儿童艰难梭菌肠炎1例报告

正随着抗生素的广泛使用,抗生素相关性腹泻的发病率在儿童逐年上升。艰难梭菌肠炎是目前已知的抗生素相关性腹泻的主要原因之一,占20%~30%,也是伪膜性肠炎的病因。但临床对艰难梭菌肠炎的认识仍不足,经常有漏诊及误诊现象,对患儿造成不良影响。近几年儿童胃肠镜技术的进步及黏膜病理的开展,为联合诊断艰难梭菌肠炎提供了条件。现将笔者医院收治的1例艰难梭菌肠炎病例报告如下。1病历资料患儿女,2岁3个月,主因"腹泻10 d"于2017-04-     

粪菌移植治疗幼儿严重食物过敏性胃肠病1 例并文献复习

目的探讨严重食物过敏性胃肠病患儿的粪菌移植治疗。方法回顾1例严重食物过敏性胃肠病患儿的粪菌移植治疗过程,并复习相关文献。结果患儿,男,2岁,以肠道感染起病,予以足疗程抗感染及对症支持治疗,腹泻仍迁延不愈,最终给予粪菌移植治疗后,好转出院,随访2个月未见不良反应。检索国外文献,儿童粪菌移植主要应用于难辨梭状芽孢杆菌感染(CDI)和炎症性肠病(IBD)中,有效率分别为90%~100%和55.6%~100%;而国内文献中,粪菌移植在儿童中主要用于CDI和抗生素相关性腹泻病中,有效率100%,均未见严重不良反应。结论粪菌移植治疗儿童严重食物过敏性胃肠病短期安全有效,但其在儿童中的应用技术还不成熟,需要更多、更深入的研究。     

长时间静脉-动脉体外膜肺氧合合并碳青霉烯类耐药肺炎克雷伯菌血流感染一例并文献复习

目的:探讨静脉-动脉体外膜肺氧合(VA-ECMO)患儿合并重症耐药菌感染的临床表现、诊断、治疗及预后,提高临床对ECMO期间重症感染的识别和管理。方法:回顾分析1例9岁VA-ECMO合并耐碳青霉烯类肺炎克雷伯菌血流感染患儿的临床资料。文献复习儿童ECMO支持期间发生血流感染的治疗现状,结合病例总结ECMO治疗时血流感染...     

儿童抗生素相关性艰难梭菌腹泻的病例对照研究

摘要 目的：探讨儿童抗生素相关性腹泻（AAD）中艰难梭菌感染（CDI）的发生情况及临床特点,为抗生素相关CDI的诊治提供依据。方法：纳入2016年6月1日至2017年10月1日在复旦大学附属儿科医院行CD毒素A/B检测和CD厌氧培养且符合AAD诊断标准的住院患儿,排除＜1月龄、粪便常规细菌培养和病毒检测等临床信息不完整的病例,重复病例仅纳入首次诊断AAD时的临床信息。毒素A/B检测阳性或结肠镜检查提示假膜性肠炎者CDI组;余为非CDI组。单人从病志中采集一般资料,基础疾病,出现AAD相关腹泻症状前2个月内的抗生素使用情况,1个月内的治疗和药物使用情况,实验室指标等。结果：符合本文纳入标准的AAD患儿150例,年龄40 d至15岁2月,中位年龄1.4岁,男103例(68.7%)。CDI组24例（16.0%）,非CDI组126例。①CDI组急性腹泻22例（中位腹泻天数8 d）,因克罗恩病导致的慢性腹泻急性加重1例;因结肠息肉导致的迁延性腹泻急性加重1例,发热11例（45.8%）,呕吐8例（33.3%）,腹痛2例（8.3%）,腹胀1例（4.2%）;1例（1/5,20%）结肠镜显示为伪膜性肠炎。②CDI组和非CDI组发病年龄,性别,基础疾病,腹泻前2个月内抗生素应用情况,腹泻前1个月内手术或糖皮质激素、免疫抑制剂和抑酸药应用情况,实验室指标差异无统计学意义(P＞0.05)。多因素logistic分析显示CDI和非CDI临床表现和常规实验室检测指标差异无统计学意义(P＞0.05)。③AAD的主要治疗措施为停用广谱抗生素,益生菌辅助治疗,CDI患儿症状无好转时加用甲硝唑（应用5~7 d后未见明显好转改口服万古霉素）。CDI组腹泻均好转或痊愈,非CDI组117例（94.4%）腹泻症状好转,9例死于腹泻外的其他原因。结论：儿童AAD中 CDI发生率为16.0%,发热、呕吐为最常见的临床表现,经治疗后预后良好,仅凭临床表现和实验室检测指标不能区分儿童ADD中CDI和非CDI。     

