四川凉山地区HIV/AIDS患儿合并支气管扩张症的临床特点分析

目的分析四川凉山地区HIV/AIDS患儿合并支气管扩张症的临床特点。方法回顾性分析2018年1月至2019年12月于凉山彝族自治州越西县第一人民医院感染科住院治疗的HIV/AIDS合并支气管扩张症患儿,共21例。收集患儿基本信息、临床资料和影像学检查资料等。结果21例患儿中,男童10例,女童11例,以7~10岁年龄段为主,HIV感染途径以母婴传播为主。主要临床表现为持续或反复咳嗽、咳痰以及发热、气促等。21例患儿中,有15例患儿的生长发育水平低于正常同龄儿。在合并机会性感染中,以细菌性肺炎的发生率最高,其次依次为结核病、肺孢子菌肺炎。双肺为支气管扩张的最常见受累部位,以混合支气管扩张为主。结论早诊断、早治疗对降低四川凉山地区HIV/AIDS患儿合并支气管扩张症的发病率和病死率具有重要意义。     

Clinical and epidemiological features of HIV-1 seropositive hospitalized Ethiopian children

Eleven children were identified as being seropositive for HIV-1 at the Ethio-Swedish Children's Hospital, Addis Abeba, Ethiopia between January 1988 and September 1989. The diagnosis was confirmed by both ELISA and Western blot methods performed at the National Research Institute of Health, Special Laboratory for AIDS. The mean age was 2 years and 5 months, with a range of 1 week to 10 years. There were 7 boys and 4 girls. The most common admitting diagnoses were pneumonia (5), gastroenteritis (5), marasmus (5), disseminated tuberculosis (4), and abandonment (3). One patient had extensive facial molluscum contagiosum. Symptoms at admission or during hospitalization included diarrhoea (9), failure to thrive (8), fever (7), and cough (7). Physical findings included hepatosplenomegaly (5), lymphadenopathy (3), and oral candidiasis (2). No patient with an opportunistic infection or radiographic evidence of lymphocytic interstitial pneumonitis (LIP) was identified. Five patients were classified as marasmic and 4 as underweight. Evidence suggestive of encephalopathy (developmental delay and/or microcephaly) was present in 5 patients. The VDRL was non-reactive in the 5 patients in whom it was tested. Nine children were presumed to have acquired the infection by perinatal transmission, though the passive transfer of maternal antibodies or postnatally acquired infection could not be excluded. One child was thought to have acquired the infection by blood transfusion. Three children died during their hospital stay. Paediatric HIV infection exists in Ethiopia; however, these children do not present with characteristic opportunistic infections but with signs and symptoms reflecting the most common paediatric problems seen in the country. Prevention of HIV infection in children entails the prevention of infection in women of childbearing age, counselling of infected women, and effective screening of blood products.     

小儿艾滋病72例临床分析

目的：通过分析小儿艾滋病（AIDS）的临床资料,探讨小儿AIDS的流行病学和临床特点,以预防小儿AIDS的发生。方法：回顾性分析72例小儿AIDS的临床资料,72例患儿用酶联免疫吸附法（ELISA）测人类免疫缺陷病毒（HIV）抗体均为阳性。结果：小儿AIDS患儿以长期反复发热、迁延性咳嗽、腹泻、消瘦合并霉菌和结核感染为主要表现,临床表现无特异性,预后差,病死率为100%。结论：小儿AIDS主要是由感染HIV的育龄妇女经垂直传播而感染,应结合流行病学进一步检测HIV抗体,防止误诊或漏诊,及时有效地阻断母婴传播是预防小儿AIDS发生的关键。     

肺炎患者医院感染的预防与护理措施分析

目的对肺炎患者医院感染的预防与护理措施进行探讨分析。方法回顾性分析2013年1⁶月我院呼吸内科明确诊断为肺炎的患者医院感染的发生情况,结合患者伴随疾病、住院时间、抗生素使用情况、年龄等考虑肺炎患者发生院感的因素,分析医院感染诱发因素及护理干预效果。结果采取相应预防与护理措施后,医院感染发生率明显降低(P<0.05),差异具有统计学意义;在发生院感的相关因素中,采取措施前后住院时间、抗生素使用情况、伴随疾病上的差别较大,而在年龄等方面差异不明显。结论医院感染虽然在肺炎患者中普遍多发,积极采取相应的预防与护理措施可以明显降低院感发生率,值得临床科室学习应用。     

