Severe West Nile virus meningoencephalitis in a pediatric renal transplant recipient: successful recovery and long‐term neuropsychological outcome

West Nile Virus is an arbovirus that has rapidly spread throughout the United States since the first case was described in Queens, New York in 1999. There has been increasing reports of both community‐acquired and organ‐derived infections in renal transplant recipients. In immunocompromised individuals, WNV infection is a life‐threatening disease with significant neurological morbidity. We report the only pediatric case of community‐acquired WNV disease in a renal transplant recipient to undergo detailed long‐term neuropsychological assessment. Increased surveillance and prompt treatment of WNV meningoencephalitis is critical, and our report highlights the effectiveness of immunosuppression reduction without compromising allograft outcomes.     

Chikungunya disease among infants in French West Indies during the 2014 outbreak

BackgroundWe aimed to describe the clinical and laboratory features of Chikungunya disease in infants aged from 1 month to 2 years.MethodsThis epidemiologic study was carried out at the Pointe-à-Pitre University Hospital from May to September 2014. We collected data prospectively from infants hospitalized for Chikungunya disease.ResultsA total of 154 infants were included. Hyperthermia was greater than 38.5 °C the first 48 h and during on average 2.7 days. Pain (on mobilization and/or cutaneous hyperesthesia and/or arthralgia) was present in 82% of the cases. Loss of appetite was reported for 62% of the infants. Initial maculopapular erythematous eruption occurred in 69% of the cases. A vesiculobullous eruption was secondarily observed in 7% of the cases. Edema on the feet and/or hands was present in 48% of the cases. Febrile seizure was observed in 12% of the cases. Lymphopenia was the most frequent laboratory finding, present in 94% of the infants. No cases of thrombocytopenia were observed. The reported complications were: bullous epidermolysis, state of epilepticus, and severe acute hepatitis.ConclusionThis study highlights a suggestive clinical presentation of Chikungunya diseases combining pain, fever, tachycardia, foot and/or hand edema. Lymphopenia, monocytosis, and the absence of thrombocytopenia were relevant biological signs.     

High-dose intravenous immunoglobulin treatment in cryptogenic West and Lennox-Gastaut syndrome; an add-on study

In an add-on pilot study, a group of 15 children with cryptogenic and intractable West syndrome (3) and Lennox-Gastaut syndrome (12) received intravenous immunoglobulin (IVIg, 0.4g/kg body weight per day for 5 consecutive days, followed by the same dose once every 2 weeks for 3 months). Five patients had been treated previously with ACTH without success. The reduction in clinical seizures averaged 70%. Electroencephalographic (EEG) recordings revealed a mean reduction in epileptic discharges of 40%. In all 15 patients, acceleration of EEG background activity occurred, and psychomotor development improved. Prior to IVIg administration, CSF examinations were normal. After IVIg administration, the serum total IgG concentration increased by an average of 76%, and the CSF IgG concentration by 44%. According to our data, IVIg crosses the blood-CSF barrier, and might be effective in the treatment of West syndrome and Lennox-Gastaut syndrome. We suggest it should be considered when other treatments, such as ACTH, have failed.     

Assessment of febrile seizures in children

Febrile seizures are the most common form of childhood seizures, affecting 2–5% of all children and usually appearing between 3 months and 5 years of age. Despite its predominantly benign nature, a febrile seizure (FS) is a terrifying experience for most parents. The condition is perhaps one of the most prevalent causes of admittance to pediatric emergency wards worldwide. FS, defined as either simple or complex, may be provoked by any febrile bacterial or (more usually) viral illness. No specific level of fever is required to diagnose FS. It is essential to exclude underlying meningitis in all children with FS, either clinically or, if any doubt remains, by lumbar puncture. There is no evidence, however, to support routine lumbar puncture in all children admitted with simple FS, especially when typical clinical signs of meningitis are lacking. The risk of epilepsy following FS is 1–6%. The association, however small, between FS and epilepsy may demonstrate a genetic link between FS and epilepsy rather than a cause and effect relationship. The effectiveness of prophylactic treatment with medication remains controversial. There is no evidence of the effectiveness of antipyretics in preventing future FS. Prophylactic use of paracetamol, ibuprofen or a combination of both in FS, is thus a questionable practice. There is reason to believe that children who have experienced a simple FS are over-investigated and over-treated. This review aims to provide physicians with adequate knowledge to make rational assessments of children with febrile seizures.     

