儿童艰难梭菌肠炎1例报告

正随着抗生素的广泛使用,抗生素相关性腹泻的发病率在儿童逐年上升。艰难梭菌肠炎是目前已知的抗生素相关性腹泻的主要原因之一,占20%~30%,也是伪膜性肠炎的病因。但临床对艰难梭菌肠炎的认识仍不足,经常有漏诊及误诊现象,对患儿造成不良影响。近几年儿童胃肠镜技术的进步及黏膜病理的开展,为联合诊断艰难梭菌肠炎提供了条件。现将笔者医院收治的1例艰难梭菌肠炎病例报告如下。1病历资料患儿女,2岁3个月,主因"腹泻10 d"于2017-04-     

益生菌在儿童抗生素相关性腹泻病的应用

儿童抗生素相关性腹泻(AAD)是指抗生素扰乱和破坏肠道菌群稳态,是儿科临床上最为常见的副反应。艰难梭菌相关性腹泻(CDAD)是AAD中的严重结肠炎类型。抗生素造成肠道菌群的结构改变,多样性减少,菌群组成结构重新分布;宿主肠黏膜免疫应答模式变化,开放病原菌侵入结合位点,诱导耐抗生素机会菌株的定植,感染易感性增高;菌群构成改变,干扰糖和胆汁酸代谢等原因引起腹泻。益生菌早期干预可以有效减低AAD和CDAD的发生率,临床上在使用抗生素同时应用益生菌是合理有效的。     

儿童艰难梭菌感染

随着广谱抗生素的大量使用,艰难梭菌相关性腹泻(CDAD)的发生率明显上升,特别是高毒力株(027/NAP1/BI)在欧美的出现及流行,已经引起全世界的关注.CDAD的临床症状轻重不一,可从轻度腹泻到致死性假膜性肠炎和中毒性巨结肠.CDAD的确诊依赖于实验室检查,包括厌氧菌培养及细胞毒性试验、细菌毒素抗原检测、毒素基因扩增检测.处理包括停用相关抗生素,尽早应用甲硝唑或万古霉素,以及益生菌药物.     

抗生素相关性腹泻

随着抗生素的广泛应用，抗生素相关性腹泻（AAD）日益受到关注，10％－20％的AAD是由难辨梭菌感染引起的，难辨梭菌在健康儿童中的带菌率约为25％－65％，但与儿童腹泻的关系尚有争议，发生AAD的高危因素有使用广谱抗生素，抗生素治疗大于3天，两项以上医学干预措施或伴随疾病，合理使用抗生素，严格控制广谱抗生素的使用是预防AAD的关键，对于轻型AAD，停用抗生素是最有效而简单的治疗措施。     

抗生素相关性腹泻

随着抗生素的广泛应用，抗生素相关性腹泻（ＡＡＤ）日益受到关注。１０％～２０％的ＡＡＤ是由难辨梭菌感染引起的。难辨梭菌在健康儿童中的带菌率约为２５％～６５％，但与儿童腹泻的关系尚有争议。发生ＡＡＤ的高危因素有使用广谱抗生素、抗生素治疗大于３天、两项以上医学干预措施或伴随疾病。合理使用抗生素、严格控制广谱抗生素的使用是预防ＡＡＤ的矢键，对于轻型ＡＡＤ，停用抗生素是最有效而简单的治疗措施。     

与“酪酸梭菌二联活菌散剂预防肺炎儿童抗生素相关性腹泻的多中心随机对照临床试验”一文作者的商榷

张亚明 医师(225300江苏省泰州市人民医院儿科)问: 《中华儿科杂志》2012年第10期第732-736页上刊载的"酪酸梭菌二联活菌散剂预防肺炎儿童抗生素相关性腹泻的多中心随机对照临床试验"[1]一文(以下简称"该文"),通过前瞻性、多中心、中心分层区组随机、空白对照的临床试验方法,对酪酸梭菌二联活菌散剂预防肺炎住院儿童抗生素相关性腹泻(AAD)的疗效和安全性进行了研究,为临床用药提供了理论依据.但仔细阅读,觉得有如下问题值得商榷:该文"对象与方法"小节"2.给药方法和疗程"中说:"两组患儿均常规给予抗生素类药物及肺炎相关对症支持治疗……对照组患儿仅使用抗生素和对症支持治疗".从这段描述中可以看出:研究设计时,试验组193例和对照组179例入组后均应使用抗生素治疗.但"结果"小节的表1"入组以后使用抗生素类别"中,试验组只有129例(79+3 +1 +46)使用抗生素;对照组也只有112例(57+1 +1 +53)使用抗生素."入组以后使用抗生素时间"、"入组以后使用抗生素途径"中亦是如此.不知为何研究方法与结果不符?     

伪膜性肠炎诊疗进展

伪膜性肠炎的发生与抗生素的使用密切相关,其致病菌约100％为艰难梭菌.诊断主要是在临床表现的基础上通过粪便培养、毒素检测、结肠镜检查和(或)组织学检查.一旦确诊或高度怀疑本病,应立即停用原有抗生素,以甲硝唑和(或)万古霉素抗感染治疗,并辅以益生菌及营养支持治疗.近年来,仍出现新型的治疗方案.该文对伪膜性肠炎的相关情况进行阐述,以提高临床医生对其的认识.     

儿童炎症性肠病艰难梭菌感染及其易感因素分析

目的 了解儿童炎症性肠病(inflammatory bowel disease,IBD)中艰难梭菌定植及感染的发生率,评估儿童IBD患者发生艰难梭菌感染(Clostridiumdifficileinfection,CDI)的易感因素.方法 选取62例确诊IBD患儿为IBD组,选择同期因迁延性或慢性腹泻就诊并排除IBD的...     

益生菌对小儿胃肠疾病治疗效果的循证评价

对益生菌治疗小儿胃肠疾病的疗效进行循证评价.使用相关的检索词检索MEDLINE、EMBASE、Cochrane laboratory数据库至2006年12月,获取发表的关于益生菌治疗小儿胃肠疾病的系统评价及随机对照研究,用循证医学的方法分别对益生菌防治小儿急性感染性腹泻、抗生素相关性腹泻、医院相关性腹泻、坏死性小肠结肠炎、肠易激综合征、功能性便秘及幽门螺杆菌感染方面的疗效进行评价.现有的证据显示益生菌在治疗小儿急性感染性腹泻是有效的;使用益生菌能减少小儿抗生素相关性腹泻的发生;在治疗小儿坏死性小肠结肠炎及幽门螺杆菌感染时,使用益生菌有一定疗效,但使用应谨慎;而在防治小儿医院相关性腹泻、肠易激综合征及功能性便秘上,尚无证据显示使用益生菌有效.     

益生菌治疗小儿抗生素相关性腹泻随机对照研究的meta分析

目的 探讨益生菌对小儿抗生素相关性腹泻的疗效.方法 按照系统评价的要求全面检索PubMed,Medline以及EMBASE等1980至2008年所有研究益生菌与小儿抗生素相关性腹泻的随机对照试验文献,对符合纳入标准的9篇文献共计975例患儿进行了meta分析.结果 发表性偏倚分析显示9篇文献的漏斗图是对称的.异质性检验,益生菌治疗组与对照组具有临床及统计学上的同质性,可用固定效应模型进行分析;合并分析显示:合并OR值及95%可信区间为0.22(0.15,0.32),益牛菌治疗组与对照组相比,疗效的差异有统计学意义.结论 从现有的临床证据来看,益生菌治疗小儿抗生素相关性腹泻有效,安全性较高.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.