7例婴儿急性淋巴细胞白血病的临床分析

目的总结我科7例婴儿急性淋巴细胞白血病(ALL)的临床及实验室检查特点,探讨其治疗及预后的相关因素。方法回顾性分析2011年1月—2017年7月徐州市儿童医院血液肿瘤内科收治的7例婴儿ALL的临床表现、实验室检查、治疗及预后。结果 7例婴儿ALL,初诊年龄3～11个月,平均发病年龄5个月。临床表现为贫血、发热、出血、肝脾肿大,其中1例患儿就诊时白细胞大于300×10~9/L。7例骨髓形态学诊断后进一步完善了免疫学、细胞遗传学、分子生物学检查。免疫分型均为B细胞性ALL,其中有5例患儿存在MLL基因重排。2例患儿诊断后放弃治疗,1例在诱导化疗中放弃治疗,其余4例接受治疗的患儿,例2完全缓解(52个月)至今,例1完全缓解31个月后骨髓复发,例3在诱导缓解后因重症肺部感染死亡,例4诱导缓解后行脐血干细胞移植治疗,随访至今完全缓解(14个月)。结论婴儿ALL儿童白血病中罕见,我科该类患儿占同期初诊白血病的2. 0%,临床特征与其他类型白血病不同,7例中仅4例完成诱导化疗并接受后续化疗,1例缓解后复发,1例早期死亡,仅2例无病生存,预后差,复发率高。     

伪膜性肠炎诊疗进展

伪膜性肠炎的发生与抗生素的使用密切相关,其致病菌约100％为艰难梭菌.诊断主要是在临床表现的基础上通过粪便培养、毒素检测、结肠镜检查和(或)组织学检查.一旦确诊或高度怀疑本病,应立即停用原有抗生素,以甲硝唑和(或)万古霉素抗感染治疗,并辅以益生菌及营养支持治疗.近年来,仍出现新型的治疗方案.该文对伪膜性肠炎的相关情况进行阐述,以提高临床医生对其的认识.     

综合治疗小儿迁延性肠炎临床体会

我科在门诊治疗迁延性肠炎22例,年龄为7～15个月,其中一般肠炎18例,霉菌性肠炎4例。腹泻20天～3个月,粪便黄色稀水样,2～8次/日,粪检有脂肪球及白细胞。霉菌性肠炎粪便似鱼冻样粘     

儿童自身免疫性胶质纤维酸性蛋白星形胶质细胞病1例报告并文献复习

目的分析儿童自身免疫性胶质纤维酸性蛋白胶质细胞病(GFAP-A)的诊断及治疗。方法回顾分析1例自身免疫性GFAP-A患儿的临床资料,并复习相关文献。结果女性患儿,10岁2个月。以发热起病,病程早期出现呼吸困难、尿储留,其后出现进行性意识障碍及惊厥。脑脊液及血液胶质纤维酸性蛋白抗体阳性。头颅磁共振成像(MRI)示双侧丘脑及基底节病变。脊髓平扫加增强示胸段部分脊膜及部分神经根线状强化。患儿最终确诊为GFAP-A,予以丙种球蛋白及激素治疗后病情好转。结论GFAP-A可以脑膜脑炎伴或不伴脊髓炎起病,MRI示脑膜脊膜强化、多发高信号病灶、血管样放射强化,抗体检测有助诊断。     

儿童急性播散性脑脊髓炎十例临床分析及文献回顾

目的 急性播散性脑脊髓炎起病隐匿、临床表现多样化,该研究通过探究儿童急性播散性脑脊髓炎临床特点并文献复习,以提高对该病的诊治水平.方法 回顾性分析我科2002年至2017年收治的10例急性播散性脑脊髓炎患儿的临床表现、实验室检查、治疗及预后并进行文献复习.结果 发热7例,抽搐4例,乏力3例,嗜睡3例,视力障碍3例,意识障碍1例,头痛1例,语言障碍1例,吞咽困难1例;脑压升高4例,脑脊液常规及生化异常6例;头颅MRI均异常,以白质病变为主;脑电图异常3例;血清抗MOG抗体IgG阳性1例.10例患儿均使用大剂量糖皮质激素联合人免疫球蛋白治疗;7例患儿症状好转后出院;1例重症,因呼吸循环衰竭死亡;2例留有不同程度的后遗症.结论 儿童临床表现急性播散性脑脊髓炎表现缺乏特异性,头颅MRI影像学改变可协助诊断,早期糖皮质激素、人免疫球蛋白联合使用安全有效,早期识别并积极治疗可改善其预后.     