Childhood Weber-Christian disease: clinical investigation and virus detection

OBJECTIVE: To investigate clinical features of childhood Weber-Christian disease (WCD) and the relationship between WCD and virus. METHODS: The clinical characteristics, laboratory findings, therapy and clinical course of nine patients were reviewed and the viral antigens (EBV, CMV, HSV1 and HSV2) were detected. RESULTS: They were six males and three females with a median age of 9 years. They included four simple and five systemic WCD, and all presented fever and tender subcutaneous nodules. Other clinical features included hepatomegaly in nine patients, splenomegaly in two, lymphadenhypertrophy in six, respiratory system involved in two, gastrointestinal tract involved in two and convulsion and bleeding in one. Anaemia was noted in seven patients, raised ALT in three, hypergammaglobulnaemia in three, proteinuria in one and three of six patients positive of antinuclear antibodies (ANA). No viral antigens were found. Corticosteroids therapy was administrated for all patients, immunoglobulin for two, non-steroidal anti-inflammatory agents for three and cyclophosphamide for one. Five patients released after therapy and three patients died. CONCLUSIONS: WCD is a severe disease characterized by relapsing, febrile subcutaneous nodules and biopsy is needed for early diagnosis. The viral infection may not be associated with WCD.     

重庆地区婴幼儿重症肺炎呼吸道病毒病原分析

目的 了解重庆地区婴幼儿重症肺炎病毒病原的感染情况.方法 2006年12月至2008年3月,取ICU病房收集诊断为重症肺炎患儿的深部气道或机械通气气管导管内吸取物标本119例,采用RT-PCR或PCR方法 检测呼吸道合胞病毒(RSV)、人偏肺病毒(hMPV)、博卡病毒(HBoV)、腺病毒(ADV)、副流感病毒(PIV)1、2、3和流感病毒(IV)A、B等呼吸道病毒病原.结果 119例标本中病毒总检出例数为86例(72.3%),其中RSV检出率最高,为41.2%(49/119).有2种及以上病毒协同感染23例,占26.7%(23/86);RSV阳性中有19例存在协同感染,占38.8%(19/49).69例行细菌检测,其中53例为阳性,阳性率为76.8%.这69例标本中,病毒阳性率为76.8%;病毒细菌双阳性为41例,占59.4%.结论 (1)病毒感染仍是重庆地区婴幼儿重症肺炎的重要病因.(2)BSV是婴幼儿重症肺炎最常见病毒病原,其次为ADV和hMPV.(3)病毒的协同感染较在重症呼吸道患儿中可能较为普遍,但尚无证据说明病毒协同感染可加重病情.     

常规剂量与小剂量促肾上腺皮质激素治疗婴儿痉挛的对照研究

目的：比较常规剂量与小剂量促肾上腺皮质激素（ACTH）治疗婴儿痉挛（West syndrome,WS）疗效及副作用的差异,寻找ACTH的最小有效剂量。方法：采用前瞻性随机对照研究,将30例WS（8例隐原性,22例症状性）随机分为常规剂量组（n=15）或小剂量组（n=15）。常规剂量组ACTH 50 IU/d×2周,随后2周减量至停药;小剂量组每日0.4 IU/kg×2周,若痉挛发作停止,随后2周减量至停药,若未完全控制或无效,加量至每日1 IU/kg 再用2周,随后用2周的时间逐渐减量至停药。比较ACTH两种不同剂量治疗WS的疗效及副作用。结果：常规剂量与小剂量治疗WS的近期疗效相似,有效率分别为53%及60%（P>0.05）,治疗后脑电图变化、痉挛复发及复发时间两组间差异无显著性（P>0.05）。8例完成12个月以上随诊,长期疗效两组间也无差异。ACTH对隐原性WS的有效率及脑电图高峰失律消失例数均高于症状性组（P<0.05）。常规剂量组副作用发生率(93%,14/15)明显高于小剂量组(20%,3/15),常规剂量组中1例出现轻度脑萎缩。结论：ACTH 50 IU/d与每日0.4 IU/kg两种剂量治疗WS的近期及远期疗效相似,对隐原性WS的疗效优于症状性,为避免副作用的发生,ACTH的使用应从小剂量（每日 0.4 IU/kg）开始。［中国当代儿科杂志,2009,11（6）：445-448］     

细菌性血流感染患儿发热程度与预后的关系

目的研究细菌性血流感染患儿入院48 h内发热程度与预后的关系。方法回顾性统计了2008年9月至2016年9月间入住中国医科大学附属盛京医院儿科重症监护病房(PICU)所有诊断为脓毒症的病例资料,筛选出符合细菌性血流感染的病例,根据其入院48 h内最高体温将其分为5组:36.5℃组,36.5℃~组(正常对照),37.5℃~组,38.5℃~组和39.5℃~组,比较5组病死率有无差异。结果符合细菌性血流感染的病例共213例,其中36.5℃组5例,36.5℃~组44例,37.5℃~组73例,38.5℃~组69例,39.5℃~组22例。213例患儿中,死亡48例。5组病死率比较差异有统计学意义(P0.01),其中36.5℃组及39.5℃~组病死率显著高于正常对照组,差异有统计学意义;其他两组(37.5℃~组和38.5℃~组)与正常对照组比较差异无统计学意义。结论细菌性血流感染患儿入院48 h内最高体温低于36.5℃或高于39.5℃者病死率会明显升高。     

