761例住院儿童EB病毒感染分析

目的：了解儿童EB病毒（EBV）感染情况,并分析其相关疾病谱,从而为EBV感染及相关疾病的防治提供科学的理论依据。方法：采用real-time PCR法检测2010年8月至2011年7月收治的761例（年龄22 d至14岁）疑似EBV感染儿童血浆中EBV-DNA载量,并对EBV-DNA检查结果及相关疾病进行统计学分析。结果：761例血浆标本中EBV-DNA阳性标本109例,阳性率为14.3%;不同年龄组EBV-DNA阳性检出率差异有统计学意义（P<0.05）,其中婴儿组（<1岁）的阳性检出率最低（P<0.05）;不同季节间阳性检出率差异有统计学意义（P<0.05）,其中夏季阳性检出率高于冬季（P<0.05）。109例阳性标本的EBV-DNA载量范围为2.13～6.69,中位数为3.72。对62例EBV-DNA阳性住院患儿最终临床诊断分析得出,呼吸系统疾病占39%,主要为急性支气管炎、急性上呼吸道感染及急性支气管肺炎。结论：不同年龄组及不同季节间EBV-DNA阳性检出率不同;儿童EBV感染相关疾病以呼吸系统疾病为主;Real-time PCR法检测血浆EBV-DNA有助于临床上EBV感染的早期诊断。     

急性感染性多发性神经根炎患儿空肠弯曲菌感染与抗神经节苷脂GM_1抗体关系

目的：急性感染性多发性神经根炎(GBS)病因尚不清楚,目前认为与感染,尤其与空肠弯曲菌(CJ)感染有关,本文研究CJ感染与神经节苷脂(GM1)损伤的关系,探讨GBS的发病机理。方法：采用酶联免疫吸附试验测定31例GBS患儿(经典型急性感染性多发性神经根炎AIDP 23例,急性运动性轴素神经病AMAN 8例)急性期、恢复期血清和急性期脑脊液CJ-IgG抗体及GM1-IgG、GM1-IgM抗体的变化;并与非GBS神经系统疾病患儿(NGBS组)和10例正常儿童(正常组)对比。结果：AMAN急性期、恢复期血清CJ-IgG抗体水平高于NGBS组(P0.05)。GBS组脑脊液GM1-IgM水平高于NGBS组(P<0.05)。CJ-IgG与GM1-IgG、GM1-IgM具有明显的相关性(R=0.722,P=0.05)。结论：空肠弯曲菌感染是GBS发病的重要病因。神经节苷脂GM1的免疫损伤在GBS发病中起重要作用。     

Measles enteritis in infants and children.

The incidence, mortality and clinical features of measles enteritis were reported among 6484 infants and children admitted to the Pediatric Ward Dr. Pirngadi General Hospital Medan from 1st January 1987 until 31st December 1988. Of these 6484 children, 2685 suffered from gastroenteritis and 82 from measles. There were 31 cases of measles enteritis (1.2% of all gastroenteritis cases or 37.8% of measles cases). Most of measles enteritis cases (74.2%) were in the age group of 6-24 months and no case was found under six months old. The mortality of measles enteritis with bronchopneumonia and encephalitis was 25.0% while the mortality of measles enteritis with bronchopneumonia was 13.3%. There were no deaths in children just with measles enteritis alone. The overall mortality of measles enteritis with or without accompanying disease was 12.9%. The age specific death rate of measles enteritis was highest (23.1%) in the 13-24 month age group.     

The epidemiology and disease burden of rotavirus infection in the Salento peninsula, Italy

The aim of this study was to delineate the epidemiology of rotavirus gastroenteritis in the Salento peninsula, Italy. The study lasted a year and included the gathering of data on hospitalizations for enteritis caused by rotaviruses in the pediatric wards of seven hospitals in the Province of Lecce. During 2004, 7,938 children were hospitalized; 973 of them had gastroenteric symptoms and 202 were positive for rotavirus. The percentage of admissions to hospital was high in autumn and at the beginning of spring. The highest incidence of the disease was observed in children aged between 1 and 2 years, especially males. The morbidity of diarrhea caused by rotavirus followed a seasonal pattern and a distribution in terms of age group and sex that were in line with what has been seen in other geographical areas. In conclusion, on the basis of the data gathered in this study, the cases of acute gastroenteritis seem to represent an important cause of hospitalization in the Salento peninsula.     

