Fever as a sign of urinary tract infection

Prevalence of urinary tract infection (UTI) in febrile infants presenting to an emergency department is approximately 3% to 5%, higher than the post-Haemophilus influenza type b era prevalence of occult bacteremia. The majority of young children with febrile UTI arc at risk for kidney damage, especially if diagnosis or treatment is delayed. Fever, however, may be the only sign of UTI in febrile infants, Risk factors include a history of urinary tract anomalies or previous UTI, uncircumcised boys, white patients, age younger than 12 months, the absence of an alter native source for the fever, and height of fever greater than or equal to 39°C. Urine should be obtained for culture because none of the screening tests can rule out UTI definitively. The decision to treat empiric ally should be based tan strong evidence of both pyuria and bacteriuria, Hospital admission is advisable in the child who is dehydrated or toxic-appearing and considered strongly in infants younger than 6 to 12 months of age.     

轮状病毒中枢神经及肺部感染

研究背景 轮状病毒性胃肠炎是婴幼儿期最常见腹泻疾病之一。国内外对轮状病毒中枢神经及肺部感染告道甚少。 研究方法 用电镜、免疫电镜、酶联免疫吸附与阻断试验确诊轮状病毒中枢神经及肺部感染。 研究结果 200例轮状病毒性胃肠炎患儿中,并发轮状病毒性脑膜炎一例,轮状病毒性肺炎2例,其中1例同时合并胸膜炎、胸腔积液。 结论 轮状病毒中枢神经及肺部感染预后良好。     

儿童中枢神经系统感染的抗感染治疗策略

儿童中枢神经系统感染常见,以细菌、病毒和真菌为主,早期表现不典型,病情重、进展快,致残和病死率高,早期合理抗感染治疗是改善预后的关键。本文简要介绍儿童中枢感染的抗感染治疗策略,以对临床诊断治疗有所帮助。     

Neck extensor hypertonia: a clinical sign of insult to the central nervous system of the newborn

Abnormal hypertonia of the neck extensor muscles in newborns may be appreciated by observing spontaneous posture, evaluating resistance to repeated passive flexion of the head, and eliciting the head straightening reflexes. This sign correlates well with other signs of insult to the central nervous system. Of 1743 newborns over 37 wk gestational age, 17 appeared to have signs of cerebral insult according to the classical criteria of abnormal state of consciousness, tone, and reflexes. Of these 17, 12 (70%) had neck extensor hypertonia. 38 newborns appeared to have mild signs of cerebral insult with abnormalities of tone and excitability. Of these 38, 14 (37%) had neck extensor hypertonia. Only 12 (0.7%) of 1655 newborns with otherwise normal neurological examination had neck extensor hypertonia. Further studies are necessary to evaluate the prognostic value of neck extensor hypertonia in the neonatal period.     

Human herpesvirus 7 infection associated with central nervous system manifestations

The clinical features of infection with human herpesvirus 7 (HHV-7) are not well described. Exanthem subitum is the only illness that is confirmed to be caused by HHV-7. We report two children who had exanthem subitum associated with central nervous system manifestations. Two strains of HHV-7 were isolated sequentially from peripheral blood mononuclear cells and saliva of the same child who had exanthem subitum complicated with acute hemiplegia in childhood. Two strains were confirmed to be HHV-7 by means of monoclonal antibodies to human herpesvirus 6 (HHV-6) and HHV-7, polymerase chain reaction, and DNA analysis. During the convalescent period, the antibody titer to HHV-7 rose from less than 1:10 to 1:320, whereas the antibody titer to HHV-6 remained less than 1:10. Another child with exanthem subitum complicated by acute hemiplegia had serologic evidence of primary HHV-7 infection. These two cases demonstrate a new relationship between HHV-7 and central nervous system symptoms. (J PEDIATR 1996;129:301-5)     

肺炎支原体感染性中枢神经系统疾病患儿细胞因子的研究

目的探讨肺炎支原体（mycoplasma pneumoniae,MP）感染性中枢神经系统（central nervous system,CNS）疾病中细胞因子的特异性及可能的发病机制。方法25例MP性CNS感染患儿,按MP感染至CNS出现异常分为：早发组（≤7d）16例、迟发组（〉7d）9例;采用ELISA法检测25例MP性CNS感染患儿、10例病毒性脑炎患儿和10名对照组儿童血浆和脑脊液IL-6、IL-8、IL-18、肿瘤坏死因子α（TNF-α）和转化生长因子β1（TGF-β1）水平并进行比较。结果IL-6和IL-8在MP和病毒性CNS感染的患儿血浆、脑脊液中均升高,与对照组比较差异均有统计学意义（P〈0.05）。IL-18仅在迟发性MP性CNS感染组脑脊液中明显升高,与其他各组比较差异有统计学意义（P〈0.05）;而在血浆中,各组比较差异无统计学意义（P〉0.05）。TNF-α和TGF-β1在各组血浆和脑脊液中水平与对照组比较差异无统计学意义（P〉0.05）。结论IL-6、IL-8和IL-18可能参与MP引起的中枢神经系统感染,但前二者并不具有特异性;IL-18或许是MP引起的迟发性CNS感染较特异性指标;TNF-α和TGF-β1可能不参与其发病机制。     