儿童不明原因发热357例病因及临床特征分析

目的探讨儿童不明原因发热的病因分布及临床特征, 为儿童不明原因发热的早期诊断提供线索。方法收集2016年1月1日至2020年12月31日复旦大学附属儿科医院357例不明原因发热患儿的病因构成、年龄、性别、病程、住院时间、确诊时间及急性期的炎症因子水平等临床资料行病例对照分析。依据疾病种类分为感染性疾病组(简称感染组)、非感染性炎症性疾病组(简称非感染组)、肿瘤性疾病组(简称肿瘤组)和其他疾病组(简称其他组)。依据年龄分为<1岁组, 1～<3岁组、3～<6岁组、6～<12岁组及12～<18岁组, 组间比较采用Mann-WhitneyU检验、Kruskal-WallisH检验和χ2检验。结果 357例患儿中男217例、女140例, 就诊年龄5.1(2.0, 9.3)岁, 起病年龄3.9(1.3, 9.2)岁, 确诊时间94(66, 213)d, 住院时间8(6, 14)d。感染组163例(45.7%)、非感染组133例(37.2%)、肿瘤组21例(5.9%), 其他组40例(11.2%), 4组间起病年龄差异有统计意义(H=94.01, P<0.01),...     

特殊部位新型隐球菌感染1例并文献复习

目的报道1例原发性腹腔淋巴结新型隐球菌感染的患儿并复习相关文献,旨在加深对该病的理解,为临床医师提供借鉴。方法病例总结和文献综述。结果患儿平素健康,无免疫力缺陷。因持续发热半月余伴腹痛、咳嗽、嗜酸性粒细胞异常增高入院。影像学发现腹腔多个淋巴结肿大,采用抗生素及支持疗法,病情不能缓解,经验性给予抗真菌(氟康唑)治疗,症状好转。行腹腔镜下淋巴结活检术,病理检查证实为新型隐球菌性肉芽肿。继续抗真菌治疗,临床随访半年无复发。结论临床上出现持续发热、嗜酸性粒细胞增高、腹腔淋巴结肿大明显而中毒症状不重的患儿,在考虑可能存在恶性淋巴瘤、结核菌感染的同时,要高度警惕新型隐球菌感染的可能并行经验性抗真菌治疗,而微创手术活检或针刺取材病理学检查是明确这类疾病的可靠方法,值得在临床上推广使用。     

Infectious Complications in Childhood Leukemia

Since children with acute leukemia have prolonged periods of severe neutropenia due to the disease itself or its intensive chemotherapy, they often develop life-threatening infectious complications. A protected environment and prophylactic antibiotics for patients with severe neutropenia have been shown to decrease the incidence of infectious morbidity. In spite of the high mortality rate of infections, on the other hand, their diagnosis is not well established because the percentage of microbiological detectability by blood culture is low. The differentiation of infections may be possible by using some supplementary measures and particular laboratory parameters. Febrile neutropenic patients with leukemia should promptly receive empiric treatment with combinations of two or three broad-spectrum antibiotics that are bactericidal and synergistic toward the presumed pathogens, or with antifungal drugs if patients are resistant to antibiotics, as well as supportive measures such as granulocyte transfusion, intravenous gamma-globulin and granulocyte colony-stimulating factor.     

小儿肛门漏油症47例分析

目的 报告47例小儿肛门漏油症病例，并分析其临床资料，归纳临床表现，制订诊断标准及治疗方案。方法 凡符合诊断标准（肛门不自主油脂溢出；精神、食欲正常，无腹痛、腹泻及便秘等症状，除肛门周围有油脂污染无其他导演体征者；大便外观成形，次数增加或／或成形便表面可见油脂物；粪便涂片检查脂肪球阳性，无其他异常成分；未曾服用减肥药）之患儿均纳入本观察组。并均予以多酶片（每片含胰脂肪200U、胰蛋白酶160U、胃蛋白酶48U、胰淀偻酶1900U）治疗，每次1－2片，每日3次，连续服用10日为1个疗程。结果 本组47例，男40例、女7例，男：女＝5．7：1。47例均小于10岁，其中1－3岁17例占36．18％；－6岁15例占31．91％；－10岁15例占31．92％。病程2例－8个月，其中＜7天20例占42．55％；8－14天5例占10．64％；15－21天5例占10．64％；＞21天17例占36．17％。服用多酶片后显效30例占63．83％；有效10例占21．28％；失访7例占14．89％。结论 小儿肛门漏油症临床表现独特，病因不明，多酶片口服治疗有效。     