儿童金黄色葡萄球菌感染致急性骨髓炎合并脓毒性肺栓塞伴深静脉血栓形成一例临床分析

目的:探讨儿童金黄色葡萄球菌感染引起的急性骨髓炎合并脓毒性肺栓塞(SPE)伴深静脉血栓形成(DVT)的临床特点及诊断、治疗要点。方法:回顾性分析天津市儿童医院重症医学科收治的1例金黄色葡萄球菌感染引起的骨髓炎合并SPE伴DVT患儿的临床特点及随访情况,并复习文献。结果:患儿为13岁女童,以左下肢肿痛、发热、呼吸困难为主...     

Infective endocarditis in children. Apropos of 13 cases

From 1978 through 1987, thirteen pediatric patients aged 14/12 years to 16/12 years were hospitalized for infective endocarditis (IE). Ten cases presented as acute septicemia with modification or development of a murmur and/or heart failure. Three patients had subacute endocarditis. Prior to the endocarditis, ten patients had recognized heart disease, whereas three had no known cardiac abnormality. The organism was recovered in seven cases, from blood cultures in six cases (3 Staphylococcus aureus, 1 group D streptococcus, 1 Staphylococcus albus, and 1 Salmonella typhi) and from a prosthesis in one case (Corynebacterium). Echocardiography confirmed the diagnosis in every patient except the one that had a prosthesis. Although all the patients received parenteral antimicrobial therapy, selected according to bacteriologic data when available, complications developed in every case, including heart failure in nine patients. Three children died, eight underwent valve replacement or repair once the infection was under control, and two have residual valvular disease. This study confirms that, in pediatric patients, the prognosis of IE remains severe despite advances in antimicrobial therapy and the contribution of echocardiography.     

Zenker's diverticulum in childhood: a new case.

Zenker's diverticulum (ZD) is a very rare pathology in childhood and to date only few pediatric cases have been reported in literature. Herein we report on a case of ZD with cervical abscess formation and oral purulent drainage in a 6-year old girl with severe malnutrition. Diverticulectomy was performed as surgical treatment. The patient is free of symptoms after two years' follow-up.     

Endoscopic antireflux surgery leading to obstruction in pediatric renal transplant patients

To describe a multicenter experience with management of ureteral obstruction after injection of Dx/HA for VUR in pediatric renal transplant patients. The records of all pediatric renal transplant patients who underwent Dx/HA injection for VUR and had subsequent obstruction were identified, and the management and outcomes were reviewed. Follow‐up ranged from 1 to 10 years. There were four patients identified, all of whom had a history of rising creatinine, recurrent UTI, and increasing hydronephrosis which led to the diagnosis of high‐grade VUR. Obstruction was diagnosed within 24‐72 hours after injection in three patients. One patient was asymptomatic, and rising creatinine and hydronephrosis were noted 1 month after injection. One patient was managed expectantly, while three patients underwent ureteral stent placement. After the stent was removed, one patient went on to open reimplant due to delayed obstruction, the second patient with voiding dysfunction is currently managed with an indwelling ureteral stent and may require further definitive surgery, the third patient recovered, and the fourth is being observed. Our cases illustrate that despite initial successful management of the obstruction in some, delayed obstruction is possible and may necessitate open reimplant. It is imperative that these patients have close follow‐up after Dx/HA.     

Pyocele of the scrotum in the pediatric patient

Pyocele of the scrotum has been reported but is not well described in the pediatric population. The majority of published cases have been treated definitively with surgical drainage, and the severity of some cases has led to orchiectomy. We report a cases series of four boys with idiopathic pyocele, two of whom were managed successfully without operative intervention. Of these, one case was likely due to hematogenous spread of infection, and one case was secondary to spread of abdominal contamination via a patent processus vaginalis. To our knowledge, this is the first case series reporting non-surgical management of infant pyocele. Although rare, this clinical entity should be considered in the differential diagnosis of acute scrotum in the pediatric patient.     

Malnutrition screening in hospitalized children: influence of the hospital unit on its management]

OBJECTIVES: The aims of this study were to assess the prevalence of malnutrition in a pediatric population hospitalized in a French regional hospital and to evaluate the influence of type of hospital unit (pediatric or not) in the screening and the management of malnutrition. PATIENTS AND METHODS: This one-day cross-sectional survey was performed in three different seasons during 2003. Every child aged 2 months to 16 years old, hospitalized for more than 48 hours was included. Weight for height, Z-score and Body Mass Index Z-score were used for nutritional assessment. Type of hospitalisation unit, date of admission, associated diagnosis, screening and treatment of malnutrition were also taken into account. RESULTS: Two hundred and eighty hospitalized children were undernourished (11%) and thirty-one children were obese (11%) with no difference in prevalence of malnutrition between pediatric and non-pediatric units. At the time of the study, malnutrition was recognized in one third of the children, at a similar rate whatever the type of hospitalized unit. The children hospitalized in pediatrics wards benefited more frequently from nutritional intervention, i.e. dietician care (43 vs. 16% P < 0.01). CONCLUSION: Prevalence of malnutrition in hospitalized children is low and the same in pediatric or non-pediatric units. Screening of malnutrition remains unsatisfactory in hospital. However, malnutrition is more frequently treated in pediatric unit compared with non-pediatric unit.     

