小儿急性呼吸道病毒感染和细菌感染的鉴别诊断

随着小儿其它急性传染病的控制,急性呼吸道感染(ARI)已列居感染性疾病的首位。引起ARI 的病原大约80～90%为病毒(发展中国家细菌性比例较高),其次是细菌。而支原体、霉菌、原虫等也能引起ARI。为指导基层临床治疗,概括为三种情况,即病毒感染、细菌感染和病毒、细菌混合感染。现将基层儿科工作者如何鉴别诊断谈几点体会。一、病史重点应注意以下几点。1.年龄与发病季节:病毒感染主要侵犯小年龄组,7～14岁显著减少;而细菌特别是支原体则随年龄增长而增加。混合感染特别多见于婴幼儿,其发病率较学龄儿童高3倍以上,而肺炎的发病率则大42倍。腺病毒3型引起咽结合膜热多发生于春季,柯萨奇A 组病毒引起的疱疹性咽峡炎多发生在夏秋季,而轮状病毒引起的感染高峰在晚秋,流感病毒流行季节多集中在冬末春初,而鼻     

MxA蛋白在病毒、细菌感染鉴别中的应用

目的：探讨血MxA蛋白鉴别病毒与细菌感染诊断指标的应用价值。方法：采用流式细胞仪检测64例患儿血淋巴细胞中MxA蛋白和血清C－反应蛋白（CRP）。结果：病毒感染组血MxA蛋白与对照组相比显著升高（P＜0．01），细胞感染组与对照组相比无显著差异；细菌感染组和腺病毒组血清CRP显著高于对照组（P＜0．01），其它病毒感染组CRP未见升高。结论：作为病毒与细菌感染鉴别诊断指标，MxA蛋白较CRP更具有意义。     

小儿急性呼吸道感染与病毒

自从应用组织培养方法于病毒方面的研究以来,打开了发展病毒学的道路。近年在呼吸道病毒的研究方面,又有了新的进展。病毒感染对于小儿急性呼吸道疾病(以下简称ARD)的重要性,逐渐有了明确的认识。根据多数的报导来看,病毒感染约占小儿ARD的20～50％,其中现已发现的病毒约占60～70％,尚有一些病毒有待今后继续研究和鉴定。     

小儿急性发热的常见病因分析

急性发热是小儿最常见的临床症状之一,常指直肠肛门的温度≥38℃,持续时间不超过1周.特别是年龄在1～5岁的小儿,急性发热以及与之相关的各种发热性疾病和危重症的鉴别对儿科临床有重要意义.     

小儿急性瘫痪的诊断与鉴别诊断

瘫痪是小儿神经系统疾病常见症状之一 ,临床上以随意肌运动障碍为特征 ,表现为肢体、躯干或面部肌肉活动减弱或消失 ,伴或不伴感觉功能障碍。临床根据肌力大小 ,将瘫痪分为完全性瘫痪 (0级 )、接近完全性瘫痪 (1级 )、重度瘫痪(2级 )、中度瘫痪 (3级 )、轻度瘫痪 (4级 )等。遗传因素或先天因素引起的慢性瘫痪 (如进行性肌营养不良、脊肌萎缩症、脑性瘫痪等 )已被儿科工作者熟知 ,但部分获得性急性瘫痪诊断较为困难 ,特别是近年来十分强调急性弛缓性麻痹(acuteflaccidparalysis,AFP)的报告制度 ,使急性瘫痪的鉴别诊断显得更为重要 ,因此很…     

小儿急性阑尾炎的诊断与鉴别诊断

小儿急性阑尾炎是小儿外科最常见的急腹症之一,早期正确诊断是合理治疗必要的前提,但是目前诊断与鉴别诊断仍然存在许多问题.充分了解小儿急性阑尾炎的临床特点及需要鉴别诊断的内外科疾病,通过典型临床症状、仔细的体格检查、实验室及影像学检查综合评估,能够正确诊断该病,必要时可以采用腹腔镜检查明确诊断.     

小儿常见非病毒感染性疾病引起的肝脾肿大

1　细菌感染1.1　伤寒　伤寒的肝损害可能与伤寒杆菌在肝内繁殖产生高浓度内毒素致炎症反应和细胞损害有关。伤寒的主要病理变化是全身网状内皮系统单核 巨噬细胞的增生反应,其中以肠道最为显著,其次为肝脏、脾脏。肝细胞呈灶性坏死并伴有单核细胞浸润,肝窦扩张和淤血,汇管区炎性细胞浸润,由于肝内巨噬细胞的增生、坏死和单核细胞的浸润,即形成伤寒肉芽肿或伤寒结节。脾脏可见脾窦扩张充血、髓质明显增生、巨噬细胞浸润,并出现伤寒结节。肝脾肿大是儿童伤寒最重要的体征,伤寒肝炎也是儿童伤寒最常见的并发症。儿童伤寒肝大发生率为79 79% ,…     

引起3个月以下婴儿发热的细菌和病毒病原体

作者研究了1982年2～6月和同年9月～次年1月因发热(肛温≥38℃)入檀香山某医院儿科的182例月龄不足3个月病婴的发热原因。入院时除做血、尿常规及胸部X片检查外,均做血、尿、粪和脑脊液的细菌与病毒培养。此外,鼻咽分泌物也做了病毒培养。对部分鼻咽部和粪的病毒培养阳性者,尚检测了急性期与恢复期双份血清的病毒     

小儿发热的诊断

一、有关发热的概念本文是以发热为主要症状,且其发热多持续一定期间,并曾作过各种检查,仍未查明原因者做为诊断对象。大多是除发热外,几乎没有其他症状。有的病例在经过中出现了其他症状有迹可循,可能就不成为诊断上的问题了。     

