的患儿随机分为治疗组(更昔洛韦)和对照组(炎琥宁)。观察2组治疗前、后发热、吐泻、脱水及电解质紊乱结合变化。结果治疗组,对照组治疗后发热、呕吐、脱水、腹泻次数,血、便常规改变均较治疗前明显减轻,治疗后,更昔洛韦组退热轮状病毒转阴和腹泻次数好转平均时间优于对照组,(P<0.05)。治疗3d后消化道症状的改善总有效率高于对照组。结论更昔洛韦治疗小儿轮状病毒肠炎疗效显著。     

更昔洛韦治疗小儿病毒性呼吸道感染临床观察

儿科以呼吸道感染性疾病多见，而病毒为主要的病原。2004年6～12月我院使用湖北科益药业公司的更昔洛韦（丽科伟），采用随机对照法观察其治疗小儿病毒性呼吸道感染的疗效及安全性，现将结果报告如下。     

Treatment of congenital varicella with acyclovir

We describe three newborns who developed varicella six hours, five or eight days after delivery. Because of the high lethality rate of congenital varicella treatment with acyclovir appeared to be indicated. Acyclovir was administered intravenously in a dosage of 3 X 5, 3 X 7.5, and 3 X 10 mg/kg/day for three to five days. All patients showed prompt clinical improvement and the skin lesions disappeared. Side effects were not observed. Dependent on the dosage radioimmunological determination of acyclovir serum levels revealed basic values between less than 0.34 to 13.9 mumol/l; peak levels ranged from 14.0 to 70.2 mumol/l. Our preliminary results demonstrate that acyclovir can be successfully used to treat congenital varicella. A dosage of at least 3 X 7.5 mg/kg/day is recommended.     

Varicella infection complicated with meningitis after immunization

A healthy 45 month old boy who had received varicella vaccine 21 months previously developed aseptic meningitis along with an episode of varicella. The presence of viral DNA in cerebrospinal fluid (CSF) detected by polymerase chain reaction (PCR) with Southern blot hybridization confirmed the relationship between the symptoms and the CSF pleocytosis. This is the first reported case of this complication of varicella meningitis occurring in a child with documented immunization and seroconversion.     

Ultrasonic evaluation of complicated meningitis

Sixty children of proven meningitis and with clinical suspicion of its complications and open fontanelle were evaluated by real time ultrasound. Twenty of these patients had normal ultrasound findings while 40 showed varied sonographic features suggesting complications of meningitis, e.g., ventricular dilatation, pus in the ventricles, increased periventricular echogenicity, brain abscess, subdural effusion, porencephalic cysts, etc. Ultrasound is very useful in the diagnosis and serial follow up of these complications.     

Primary varicella zoster infection compared to varicella vaccine reactivation associated meningitis in immunocompetent children

We diagnosed varicella zoster virus (VZV) meningitis in a healthy adolescent boy who presented without a rash or fever. We aim to compare VZV reactivation meningitis in children after primary VZV infection and VZV vaccination. We reviewed the literature up until June 2020 using Pubmed/MEDLINE and EMBASE databases using ‘varicella zoster’, ‘meningitis’ and ‘children’ as keywords. Only English articles were included. Twenty‐five cases were included in this review. Children who had VZV reactivation meningitis after vaccination were younger (7 ± 3.4 years vs. 11.9 ± 3.6 years, P = 0.0038), had a shorter interval between first exposure to reactivation (5.6 ± 2.9 years vs. 8.8 ± 3.2 years, P = 0.018) and more likely to have a rash (100% vs. 55%, P = 0.04). VZV reactivation meningitis occurs after both primary VZV infection and VZV vaccination. The absence of exanthem, fever or meningism does not rule out VZV meningitis.     

化脓性脑膜炎合并硬膜下积液80例分析

目的 探讨更合理的化脓性脑膜炎合并硬膜下积液的诊断与治疗方法。方法 收集1992年1月至1999年12月确认为化脓性脑膜炎的病例291例，男188例，女103例，年龄10d至13岁。结果 291例化脓性脑膜炎中并发硬膜下积液者80例，发病率为27．5％，年龄在15d－16个月，均为前囟门未闭的儿童。在并发硬膜下积液的80例中以肺炎双球菌脑膜炎为多，占37例（46．3％），其次为嗜血流感杆菌脑膜炎，21例（26．3％）。不同细菌脑膜炎硬膜下积液的发生率不同。硬膜下积液多出现在病程的4－10d。80例合并硬膜下积液的病人中，单纯性积液7例；硬膜下感染45例；积脓28例，2例死亡。结论 硬膜下积液、感染或积脓的病因尚不明确，可能与化脓性脑膜炎时，脑血管通透性增强，脑血管表浅静脉发生炎性栓塞，细菌随血液循环进入硬膜下腔等因素有关。诊断明确者经过积极合理的治疗，成活者，积液均于6个月内吸收。     

Pneumococcaemia complicated by meningitis.

Meningitis developed in 3 of 14 children with occult pneumococcaemia; in 2 of them it developed while they were being treated with low doses of intravenous penicillin, in the third child it developed at a time when he was not being treated. All children with occult pneumococcaemia should be treated with intravenous penicillin as are those with pneumococcal meningitis.     

Treatment of pneumococcal meningitis with dexamethasone

Our aim was two compare two different dexamethasone administration schedules in pneumococcal meningitis: short course (48h) and long course (96h) treatment. We diagnosed 18 pneumococcal meningitis treated with the two different schedules. We found a statistically significant longer duration of primary fever in patients who received dexamethasone for two days. We found no differences in the appearance of secondary fever, or in the development of severe neurological handicaps, or death between the two groups. We conclude that they are no significant differences between the two treatment schedules and that there is a need for developing early prognostic markers and adjuvant therapies that improve the outcome of patients with pneumococcal meningitis.     

伤寒杆菌败血症并化脓性脑膜炎一例

患儿女,4个月。因发热、咳嗽1d,抽搐2次,伴嗜睡半天于2004年7月25日晚入院。病前1周曾因“感冒”,发热2d。入院时查体:体重7·5kg,体温38·3℃,脉搏210次/min,呼吸100次/min,血压85/55mm Hg(1mm Hg=0·133kPa)。肥胖儿外观,嗜睡,对外界缺乏反应,四肢凉,皮肤发花,无皮疹及出血点,前囟1cm×1cm,稍凹,双眼凝视,瞳孔等大,对光反应存在。口唇稍发绀,颈有抵抗,双肺清,心无杂音,腹平软,肝右肋下3·5cm,脾未触及,四肢肌张力高,腱反射亢进。血常规:Hb95g/L,WBC1·9×109/L,N0·6,L0·3,M0·02,血小板85×109/L。尿、粪常规(-)。血气分析:pH7·3…