Acute gastric volvulus in neonates - a diagnostic dilemma.

INTRODUCTION: Gastric volvulus is a rare, potentially life-threatening condition, which is difficult to diagnose. This study presents a series of acute gastric volvulus in neonates with the aim of describing this rare disease and its varied clinical manifestations. MATERIAL AND METHODS: The data of all neonates presenting with acute gastric volvulus between January 2001 and January 2007 was retrospectively reviewed. Diagnosis was made on suspicion and was documented by a barium study. All patients were operated by open anterior gastropexy with or without a feeding gastrostomy. RESULTS: Four patients were male and 1 was female. All were treated with gastropexy with or without feeding gastrostomy. Four patients recovered well after surgery. There was one postoperative death. CONCLUSION: Gastric volvulus is extremely rare in neonates but it should be considered in the differential diagnosis after sudden onset or recurrent vomiting in the pediatric age group. Early diagnosis and treatment gives excellent results.     

Propylthiouracil hepatotoxicity: two pediatric cases and review of the literature

We have observed isolated hepatotoxicity in two children treated with propylthiouracil (PTU) for hyperthyroidism. Neither patient had risk factors for or clinical evidence of preexisting liver disease. In one patient the drug was promptly discontinued when signs of liver disease were noted. This patient quickly recovered. The second patient continued to receive PTU for several days after developing symptoms. Her illness progressed to fulminant hepatic failure with encephalopathy, and she died. These are the third and fourth pediatric cases reported, and there have been 10 cases reported in adults in the English language literature. Thirteen of the 14 patients are female. The literature regarding all these patients is reviewed. Propylthiouracil may cause lethal hepatic damage. This drug should be discontinued immediately if signs or symptoms of hepatic injury are detected.     

Unusual Cutaneous Toxicity Following Treatment With Dactinomycin: A Report of Two Cases

Dactinomycin-induced cutaneous toxicity is rare in pediatric patients not receiving radiation therapy. We describe dactinomycin-related lesions in the axilla, groin, and central line exit site of two children treated for rhabdomyosarcoma, neither of whom had received radiation treatment. One patient was initially treated with systemic antifungal therapy, and developed recurrent lesions on reexposure to the drug. The other was noted to have mild, diffuse hyperpigmentation. Skin biopsies revealed interface dermatitis with syringometaplasia in both cases. Both children recovered uneventfully within 4 weeks. Recognition of unusual rashes with a characteristic distribution in patients receiving dactinomycin should aid in diagnosis, and help avoid unnecessary therapeutic procedures. © 1995 Wi1ey-Liss, Inc.     

Posterior urethral valves in Senegalese children. Fourteen cases]

Fourteen pediatric cases of posterior urethral valves in patients aged 6 months to 14 years (with four infants and ten older children) are reported. The main symptoms were vesical, including dysuria, acute urinary retention and dribbling. One patient presented with diarrhea, vomiting and dribbling. Urethral valves were looked for as part of the evaluation for urinary lithiasis in one patient, and in another urinary lithiasis developed following the diagnosis of urethral valves. In half the cases, onset of symptoms occurred within one year of birth. Urethrocystography allowed to evidence the valves and to evaluate repercussions on the bladder including hyperplasia (7 cases) and diverticula (2 cases). The intravenous urogram disclosed bilateral ureterohydronephrosis in eight cases. Pathogens recovered from the urine included Klebsiella (3 patients), Pseudomonas (4 patients), Proteus (one patient), and E. coli (one patient). Most patients were treated by catheter lamination under antimicrobial therapy. Two patients died from renal failure. Results were considered satisfactory in nine cases with follow-ups ranging from 1 month to 4 years. Three patients were lost to follow-up. Early diagnosis is essential and management should rely mainly on endoscopic resection which reduces the length of the hospital stay and the risk of infection.     

A review of four cases of Branhamella catarrhalis bacteremia in children

Branhamella catarrhalis was recovered from one blood culture each from three infants and one neonate admitted to the Trousseau Hospital (Paris) between 1986 and 1988. Clinical features included fever in every case, otitis in three cases, pneumonia in two cases, diarrhea in one case, and enterocolitis in one case. All the strains were beta-lactamase producers. Outcome was favorable in every case. The antimicrobial agent used was erythromycin in one case, amoxicillin in one case, and a third generation cephalosporin in two cases. We reviewed the pediatric literature for reports of Branhamella catarrhalis infections that seem more frequent or better detected than previously. The high prevalence of ampicillin-resistant strains is pointed out.