Yersinia enterocolitica infection mimicking surgical conditions

Yersinia enteritis may present with alarming gastrointestinal manifestations. The aim of this study was to review the cases of children admitted to a general hospital with a preliminary diagnosis of surgical nature and subsequently proven to be infected by Yersinia enterocolitica. All cases of children aged less than 14 years with stool cultures positive for Y. enterocolitica during the 12-year period January 1993 through December 2004 were analyzed. Y. enterocolitica was isolated from the stools of 71 children with gastrointestinal manifestations; 27 children were treated as outpatients and 44 were hospitalized. Six were admitted to the Pediatric Surgery Department (13.6% of the total hospitalizations and 8.4% of all Y. enterocolitica cases). Four of the Pediatric Surgery patients presented with abdominal pain and right lower quadrant tenderness. The preliminary diagnosis of appendicitis was excluded during hospitalization and none of them underwent appendectomy. The other two children were admitted for vomiting initially attributed to a preceding head injury and for diarrhea and a perianal abscess. Two children were given antibiotics and all had an excellent outcome. Y. enterocolitica enteritis manifestations can infrequently mimic appendicitis or other surgical conditions but should remain in the differential diagnosis of children presenting with an acute abdomen.     

586例急性中毒住院患儿临床特征分析

目的对急性中毒住院患儿的临床特征进行分析,为儿童急性中毒的预防和治疗提供参考。方法回顾性分析重庆医科大学附属儿童医院2006年1月至2015年12月出院并确诊为中毒的586例住院患儿的临床资料。结果 586例患儿中,男354例,女232例;年龄24 d至15.8岁;婴幼儿和学龄前期患儿450例(76.8%);农村患儿463例(79.0%);意外中毒551例(94.0%)。药物、农药、鼠药中毒分别221例(37.7%)、167例(28.5%)和175例(29.9%)。中毒物质在城市和农村患儿的分布差异有统计学意义(P0.01),其中城市中毒患儿以药物为主要中毒物质,农村患儿中农药中毒所占比例最高。药物、农药、鼠药中毒患儿的主要临床表现差异有统计学意义(P0.01),分别以神经系统、消化系统、循环系统症状为主;不同物质中毒患儿治疗总有效率差异无统计学意义。结论儿童急性中毒主要发生在婴幼儿和学龄前儿童;多发生在农村;多为意外中毒;药物中毒是造成急性中毒的主要原因;不同物质所致中毒患儿主要的临床表现不同,但临床治疗的总有效率无明显差异。     

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目的了解博卡病毒(HBOV)在急性喘息患儿中的流行病学特点及病毒载量与相应疾病严重程度的关系。方法收集2011年3月至2011年8月温州育英儿童医院住院部237例急性喘息患儿和同期96例无喘息住院患儿鼻咽部分泌物标本。采用荧光定量多聚酶链反应方法进行HBOV检测。结果 237例急性喘息患儿鼻咽部吸取物中共检出HBOV阳性62例(26.2%),96例无喘息患儿鼻咽部吸取物中,共检出HBOV12例(12.5%),两组HBOV检出率差异有统计学意义(χ2=7.377,P<0.01)。62例HBOV阳性患儿中,28例(45.16%)混合其他病毒感染,其中合并RSV感染21例(33.87%)。RSV单一感染与HBOV单一感染患儿、HBOV单一感染与HBOV混合感染患儿临床资料两两比较,差异无统计学意义(P>0.05)。HBOV阳性患儿的鼻咽部吸取物中病毒载量介于2.59×103～5.36×109拷贝/mL,中位数为6.2×103拷贝/mL(四分位数间距,2.6×103～4.4×104拷贝/mL);HBOV单一感染组患儿疾病严重程度与病毒载量的等级呈显著正相关,相关系数r=0.752(P<0.01);HBOV混合感染组患儿疾病严重程度评分与病毒载量的等级无相关性(P>0.05)。结论 HBOV在急性喘息患儿中流行,是导致婴幼儿喘息的重要病原。HBOV单一感染时其致病作用随着病毒载量等级的升高而增强。     

