儿童腹泻沙门菌和志贺菌的分布及耐药性分析

目的：儿童腹泻沙门菌和志贺菌的分布及耐药性分析。方法收集2014年5月至2015年10月我院腹泻门诊112例1~8岁患儿粪便标本，用诊断血清和VITEK 2系统进行鉴定并行药敏试验。结果112例患儿粪便标本检出沙门菌78株，志贺菌34株。沙门菌血清型分布主要为B群鼠伤寒沙门菌34株（43.6％）及德尔卑沙门菌11株（14.1％）；D群20株（25.6％）肠炎沙门菌。志贺菌血清型分布主要为31株（91.2％）弗氏志贺菌。78株沙门菌的药敏试验敏感率较高的药物依次为亚胺培南、厄他培南、头孢吡肟、头孢他啶、头孢曲松、左氧氟沙星、哌拉西林／他唑巴坦。34株志贺菌的药敏试验敏感率较高的药物依次为亚胺培南、厄他培南、哌拉西林／他唑巴坦、头孢吡肟、呋喃妥因、头孢他啶。结论儿童腹泻沙门菌检出率最高依次为鼠伤寒、肠炎及德尔卑沙门菌，志贺菌以弗氏志贺菌为主。沙门志贺菌属引起的儿童腹泻抗菌药物敏感率较高的药物为亚胺培南、厄他培南、头孢吡肟、头孢他啶、哌拉西林／他唑巴坦，耐药率较高依次为氨苄西林、氨苄西林／舒巴坦。第三、四代头孢菌素类抗生素可以作为临床经验用药的首选药物，哌拉西林／他唑巴坦治疗效果好，值得推广应用。     

小儿沙门菌感染临床特点及耐药性分析

目的 探讨儿童沙门菌感染的临床特点和耐药情况,为临床诊疗提供帮助。方法 收集2013~2017年经粪便培养出沙门菌阳性的163例住院患儿的临床特征、沙门菌血清型分布情况及药敏试验结果,并进行回顾性分析。结果 163例沙门菌阳性患儿中,≤ 1岁患儿79例（48.5%）;临床表现以发热、腹泻为主,体温 > 39℃达121例（74.2%）,腹泻超过10次/d有52例（31.9%）,且合并呼吸道感染多见,共56例（34.4%）;沙门菌感染好发于夏秋季,5~10月共检出131例（80.4%）。血清分型以鼠伤寒沙门菌、肠炎沙门菌为主,分别为100例（61.3%）、15例（9.2%）;不同血清型沙门菌对头孢噻肟耐药率均在20%以上,对β内酰胺酶抑制剂（阿莫西林/克拉维酸、哌拉西林/他唑巴坦）敏感性较高,尚未出现对碳青霉烯类（亚胺培南）耐药株。结论 ≤ 1岁婴儿夏秋季易感染沙门菌,常见血清型为鼠伤寒沙门菌;临床表现以发热、腹泻为主,合并呼吸道感染多见;沙门菌对三代头孢菌素类的耐药率有所增加,临床治疗应根据药敏试验结果合理使用抗菌药物。     

93例儿童鼠伤寒沙门菌多位点序列分型与临床特征及耐药相关性分析

目的了解儿童鼠伤寒沙门菌多位点序列分型(MLST分型)、临床特征及耐药特性, 为儿童鼠伤寒沙门菌感染诊治提供参考。方法回顾性收集2017年11月至2020年10月福建省妇幼保健院经粪便或血培养确诊鼠伤寒患儿的临床信息, 并对样本中分离的鼠伤寒沙门菌进行MLST分型及药敏试验。使用Kruskal-Wallis检验、χ2检验、Fisher′s精确概率法进行统计学分析。结果 96例患儿分离出鼠伤寒沙门菌, 有效病例93例。其中92例来自粪便培养, 1例来自血培养;男53例(56.99%), 女40例(43.01%);发病年龄主要集中在12.0(8.5, 22.0)月龄, 7月至10月是发病高峰。按MLST分型将患儿分为ST34型(58例)、ST19型(22例)及其他型(13例)。不同MLST分型鼠伤寒沙门菌感染后引起呼吸道症状差异有统计学意义(χ²=17.657, P<0.001), ST34型鼠伤寒沙门菌肠炎者更常伴有呼吸道症状(Cramer V=0.421, P<0.001)。药敏试验:不同MLST分型对氨苄西林(χ²=8.774,...     

2016至2020年上海某三甲儿童专科医院细菌性肠炎病原菌及其临床特征分析

目的探讨儿童细菌性肠炎的病原菌及其耐药情况, 分析儿童细菌性肠炎的临床特征, 为临床诊治提供依据。方法分析总结2016年1月至2020年12月我院就诊治疗的细菌性肠炎患儿的粪培养菌种结构、药物敏感性, 同时对比沙门菌及大肠埃希菌感染患儿的临床特征。结果共173例患儿纳入研究, 年龄21 d～15岁, 中位年龄2.00(1.10, 3.54)岁。夏季及秋季发病比例最高, 分别为40.5%和29.5%。粪便中共培养出173株细菌, 沙门菌148株(85.6%), 大肠埃希菌18株(10.4%), 金黄色葡萄球菌5株, 志贺菌2株。沙门菌感染患儿粪便中白细胞检出比例为101/141(71.6%), 明显高于大肠埃希菌感染者[4/16(25.0%)](χ2=14.1, P<0.001);沙门菌感染患儿外周血C-反应蛋白>8 mg/L比例为88/113(77.9%), 明显高于大肠埃希菌感染者[6/13(46.2%)](χ2=4.63, P=0.03)。沙门菌及大肠埃希菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的敏感性在85%以上;对头孢吡肟、头孢他定及头孢曲松敏感性在75%以上;对氨...     