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。     

Differentiation of bacterial and viral community-acquired pneumonia in children

Background: Microbe‐specific diagnosis of pediatric community‐acquired pneumonia (CAP) and the distinction between typical‐bacterial, atypical‐bacterial and viral cases are difficult. The aim of the present study was to evaluate the role of four serum non‐specific inflammatory markers and their combinations, supplemented by chest radiological findings, in the screening of bacterial etiology of pediatric CAP. Methods: Serum procalcitonin (PCT), serum C‐reactive protein (CRP), blood erythrocyte sedimentation rate (ESR) and white blood cell (WBC) counts were determined in 101 children with CAP, all confirmed on chest radiograph. Evidence of etiology was achieved in 68 patients (67%) mainly using a serologic test panel including 15 pathogens. Results: For the combination of CRP > 100 mg/L, WBC count > 15 × 10⁹/L, PCT > 1.0 ng/mL and ESR > 65 mm/h, the likelihood ratio for a positive test result (LR+) was 2.7 in the distinction between pneumococcal and viral CAP and 3.9 between atypical and viral CAP. If there was a higher value in one of these four parameters (CRP > 200 mg/L, WBC count > 22 × 10⁹/L, PCT > 18 ng/mL or ESR > 90 mm/h) LR+ changed to ≥3.4, which means a significant increase from pre‐test to post‐test disease probability. An alveolar radiological infiltration was associated with higher values in non‐specific inflammatory markers when compared with interstitial infiltrates, but there were no significant associations between radiological and etiological findings. Conclusions: CRP, WBC count, PCT and ESR or their combinations have a limited role in screening between bacterial and viral pediatric CAP. If all or most of these markers are elevated, bacterial etiology is highly probable, but low values do not rule out bacterial etiology.     

小儿急诊发热的处理

小儿发热是儿科最常见的症状之一,正确及时处理发热、并尽快找出相关病因是每位儿科急诊医生必须熟练掌握的技术.发热可出现于多种疾病中,如不及时治疗,极易引起高热惊厥,给儿童的身心带来一定影响.WHO建议,当小儿腋温高于38℃时,应采用安全有效的解热药治疗.     

Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection

Because infants hospitalized with respiratory syncytial virus (RSV) infection frequently receive antibiotics, our study was undertaken to determine what the actual risk of secondary bacterial infections in patients with RSV infection is and what effect antibiotic treatment might have on the course of illness. In a 9-year prospective study of 1706 children hospitalized with acute respiratory illnesses, 565 children had documented RSV infections. A subsequent bacterial infection rarely developed in those with RSV lower respiratory tract disease. The rate of subsequent bacterial infection was 1.2% in the total group of children infected with RSV, and 0.6% in the 352 children who received no antibiotics. A significantly greater proportion (4.5%) of subsequent bacterial infections occurred in infants who received parenteral antibiotics (p = 0.01), and especially in a subgroup who received parenteral antibiotics for 5 or more days (11%, p less than 0.001). We conclude that the risk of secondary bacterial infection appears to be low for most infants with RSV infection. In a few infants given parenteral broad-spectrum antibiotics the risk may be greater, but whether this is related to the antibiotic therapy or to other risk factors is not clear.     

病毒感染与细菌感染患儿血清降钙素原水平比较

目的　比较分析病毒感染与细菌感染患儿血清降钙素原 (PCT)水平 ,探讨血清降钙素原测定在细菌感染中的诊断意义 ,为临床抗生素的使用提供依据。方法　共 85例患儿 ,平均年龄 8.9岁 (10月至 12岁 ) ,其中病毒感染 5 3例 ,细菌感染 32例。采用半定量固相免疫测定法测定患儿血清中的PCT ,PCT水平分为 <0 .5 μg/L,0 .5 μg/L～ ,2 .0 μg/L～ 和≥ 10 μg/L 4个等级。进行 χ2 检验和Ridit分析。结果　细菌感染组患儿血清PCT水平高于病毒感染组 ,差异有显著性意义 (P <0 .0 1)。若以血清PCT≥ 0 .5 μg/L为阳性则诊断小儿细菌感染的敏感性为 87.5 % ,特异性为 92 .1% ,阳性预测值为 73.7% ,阴性预测值为 91.5 % ,阳性拟然比为 4 .6 5 ,阴性拟然比为 0 .15 ,诊断符合率为 83.5 %。结论　血清PCT是小儿细菌感染的敏感标志物之一 ,血清PCT检测有助于细菌感染的诊断 ,并可作为抗生素的使用依据。     

Predicting serious bacterial infection in young children with fever without apparent source

The aim of this study was to design a clinical rule to predict the presence of a serious bacterial infection in children with fever without apparent source. Information was collected from the records of children aged 1-36 mo who attended the paediatric emergency department because of fever without source (temperature > or = 38 degrees C and no apparent source found after evaluation by a general practitioner or history by a paediatrician). Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis and ethmoiditis. Using multivariate logistic regression and the area under the receiver operating characteristic curve (ROC area), the diagnostic value of predictors for serious bacterial infection was judged, resulting in a risk stratification. Twenty-five percent of the 231 patients enrolled in the study (mean age 1.1 y) had a serious bacterial infection. Independent predictors from history and examination included duration of fever, poor micturition, vomiting, age, temperature < 36.7 degrees C or > or = 40 degrees C at examination, chest-wall retractions and poor peripheral circulation (ROC area: 0.75). Independent predictors from laboratory tests were white blood cell count, serum C-reactive protein and the presence of >70 white blood cells in urinalysis (ROC area: 0.83). The risk stratification for serious bacterial infection ranged from 6% to 92%. CONCLUSION: The probability of a serious bacterial infection in the individual patient with fever without source can be estimated more precisely by using a limited number of symptoms, signs and laboratory tests.