Low fecal elastase: potentially related to transient small bowel damage resulting from enteric pathogens

Fecal elastase is considered to be a highly sensitive and specific non-invasive exocrine pancreatic function test. However, enteropathy may theoretically cause decreased exocrine pancreatic enzyme secretion through alteration of enteric hormone release. OBJECTIVE: The aim of this study was to evaluate the possible influence of transient small bowel damage on pancreatic elastase secretion. METHODS: We studied 166 children (aged 4 months to 14 years, mean 2 years); 114 of these children had acute enteritis and 52 children were control subjects (with gastro-intestinal symptoms or extra-intestinal diseases). Feces were collected from each patient 3 days after the onset of diarrhea and then tested for fecal elastase, bacterial pathogens, Rotavirus, and Adenovirus. Liquid fecal samples were not considered eligible for elastase measurement. Pancreatic elastase was measured using an ELISA method (Sche.Bo.Tech, Germany). We classified the results, expressed in microg/g stool, as: severe pancreatic insufficiency (<100 microg/g), moderate pancreatic insufficiency (100 to 200 microg/g), and normal (>200 microg/g). RESULTS: In the acute enteritis group we found severe levels in 14 (12%) children, moderate levels in 18 children (16%), and normal levels in 82 children (72%). In contrast, 52 of 52 (100%) control subjects demonstrated normal results. Statistical analysis (Wilcoxon rank test) demonstrated a significant difference between the enteritis and control groups (P < 0.01). Serial measurement of fecal elastase performed in 10 patients with enteritis showed a progressive increase of levels in 6 patients and an early decline with subsequent increases in the other 4 patients. CONCLUSIONS: Transient exocrine pancreatic insufficiency may be present in transient small bowel disease, caused by both bacterial and viral infections, possibly related to reduced enteric CCK secretion.     

空肠弯曲菌脂多糖在空肠弯曲菌诱发周围神经病中的致病作用

目的　探讨空肠弯曲菌 (CJ)中脂多糖 (LPS)成分在CJ诱导的周围神经病致病中的作用。方法　分别用CJPen 19的LPS和CJ免疫大鼠。免疫后取坐骨神经作病理检查 ,通过ELISA法测抗CJLPS抗体滴度 ,将免疫血清神经外膜下注射 ,作病理检查。结果　 1.CJ组坐骨神经原纤维病变率为 11.0 % ,CJLPS组坐骨神经原纤维病变率为 10 .46% ,两者无显著性差异 (P >0 .0 5 )。两组均于免疫 14d后出现病变 ,d3 5达高峰 ;2 .神经外膜下注射免疫血清后CJ组坐骨神经原纤维病变率为 65 .2 % ,CJLPS组坐骨神经原纤维病变率为62 .5 % ,两者之间也无显著性差异 (P >0 .0 5 ) ;3 .血清抗CJLPSIgG、IgM类抗体滴度在两组无显著性差异。IgM滴度于免疫后 14d达最高水平。IgG滴度 14d后上升 ,d3 5达高峰。 结论　CJLPS是CJ诱发免疫性周围神经病的主要致病抗原成分     

临床路径在儿童轮状病毒肠炎患儿中的应用及临床评价

目的：临床路径是一种多学科的、综合性的整体管理方式。本研究旨在评价临床路径在轮状病毒肠炎患儿中应用的效果。方法：将71例轮状病毒肠炎住院患儿作为观察组,按临床路径接受个体化治疗、护理。 同时选取同期75例轮状病毒肠炎住院患儿为对照组,给予传统的治疗、护理方式。结果：与对照组比较,观察组患儿住院日明显缩短,住院费用明显降低,患儿家长满意度明显增加,差异均有统计学意义（P<0.05）。结论：应用临床路径可减少轮状病毒肠炎患儿平均住院日和住院费用,提高护理质量,增加患儿家长的满意度。     