北京地区儿童感染性腹泻病原学和耐药性分析

目的 研究北京地区儿童急性感染性腹泻的病原学变化、流行病学特征及耐药性变迁情况.方法 对2008年肠道门诊临床初步诊断为急性细菌性腹泻病儿童的新鲜粪便标本进行细菌分离培养和血清分型鉴定,采用纸片扩散法进行药敏试验,并以免疫层析双抗体夹心法定性检测A群轮状病毒抗原.结果 301份粪便培养共检出病原菌4种70株(有1份同时检出2种细菌),检出率为22.9%(69/301)、其中男孩检出48例,女孩21例,男女检出比为2.29:1;2岁以下患儿检出56例(81.2%).检出沙门菌32株(45.7%),志贺菌13株(18.6%),致泻性大肠杆菌6株(8.6%),金黄色葡萄球菌19株(27.1%).13株志贺菌中检出B群9株(69.2%),19株金黄色葡萄球菌中有16株发生于＜1岁组婴儿.沙门菌和志贺菌的耐药率分别为氨苄西林(61.3%、92.3%)、复方新诺明(16.1%、61.5%)、环丙沙星(9.7%、30.8%)、头孢曲松(16.1%、23.1%).301份标本中A群轮状病毒阳性30份,其中同时粪便培养阳性者10份.结论 2008年北京地区儿童细菌性腹泻的病原菌以沙门菌为主,志贺菌属中以B群为主要流行株,两者的易感人群以2岁以下婴幼儿为主,而金黄色葡萄球菌感染以1岁以下婴儿为主;多重耐药仍以志贺菌明显,沙门菌的耐药率有所上升;儿童感染性腹泻中细菌与轮状病毒混合感染的比例上升.     

儿童侵袭性沙门菌感染的临床特点和药物敏感性分析

目的探讨儿童侵袭性沙门菌感染的病原血清型分布及耐药特征。方法回顾分析2012年1月至2015年12月经血液或脓液培养确诊的66例侵袭性沙门菌感染患儿的临床特点、血清型分布和药敏结果。结果 66例患儿中,男48例、女18例,2岁以下43例;住院患儿60例,门诊患儿6例;5—10月份检出者占80.30%。住院患儿主要临床表现为发热55例(91. 67%)、腹痛和/或腹泻32例(53. 33%)、贫血36例(60. 00%)、咳嗽28例(46. 67%)、肝脏肿大24例(40. 00%)、脾脏肿大12例(20.00%)。所有患儿中,白细胞总数升高45例(68.18%),嗜酸性粒细胞比例下降56例(84.85%),其中15例嗜酸性粒细胞消失,超敏C反应蛋白不同程度升高51例(77. 27%)。沙门菌血清型主要分布在D群和B群,分别为26例(39.39%)和22例(33.33%);未检出耐亚胺培南和厄他培南侵袭性沙门菌菌株,检出菌株对头孢吡肟、头孢他啶、头孢曲松和氨曲南的敏感率均70.00%。结论儿童侵袭性沙门菌感染在2岁婴幼儿中最为多见,5—10月份高发,血清型以D群和B群为主,临床表现多样,应结合血清型及药敏结果慎重选择抗生素治疗。     

1997-2006年重庆地区儿童细菌性腹泻病原菌分布与药敏结果分析

目的 探讨重庆地区近10年儿童细菌性腹泻的病原菌分布、流行趋势及药敏变迁等情况.方法 收集重庆医科大学附属儿童医院1997-2006年间以腹泻病住院并经粪便细菌培养确诊为细菌性腹泻的患儿1044例,对其临床资料进行回顾性研究.结果 (1)10年间从11895住院的腹泻患儿中分离出肠道病原菌1044株,总检出率为8.8%,其中包括志贺菌(826株)、沙门菌(90株)、大肠埃希菌(101株)、铜绿假单胞杆菌(21株)和变形杆菌(6株),呈逐年下降趋势.(2)各年均以志贺菌检出占优势,并以福氏Ⅱ型为主(62.3%),且宋内菌的检出构成比逐年上升;8～11月份为检出高峰期,占总检出的58.7%.(3)学龄前期检出率最高(34.4%),青春期最低(1.4%),均以志贺菌为主,而婴儿期以大肠埃希菌感染最显著(占36.4%).(4)氨苄青霉素、利福平、痢特灵、红霉素对所有的细菌都耐药,耐药率都在95%以上,三代头孢的耐药率在3.7%～50.0%;氟喹诺酮类、氨基糖苷类的耐药率分别为21.6%～87.9%、28.6%～92.5%.结论 重庆地区儿童腹泻病原菌的检出呈逐年下降,以志贺菌为主,婴儿期则以大肠埃希菌感染最显著;(2)各抗菌素中,病原菌对三代头孢最敏感,其次为氟喹诺酮类,对氨基糖苷类及其它抗生素耐药.     

