新生儿轮状病毒感染合并类白血病反应一例

患儿男,生后4 h,因窒息复苏后反应差人院.系第2胎第1产,胎龄43+3周,剖宫产出生,出生体重2 500 g.Apgar评分1 min 5分,5 min 10分,羊水Ⅲ°浑浊.     

婴儿气管插管吸出痰液内检出耐亚胺培南肺炎克雷伯菌一例

患儿男，10d，早产后发生肺炎并窒息，体温39．5℃，于2006年6月入院治疗。患儿表情淡漠，临床行气管插管。血常规：WBC1．6×10^9／L，N0．76，L0．24；X线检查：双肺纹理明显增多；临床诊断：新生儿肺炎。为有效控制感染，首先选用头孢哌酮治疗4d，效果不佳，后改用亚胺培南治疗7d临床疗效仍不佳，2次从气管插管中吸取痰培养，痰标本按《全国临床检验操作规程》进行处理，使用血平板，[第一段]     

小儿艾滋病合并卡氏肺孢子虫肺炎48例临床诊治体会

获得性免疫缺陷综合征(AIDS)又称艾滋病,是人类免疫缺陷病毒(HIV)感染的一种表现。HIV感染和艾滋病的特点是发生各种各样严重的机会菌和非机会菌感染,卡氏肺孢子虫肺炎(PCP)是最常见的艾滋病相关性机会感染,HIV感染患儿有许多感染性和非感染性肺部合并症,但以PCP、淋巴间质性肺     

人神经干细胞移植治疗重度新生儿缺氧缺血性脑病一例

目的探讨人神经干细胞移植方法治疗重度新生儿缺氧缺血性脑病（HIE）的可行性。方法一例出生75天的重度HIE后遗症患儿,智力运动发育严重滞后,肌张力异常,磁共振图像显示脑实质多发软化灶和萎缩。取孕11周人胚胎前脑细胞,经体外培养扩增为人神经干细胞（neural stem cells,NSCs）,并经患儿脑室穿刺注入。结果移植28天后患儿不仅肌张力显著改善,智力运动发育迅速追赶、接近正常同龄水平。PET显示顶颞叶放射性增加,细胞代谢明显增强,提示植入的细胞存活。结论本例人胚胎来源NSCS移植治疗重度新生儿HIE后遗症,近期临床疗效显著,远期疗效有待进一步观察。     

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...     

Lethal double infection with Acremonium strictum and Aspergillus fumigatus during induction chemotherapy in a child with ALL

Fungal infections are a major cause of morbidity and mortality in patients during chemotherapeutic treatments and malignant hematologic disease. We present a case of a double fungal infection with disseminated Acremonium strictum (A. strictum) and pulmonary Aspergillus fumigatus (A. fumigatus) and its rapid clinical course. A 17-year-old boy with prolonged neutropenia developed a disseminated fungal infection during induction chemotherapy of his acute lymphoblastic leukemia. The infection was rapidly lethal despite neutrophil recovery and early antifungal combination therapy with amphotericin B and caspofungin. Since there are only a few reports about invasive Acremonium infections, we present this case with regard to differences in the clinic pathologic features of Aspergillosis and other opportunistic fungal infections due to Fusarium or Acremonium species.     

Mycoplasma pneumoniae pneumonia in a four-year-old child with transient abscess in the right lower lobe]

The frequency of Mycoplasma pneumoniae infection among community-acquired pneumonia, underestimated for a long time, is now better known. Severe evolution is yet uncommon. Differential diagnosis with Streptococcus pneumoniae is often difficult. CASE REPORT: A 4-year-old child was admitted for a right lower lobe pneumonia, with very high values of white blood cell count and CRP, worsening despite a treatment with high doses of amoxicillin, then with cefotaxime and vancomycin. Diagnosis of M. pneumoniae infection was considered only on the tenth day after admission and confirmed on the thirteenth day. Clinical outcome rapidly improved with macrolide antibiotherapy. Radiologic outcome consisted, two months after the beginning of the pneumonia, in abscess of the right lower lobe, which recovered in one month with continuing oral antibiotherapy. CONCLUSION: Lung abscess is very rare in M. pneumoniae pneumonia, as only two other cases were described in the literature. In all three cases, macrolide therapy was delayed. Those cases highlight the importance of considering M. pneumoniae infection in a beta-lactams-resistant community-acquired pneumonia, whatever its severity may be, and to start macrolide antibiotherapy. Our case also shows the possibility of a conservative treatment in case of pulmonary abscess, if clinical tolerance is good.     

Hemobilia in a child with liver abscess

Hemobilia in children is rare and has so far been described only as a complication of blunt abdominal trauma. A case of hemobilia secondary to liver abscess treated successfully by selective arterial embolization is described. Hemobilia should be considered in any case of gastrointestinal hemorrhage before any operative intervention is undertaken.     

小儿脾脓肿一例

患儿　女 ,3岁半 ,因间断性上腹痛伴不规则发热 5个月入院。入院前曾在外地某医院住院 2个月余 ,住院期间辅助检查示血象升高 ,WBC在 8 5～ 36 6× 10 9/L ,N 0 4～ 0 9,Hb 93～ 130g/L ,ESR 6 8～ 94mm/ 1h ,3次血培养阴性 ,最后B超检查脾内探及一 3 5cm× 1 6cm低回声区 ,疑诊脾脓肿 ,继续保守治疗 ,先后应用“凯福隆、菌必治、优立新、复达欣”等抗生素 ,体温仍在 38℃～ 39℃ ,改用“泰能”后体温一度降为低热 ,应用 1周停药后体温复升 ,遂转入我院。体检 :神志清 ,精神较差 ,营养欠佳 ,面色略黄 ,颈软 ,心肺正常 ,腹部平坦 ,无…     

Methemoglobinemia associated with dapsone therapy in a child with pneumonia and chronic immune thrombocytopenic purpura

This report describes a case of methemoglobinemia in association with dapsone therapy. The patient, an immunocompromised child with chronic immune thrombocytopenic purpura, presented with fever, cough, perioral cyanosis, bilateral lower lobe rales, and low O2 saturation by pulse oximetry (89%). His medications included prednisone and rituximab for chronic immune thrombocytopenic purpura, and dapsone for Pneumocystis carinii pneumonia prophylaxis. Because of his lack of dyspnea and tachypnea, and the temporal association of his perioral cyanosis with the initiation of dapsone therapy, a methemoglobin (MetHb) level was obtained and found to be elevated at 9.6%. The authors discuss the mechanism and treatment of methemoglobinemia secondary to dapsone. They also stress the importance of monitoring for signs and symptoms of methemoglobinemia in immunocompromised patients on dapsone therapy for P. carinii pneumonia prophylaxis.     

Lung abscess in a child with Mycoplasma pneumoniae infection

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in children, while lung abscess is a severe complication of bacterial pneumonias caused mainly by pyogenes. Here we report a previously healthy 10-year-old boy admitted to our unit for a right upper lobe pneumonia, with a 15-day history of fever and cough insensitive to oral amoxicillin and intramuscular ceftriaxone. Chest computed tomography scan revealed that the right upper lobe consolidation was an abscess and that a similar formation was present in the right mid region. Serology allowed the diagnosis of M. pneumoniae infection. The clinical picture rapidly improved after initiation of oral clarithromycin, and radiographic resolution, without sequelae, was observed after 1-month treatment. Lung abscess in children is a rare complication of M. pneumoniae infection and only three previous cases have been described in the literature, all associated with a delayed diagnosis and late initiation of macrolide therapy. A long-term treatment with oral macrolide allows a prompt recovery and restitution ad integrum of the lung.