Spectrum of post-enteritic reactive arthritis in childhood

Eleven children (7 boys and 4 girls) suffered from reactive arthropathies following an enteritis. Mean age at onset of disease was 9.7 years (range 3.3-14.5 years). Six children had a classical Reiter's syndrome and two a juvenile spondyloarthritis diagnosed earlier. In 10/11 children, onset of disease was within 5 weeks following a febrile enteritis. The enteritis was confirmed in all 6 cases examined during the first three months after onset of disease. The arthritis was predominantly oligoarticular and affected mostly the joints of the lower extremities and toes. Recurrent enthesopathies and arthralgias occurred in most children. HLA-B27 was positive in 9 (82%). During a follow-up of 0.9 to 6.7 years, arthritis relapsed in most of the patients and 4 children had severe arthritis, and 5 sacroiliitis. Urethritis and occular signs relapsed frequently, but there were no noticeable disabilities. Two other girls had self-limited arthralgia and erythema nodosum following a febrile enteritis. This disease may represent the first stage of the broad clinical spectrum of the reactive arthropathies. In our outpatient clinic of paediatric rheumatology, 9% of 127 patients had reactive arthropathies. They show close relationships to each other and to other HLA-B27-associated spondyloarthropathies. The differentiation of this group of diseases from the juvenile rheumatoid arthritis is possible and relevant.     

轮状病毒肠炎患儿血清及粪便白细胞介素-18和干扰素-γ含量的变化及意义

目的：轮状病毒是世界范围内婴幼儿腹泻的主要病原体之一,但其发病机制尚不完全清楚。该研究旨在探讨急性轮状病毒肠炎患儿血清及粪便上清液中白细胞介素1-8(IL-18)和干扰素γ(IFNγ)含量的变化及临床意义。方法：收集2004年7月至2005年2月间50例因急性轮状病毒肠炎入住兰州大学第一医院及西固区医院儿科的患儿粪便及血清,用酶联免疫吸附试验检测IL-18及IFNγ的含量。选取21例同龄正常儿童血清及粪便作对照。结果：50例急性轮状病毒肠炎患儿的血清及粪便IL-18,IFNγ含量均较正常对照组明显升高(P<0.01或0.05),而且血清IFNγ含量与呕吐次数呈负相关(r=-0.368,P<0.05),粪便IL-18含量与腹泻次数呈负相关(r=-0.414,P<0.05),血清IL18含量与血清IFNγ含量呈正相关性(r=0.416,P<0.05)。结论：IL18及IFNγ在婴幼儿急性轮状病毒感染时血清和粪便中明显升高,且与病情的严重程度有关,可能在轮状病毒感染早期发挥抗病毒作用。     

Bismuth subsalicylate in the treatment of acute diarrhea in children: a clinical study

Bismuth subsalicylate (BSS) and placebo were evaluated in a double-blind, placebo-controlled study as adjunct to rehydration therapy in 123 children, aged 4 to 28 months, hospitalized with acute diarrhea. The dosing regimen was 20 mg/kg five times daily for 5 days. Significant benefits were noted in the BSS group compared with placebo as manifested by decreases in stool frequency and stool weights and an improvement in stool consistency, significant improvement in clinical well-being, and shortening of the disease duration. Patients treated with BSS had a significant reduction in duration of hospital stay (6.9 days) compared with placebo-treated patients (8.5 days). Also, intravenous fluid requirements decreased significantly more rapidly and to a greater degree in the BSS-treated group. Bismuth subsalicylate was associated with clearance of pathogenic Escherichia coli from the stools in 100% of cases but was not different from placebo in rotavirus elimination. Bismuth subsalicylate was well tolerated with no reported adverse effects. Blood bismuth and serum salicylate levels were well below levels considered toxic. In this study, BSS provided effective adjunctive therapy for acute diarrhea, allowing children to get well sooner with less demand on the nursing and hospital staff.     