1991至2017年某儿童专科医院儿童细菌性腹泻病原菌分布变迁

目的 了解重庆医科大学附属儿童医院(我院)27年儿童细菌性腹泻中肠道病原菌的分布情况。方法 回顾性分析我院1991年1月1日至2017年12月31日以腹泻起病的住院患儿,送检粪便标本的细菌培养阳性的菌株情况。同一患儿同一次住院期间,如多次送检粪便标本且分离出相同的菌株,仅纳入第1次的记录进行分析。截取患儿性别、年龄、居住环境,粪便标本中阳性病原菌的类别和检出时间等。结果 33 957份粪便标本中共分离到肠道病原菌2 409株(7.09%),志贺菌属占78.83%(1 899株),其中以福氏志贺菌为主(87.36%,1 659/1 899株),又以福氏Ⅱ型志贺菌多见(97.17%,1 612/1 659株);沙门菌属占13.24%(319株),其中以鼠伤寒沙门菌为主(69.28%,221/319株);致泻性大肠埃希菌占5.06%(122株),其中以致病性大肠埃希菌为主(77.05%,94/122株)。1995年检出率27.67%(249/900株),2000年前(除1992年)检出率均＞10%,2000年后检出率＜5%;8~10月份病原菌株数和检出率最高。1991至1999年(n=1 860株)、~2008年(n=348株)、~2017年(n=201株)比较,福氏Ⅱ型志贺菌在所有肠道病原菌中的占比由80.48%降至0,鼠伤寒沙门菌占比由4.35%上升至58.71%。婴儿中鼠伤寒沙门菌的占比最高(29.58%),其他年龄段均以福氏Ⅱ型志贺菌占比最高。结论 我院儿童细菌性腹泻的主要病原菌1991至1999年以福氏Ⅱ型志贺菌居多;～2017年以鼠伤寒沙门菌多见。     

1991至2017年某儿童专科医院儿童细菌性腹泻病原菌分布变迁

目的 了解重庆医科大学附属儿童医院(我院)27年儿童细菌性腹泻中肠道病原菌的分布情况。方法 回顾性分析我院1991年1月1日至2017年12月31日以腹泻起病的住院患儿,送检粪便标本的细菌培养阳性的菌株情况。同一患儿同一次住院期间,如多次送检粪便标本且分离出相同的菌株,仅纳入第1次的记录进行分析。截取患儿性别、年龄、居住环境,粪便标本中阳性病原菌的类别和检出时间等。结果 33 957份粪便标本中共分离到肠道病原菌2 409株(7.09%),志贺菌属占78.83%(1 899株),其中以福氏志贺菌为主(87.36%,1 659/1 899株),又以福氏Ⅱ型志贺菌多见(97.17%,1 612/1 659株);沙门菌属占13.24%(319株),其中以鼠伤寒沙门菌为主(69.28%,221/319株);致泻性大肠埃希菌占5.06%(122株),其中以致病性大肠埃希菌为主(77.05%,94/122株)。1995年检出率27.67%(249/900株),2000年前(除1992年)检出率均＞10%,2000年后检出率＜5%;8~10月份病原菌株数和检出率最高。1991至1999年(n=1 860株)、~2008年(n=348株)、~2017年(n=201株)比较,福氏Ⅱ型志贺菌在所有肠道病原菌中的占比由80.48%降至0,鼠伤寒沙门菌占比由4.35%上升至58.71%。婴儿中鼠伤寒沙门菌的占比最高(29.58%),其他年龄段均以福氏Ⅱ型志贺菌占比最高。结论 我院儿童细菌性腹泻的主要病原菌1991至1999年以福氏Ⅱ型志贺菌居多;～2017年以鼠伤寒沙门菌多见。     

儿童非伤寒沙门菌胃肠炎抗感染策略

非伤寒沙门菌(nontyphoidal Salmonella,NTS)属于沙门菌属的肠道沙门菌种,感染人类后主要引起急性胃肠炎的表现,5岁以下儿童易感,夏季多见,腹泻与发热是最常见症状,大便性状多样。最常见的血清型有肠炎沙门菌、鼠伤寒沙门菌和纽波特沙门菌,多数患者仅需补液及纠正电解质紊乱等对症治疗,存在侵袭性感染风险的人群、明确鼠伤寒沙门菌感染应考虑抗菌药物治疗,儿童首选抗生素为三代头孢菌素。近年国内NTS耐药率有增加趋势,疑似感染者尽可能在开始抗感染治疗前完善病原学检测。非伤寒沙门菌感染的临床诊疗仍存在许多争议,提高临床病例病原学确诊率、推广快速病原诊断方法、开展高循证质量临床试验,有助于规范非伤寒沙门菌胃肠炎的诊治。     

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.     

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.     

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.     

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.