非化脓性中枢感染中肠道病毒感染的临床研究

目的 分析１９９７年度非化脓性中枢感染中肠道病毒（ＥＶ）感染的临床特点。方法 采用ＲＴ－ＰＣＲ的方法检测１９９７年１２８例非化脓性中枢感染者的ＣＳＦ中ＥＶ ＲＮＡ。结果与我院非化脓性中枢感染季节分布情况比较。结果 本组年龄与ＥＶ感染关系不大,起病早期ＣＳＦ阳性检出高,非化脓性中枢感染与ＥＶ感染关系不大,起病早期ＣＳＦ阳性检出高,非化脓性中枢感染与ＥＶ在ＣＳＦ中检出一致。结论 ＥＶ是小儿时期非化脓性     

肺炎支原体感染患儿神经系统损害17例临床分析

目的　探讨肺炎支原体 (MP)感染引起神经系统损害的临床特点及诊治问题。方法　对 1997年 8月至 2 0 0 2年 8月中国医科大学第二临床学院儿科收治的 17例MP感染导致的神经系统损害患儿进行回顾性临床分析。结果　MP脑炎、脑膜炎 14例 ,占 82 4 % ( 14 / 17) ;脊髓炎 2例 ,占 11 8% ( 2 / 17) ;脑梗死 1例 ,占 5 9% ( 1/ 17)。17例中治愈 12例 ( 70 6 % ) ,好转 2例 ( 11 8% ) ,死亡 3例 ( 17 6 % )。结论　MP感染导致的神经系统损害中以肺炎支原体脑炎占多数 ,且病情重、进展快 ,致残率及病死率高。临床医生对有神经系统损害的患儿应想到MP感染的可能     

The role of lumbar puncture in children with suspected central nervous system infection

Background  

The use of the lumbar puncture in the diagnosis of central nervous system infection in acutely ill children is controversial. Recommendations have been published but it is unclear whether they are being followed.     

山东地区肠道病毒中枢神经系统感染187例分析

目的 探讨山东地区中枢神经系统肠道病毒（EV）感染的实验和临床特点。方法 采用逆转录聚合酶链反应（RT-PCR）和病毒培养技术,检测187例无菌性脑膜炎患儿中,CSF中RT-PCR和病毒培养同时阳性者62例（33.16%)。病毒培养阴性的125例中,RT-PCR阳性93例（74%）;此93例中,4例同时在血清或尿分离到EV,本实验中,RT-PCR检测EV脑膜炎的阳性率为82.89%（155/187）,而病毒培养的阳性率为33.16%(62/187)。包括EV RNA的提取,RT-PCR的全部过程在4小时内可以完成,而病毒培养繁杂,平均需要4.6天得出结果。肠道病毒脑膜炎可以散发或局部暴发,临床特点在各个年龄组有所不同,5岁以内者以发热,呕吐,激惹多见,5岁以上者以头痛,畏光,疲劳,肌痛多见。结论 EV是山东地区无菌性脑膜炎最常见的病原体。临床症状一般较轻,无特异性;RT-PCR检测能快速,敏感的诊断EV感染,快速确诊可减少抗生素的应用和住院天数,有较高的社会效益和经济效益。     

An unusual case of a central nervous system tumor presenting as a chief complaint of depression

Patients presenting to the emergency department with a psychiatric chief complaint often undergo a medical clearance examination. There is much debate in the literature as to the value of routine laboratory and other diagnostic studies in the initial evaluation of these patients. We report on a patient presenting to the pediatric emergency department with a chief complaint of depression who ultimately was found to have diabetes insipidus and a primary intracranial germ cell tumor. Although a rare outcome to a relatively common scenario in the emergency department, this case underscores the value of a detailed history, careful physical examination, and consideration of laboratory and other diagnostic studies in patients presenting to the emergency department for psychiatric evaluation.     

食源性中枢神经系统疾病

某些中枢神经系统疾病可由粪 口感染所致 ,或因致病因子污染食物所致 ,把好饮食这一关可预防许多中枢神经系统疾病。1　肠道病毒感染所致中枢神经系统感染　　经典肠道病毒含脊髓灰质炎病毒 (Ⅰ、Ⅱ、Ⅲ型 )、柯萨奇 (Ｃｏｘｓａｃｋｉｅ)病毒 (Ａ组 1～ 2 4型 ,Ｂ组 1～ 6型 )及埃可(Ｅｃｈｏ)病毒 (1～ 33型 ) ,总共 6 6型。 1976年以后还发现6 8～ 71型新型肠道病毒。肠道病毒有时可致中枢神经系统感染。1 1　急性弛缓性瘫痪 (ＡＦＰ)　肠道病毒可引起肢体不对称性下级神经元瘫痪 (小儿麻痹症 )及脑膜脑炎。由于其减毒活疫苗的广泛使用 …