小儿病毒性心肌炎与柯萨奇B组病毒抗体的关系探讨

目的探讨柯萨奇 Ｂ组病毒抗体ＩｇＭ测定在心肌炎病原学诊断和临床诊断中的意义。方法１９９６～１９９８年儿科住院病人７０例,分为心肌炎组２０例,疑似心肌炎组２５例,对照组２５例。用间接酶联免疫吸附法（ＥＬＩＳＡ）测定柯萨奇Ｂ组病毒抗体ＩｇＭ和ＩｇＧ。结果柯萨奇Ｂ组病毒抗体ＩｇＭ阳性心肌炎组１１例（５５％）,疑似心肌炎组１１例（４４％）,对照组１１例（４４％）,经统计学处理,其差别无显著性意义。结论用ＥＬＩＳＡ法测定柯萨奇Ｂ组病毒抗体ＩｇＭ,阳性提示有柯萨奇Ｂ组病毒感染,对心肌炎患儿可以作出病因和病原学诊断,但不能以此作为临床诊断心肌炎的依据。     

儿童重症社区获得性肺炎病毒学检测和危险因素分析

目的：了解儿童重症社区获得性肺炎病毒病原谱,探讨儿童重症社区获得性肺炎的危险因素。方法：收集2007年9月至2008年8月1096例社区获得性肺炎患儿的气道抽吸物标本,其中重症社区获得性肺炎100例。采用RT-PCR、PCR或巢式PCR方法对呼吸道病毒进行核酸检测。应用logistic回归法对患儿的临床相关资料进行单因素和多因素分析,以调查重症社区获得性肺炎的危险因素。结果：100例儿童重症社区获得性肺炎标本中,病毒总检出例数为82例(82％),其中RSV检出率最高（37％）,其次为HBoV(25％)和HRV (18％)。2种及2种以上病毒协同感染32例（32%）。Logistic回归分析显示,合并基础疾病及RSV感染为儿童重症社区获得性肺炎发病的危险因素（分别OR=6.623,P<0.01;OR=1.672,P<0.05）,月龄为保护因素（OR=0.475,P<0.01）。结论：RSV是儿童重症社区获得性肺炎最常见病毒病原;合并基础疾病及RSV感染是儿童重症社区获得性肺炎发病的危险因素,月龄为保护因素。     

小儿病毒性心肌炎与柯萨奇B组病毒抗体的关系探讨

目的 探讨柯萨奇B组病毒抗体IgM测定在心肌炎病原学诊断和临床诊断中的意义。方法 1996～1998年儿科住院病人70例,分为心肌炎组20例,疑似心肌炎组25例,对照组25例。用间接酶联免疫吸附法(ELISA)测定柯萨奇B组病毒抗体IgM和IgG。 结果柯萨奇B组病毒抗体IgM阳性心肌炎组11例(55%),疑似心肌炎组11例(44%),对照组11例(44%),经统计学处理,其差别无显著性意义。结论 用ELISA法测定柯萨奇B组病毒抗体IgM,阳性提示有柯萨奇B组病毒感染,对心肌炎患儿可以作出病因和病原学诊断,但不能以此作为临床诊断心肌炎的依据。     

儿童良性黑棘皮病与代谢异常

目的：观察儿童良性黑棘皮病与人体测量指标参数及代谢指标的关系,探讨儿童良性黑棘皮病与代谢性疾病的关系。方法：回顾性分析2007年2月至 2011年10月于我院诊治的29例良性黑棘皮病患儿的临床资料,以同年龄同性别同民族相匹配的32例正常儿童为对照组。比较两组儿童人体肥胖指标（体重指数、腰臀围比、体脂含量及体脂百分比）及代谢指标（血糖、胰岛素水平、血脂系列）等的不同。结果：29例良性黑棘皮病患儿体重指数、体脂含量、体脂百分数、腰臀围比、空腹血糖及胰岛素水平、甘油三酯均高于对照组（P<0.05）,而高密度脂蛋白低于对照组（P<0.05）。29例良性黑棘皮病患儿中,16例存在糖耐量异常,3例确诊为糖尿病（1例1型,2例2型）。结论：儿童良性黑棘皮病与肥胖、胰岛素抵抗及血脂异常密切相关。