Diarrheal disease in hospitalized children - importance of the persistent diarrhea

OBJECTIVE: In this paper we aim at analyzing the epidemiological and clinical patterns of children with age below 24 months who were hospitalized with diarrhoea in order to determine the prevalence of persistent diarrhoea (PD). PATIENTS AND METHODS: 300 children with diarrhoea were studied at the General Hospital of Pediatrics - IMIP in Recife, Northeast Brazil, considering the period from July 1993 to March 1994. It was a cross-sectional study. The socio-demographic, clinical and evolutive characteristics of the sample were described. A bidimensional analysis was used to compare the groups with acute and persistent diarrhoea (PD) episodes. The proportion of deaths due to persistent diarrhoea was compared to the proportion of those due to acute diarrhoea. RESULTS: The majority of the children was younger than one year of age and come from low income families living in poor environmental and social conditions. At admission it was observed that the incidence of early weaning was high (44.2%); 71.1% of the children were below the third percentile for weight as compared with the NCHS curve. During the course of PD 33.2% of the children were hospitalized. Dysentery was detected in 52% of the cases. 106 children among the 246 observed (43.1%) recovered before the 14th day, while in 140 children (56.9%) diarrhoea persisted for two more weeks. PD contributed to extend the course of hospitalization and was associated with a higher proportion of fatal cases (72.9%). CONCLUSIONS: The majority of the children was younger than one year of age and come from low income families living in poor environmental and social conditions. PD frequency among the children who were hospitalized was high and accounted for a very high proportion of fatal cases. Inadequate management in the acute phase of diarrhoea was associated with the lengthening of the disease.     

无症状或亚临床感染的COVID-19儿童临床特征分析

目的 分析无症状或亚临床感染的2019冠状病毒病（COVID-19）儿童的临床特点。方法 回顾性分析53例无症状或亚临床感染的COVID-19患儿的临床资料，总结其流行病学史、临床分型、合并感染情况、鼻咽拭子新型冠状病毒（SARS-CoV-2）核酸转阴时间、实验室检查结果、住院天数及治疗转归。结果 无症状或亚临床感染的COVID-19患儿占呼吸内科COVID-19病房住院患儿的30.5%（53/174），均呈家庭聚集性发病，其中无症状感染者35例（66%），亚临床感染者18例（34%）。17例（32%）患儿存在支原体感染。53例患儿鼻咽拭子SARS-CoV-2核酸转阴平均时间为9±4 d，实验室指标多在正常范围内，住院平均时间为11±4 d。18例亚临床感染患儿肺部CT表现为磨玻璃影、条索影、斑片状影，病变相对局限。结论 呼吸内科COVID-19病房住院患儿中无症状或亚临床感染的COVID-19患儿所占比例较高，其传播风险应引起重视，提高有效防护是儿童防御的关键。     

细菌性腹泻病403例病原学检测与临床治疗

目的 提高对感染性腹泻病的临床疗效。方法 应用肠道病原菌常规分离鉴定、药敏试验及临床疗效观察方法。对403例儿童细菌性肠炎患儿的病原学、药敏及治疗进行分析。结果 从823例急性感染性腹泻惠儿粪便中共分离出致泻病原菌403株。其中志贺菌属313株，检出率为38％；沙门菌属35株，检出率4．2％；弧菌属30株，检出率3．6％；气单胞菌属10株，检出率1．2％；类志贺邻单胞菌属ll株，检出率1．4％；侵袭性大肠杆菌5株，检出率0．6％。临床疗效及药敏试验显示，头孢曲松钠是治疗感染性腹泻病的高敏感性药物。结论 志贺菌为陕西地区主要的腹泻病原菌，占总菌株78％；头孢三代药物为当今小儿临床有效治疗药物。     

