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.     

儿童艾滋病四例

母婴传播的儿童艾滋病（AIDS）已成为潜在威胁我国儿童健康的重要危险因素。2005年5月至2006年5月我院共收治4例,现报告如下。[第一段]     

儿童原发性肾病综合征合并颅内静脉血栓4例病例报告

目的 通过对原发性肾病综合征合并颅内静脉血栓患儿行临床分析,探讨儿童NS合并颅内静脉血栓早期诊断和治疗的可行方案。方法 纳入2012年1月至2015年9月在上海市儿童医院住院的原发性肾病综合征且经头颅CT和（或）MRI确诊的颅内静脉血栓患儿,对其临床症状、实验室指标、影像学检查结果、疗效及预后进行分析。结果 4例原发性肾病综合征合并颅内静脉血栓患儿进入分析,均为男性,年龄5岁4个月至11岁4个月,出现颅内静脉血栓时间距原发性肾病综合征起病时间为1个月至7年余。4例颅内静脉血栓发病时均有神经精神系统症状,查体均未见神经系统阳性体征。3例在颅内静脉血栓发病期间D-二聚体、纤维蛋白原降解产物（FDP）均升高,抗凝血酶Ⅲ（AT-Ⅲ）下降;确诊后D-二聚体、FDP较前继续升高; 4例血清白蛋白明显降低,总胆固醇明显升高。4例出现颅内静脉血栓临床症状当日或次日均行头颅MRI增强+MRV+MRA检查,3例为左侧乙状静脉窦血栓,1例为脑栓塞。明确颅内静脉血栓诊断后,3例予尿激酶溶栓,低分子肝素钙和双嘧达莫抗凝治疗;1例脑栓塞患儿予对症和抗凝治疗;4例症状均明显改善。3例出院后6~12个月随访头颅MRI增强+MRV显示颅内异常信号均有不同程度吸收。结论 儿童原发性肾病综合征合并 颅内静脉血栓易发生于左侧乙状静脉窦。在原发性肾病综合征病程中如出现神经精神系统症状时,应及时行头颅MRI相关序列检查,有助于颅内静脉血栓早期诊断;早期积极溶栓治疗预后良好。     

儿童糖原累积病4例报告

糖原累积病(glycogen storage disease,GSD)是一类由于先天性酶缺陷造成的糖原代谢障碍疾病,它可以出现机体能量代谢障碍和糖原异常堆积[1].多数属常染色体隐性遗传,少数属X连锁隐性遗传.Von Gierke在1929年首先描述了糖原累积病的临床表现和患者肝、肾组织中糖原堆积的病理改变.根据欧洲资料,其发病率为1/(2万～2.5万).现将我院近年收治的4例糖原累积病报告如下.     

Tuberculous meningitis in native Dutch children: A report of four cases

Although it is believed that in the western countries tuberculosis is a disease confined to high-risk groups such as immigrants, we describe four cases of tuberculous meningitis (TBM) in native Dutch children. The inverse relation between the delay in starting therapy and the clinical outcome makes early diagnosis of TBM essential. The often non-specific presenting symptoms and laboratory results, the time-consuming character of cultures and the unfamiliarity of western medical staff with the disease all may contribute to a delay in diagnosis of TBM. We believe that especially gadolinium-enhanced MRI or contrast-enhanced CT can be very helpful in the early diagnosis. Although not specific, hydrocephalus and basal meningeal enhancement on MRI or CT, together with the clinical suspicion can suggest the diagnosis to such an extent that there is enough reason to start antituberculous treatment.     

偏身肥大症4例

<正>例1:男,1岁2个月,第1胎第1产,足月顺产,生后即发现其左侧上下肢及颜面较右侧肥大,舌左侧较右侧肥厚,随着年龄增大左侧肢体较右侧逐渐增长、增粗,下颏及舌尖渐向右侧偏斜。患儿母亲孕     

偏身肥大症4例

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