小儿病毒性腹泻病原谱及临床特征分析

目的　探讨小儿病毒性腹泻病原谱及临床特点。方法　采集400例2016年1至12月吉林省儿童医学中心（长春市儿童医院）住院疑似病毒性腹泻患儿粪便标本,约5 mL,应用酶联免疫吸附试验（ELISA）检测轮状病毒抗原和聚合酶链反应（PCR）方法检测轮状病毒（HRV）、杯状病毒（HUCV）、肠道腺病毒（HADV）和人星状病毒（HAstaV）核酸及基因型,同时收集患儿临床资料。结果　粪便标本HRV、HuCV、EAdV和HAstV总阳性检出率为59%（236例）;4种病毒的阳性检出情况分别为178例（75.42%）、68例（28.81%）、12例（5.08%）和5例（2.12%）,其中双重混合感染占27例（11.42%）;未知病原占164例（41%）。轮状病毒G6（93.63%,147例）、P3（91.08%）和G6［P3］（90.45%）组合为2016年流行优势型,未能分型11.79%。杯状病毒中92.65%为诺如病毒,其中98.41%为GⅡ型。住院病毒性腹泻193例年龄≤24月龄;发病高峰年龄段不同病原不同。发病高峰季为1～3月份和12月份。主要临床表现有腹泻、呕吐和发热等。结论　对于小儿病毒性腹泻,确定未知病原种类,完善病原谱非常必要。病毒性腹泻常伴发肠道外临床表现。     

Campylobacter enteritis. A 3-year experience

Campylobacter jejuni was isolated from 135 infants and children seen at the Oklahoma Children's Memorial Hospital over a 3-year period. The comparative frequency of isolation of C. jejuni, Salmonella, and Shigella were 1.5 percent, 2.2 percent, and 3.1 percent, respectively. Campylobacter enteritis was most prevalent during the warm months from May to October, peaking in July. Seventy percent of the afflicted children were 2 years old or younger; only 13 percent were older than 5 years. There were the usual clinical presentations (acute onset of diarrhea, fever, abdominal pain, and bloody stools) of Campylobacter enteritis, but other, less common, patterns also were seen. These included chronic diarrhea without significant systemic manifestations; asymptomatic bloody stools, particularly in neonates; and fever and abdominal pain without diarrhea. Severe complications included hemolytic-uremic syndrome, sepsis associated with septic arthritis and osteomyelitis, and failure to thrive.     

阿奇霉素对儿童水样便性空肠弯曲菌肠炎的疗效评价

目的 研究阿奇霉素对水样便性空肠弯曲菌肠炎的疗效.方法 31例水样便空肠弯曲菌肠炎住院患儿,经乳胶凝集试验鉴定粪便空肠弯曲菌,随机分成2组.治疗组17例,应用阿奇霉素(因培康)联合黏膜保护剂(思密达)及微生态制剂(培菲康)治疗;对照组14例,仅用黏膜保护剂及微生态制剂.比较两组治疗前后病程、总病程及粪便空肠弯曲菌转阴时间.结果 入院前2组临床资料及生化指标差异均无统计学意义.两组病例均取得良好治疗效果,阿奇霉素组在入院后病程、总病程及粪便空肠弯曲菌转阴时间上均短于对照组,差异有统计学意义(P＜0.01).结论 应用阿奇霉素治疗水样便性空肠弯曲菌肠炎可以缩短病程及粪便空肠弯曲菌转阴时间.     

Clinical severity of Norwalk virus and Sapporo virus gastroenteritis in children in Hokkaido, Japan.

OBJECTIVE: To clarify the clinical significance and etiologic impact of Norwalk virus (NV) and Sapporo virus (SV) in viral gastroenteritis in Japanese children. STUDY DESIGN: Two outbreaks each of NV gastroenteritis and SV gastroenteritis occurring in an infant home in Sapporo, Japan, as well as 95 hospitalized children with acute gastroenteritis were retrospectively evaluated using a 0- to 20-point clinical severity scoring system. RESULTS: The mean severity scores for NV and SV gastroenteritis outbreaks were 7.9 and 5.2, respectively, as compared with 8.4 for rotavirus A gastroenteritis that occurred in the same infant home. Among 95 hospitalized children with acute gastroenteritis, rotavirus A was detected in 47% followed by NV in 18%. SV was not found. CONCLUSION: Our data indicate that NV can cause severe gastroenteritis and is an important etiologic agent in hospitalized cases, whereas SV causes mild gastroenteritis in Japanese children.