关联保密法对结核病人HIV抗体检测的研究

目的探索结核病人群中HIV感染调查的方法,了解郑州地区结核病人群中HIV感染状况。方法采用连续抽样和关联保密法,对郑州地区7个结防机构2007年8月11日—11月31日就诊的活动性结核病人,用酶联免疫吸附试验(ELISA)进行HIV初筛,初筛阳性者做免疫印迹(WB)确认试验,并进行问卷调查。结果调查新登记结核病1583例,HIV阳性者9例,感染率0.57%;HIV感染病人年龄在13~60岁,男性组HIV感染率0.63%,女性组感染率为0.21%;不同年龄活动性结核病人中HIV感染者主要集中在青壮年,占88.9%;农村户口结核病人HIV感染率0.62%,城镇户口结核病人HIV感染率0.43%。固定人口HIV感染率0.67%,流动人口HIV感染率0.37%;HIV感染途径,采血浆、输入血液传播4例(44.4%),异性传播2例(22.2%)。结论关联保密法来调查结核病人群中HIV感染状况是可行的,郑州地区结核病人群中HIV感染率0.57%。     

HIV机会性混合感染治疗的研究现状

人类免疫缺陷病毒(HIV)机会性混合感染的诊断、预防及治疗愈来愈引起人们的关注。患者接受高效抗逆转录病毒疗法(HAART)后,生存率有了显著提高。参阅国内外相关文献报道,就HIV感染者潜伏结核病的诊断,HAART引起的免疫重建炎性综合征的诊断,水痘疫苗对HIV感染儿童带状疱疹的预防,HIV感染与社区耐甲氧西林金葡菌(CA-MRSA)相关性,HIV和乙肝病毒(HBV)混合感染的抗病毒治疗,HIV和丙型肝炎病毒(HCV)混合感染的抗病毒治疗以及HAART的临床终点等七方面对HIV机会性混合感染的诊断、预防及抗病毒治疗的研究现状作一综述。     

Safety and tolerability of ertapenem versus ceftriaxone in a double-blind study performed in children with complicated urinary tract infection, community-acquired pneumonia or skin and soft-tissue infection

The carbapenem antibiotic ertapenem has been shown to be safe, well tolerated and effective in treating adults with complicated urinary tract infection, skin and soft-tissue infection and community-acquired pneumonia. In this study, we evaluated ertapenem for treating these infections in children in a randomised, double-blind, active-controlled clinical trial. The primary outcome was the incidence of clinical and laboratory drug-related serious adverse events (AEs). Children were randomised in a 3:1 ratio (ertapenem:ceftriaxone) stratified by index infection and age to receive ertapenem or ceftriaxone; 303 children received ertapenem and 100 children received ceftriaxone. The median duration of parenteral therapy was 4 days for both treatments. The most commonly reported drug-related clinical AEs during parenteral therapy were diarrhoea (5.9% ertapenem, 10% ceftriaxone), infusion site erythema (3% ertapenem, 2% ceftriaxone) and infusion site pain (5% ertapenem, 1% ceftriaxone). One child in each group reported a serious drug-related clinical AE. No serious drug-related laboratory AEs were reported. In children aged 3 months to 17 years, ertapenem was well tolerated and had a comparable safety profile to that of ceftriaxone.     

儿童耐多药结核病发生的相关影响因素及其预测模型的建立

目的 探究儿童耐多药结核病（MDR-TB）发生的相关影响因素及其预测模型的建立。方法 回顾性选取2010年3月1日至2022年2月28日昆明市第三人民医院结核病病儿,统计MDR-TB发生情况,比较MDR-TB病儿与非MDR-TB病儿临床资料,通过logistic多因素回归模型分析儿童MDR-TB发生的相关影响因素,采用R语言构建儿童MDR-TB发生的列线图预测模型,并进行一致性检验。结果 共纳入850例结核病病儿,其中初治MDR-TB病儿占5.65%,复治MDR-TB病儿占24.88%,总MDR-TB病儿占10.47%;logistic多因素回归模型分析显示,年龄、吸烟史、治疗情况、感染播散性、与结核病病人接触、合并人类免疫缺陷病毒（HIV）感染、合并乙型肝炎病毒（HBV）感染是儿童MDR-TB发生的独立危险因素,规范用药是独立保护因素（P<0.05）;根据影响因素构建儿童MDR-TB发生的列线图预测模型,通过Bootstrap自抽样法验证显示该预测模型预测值与实际观测值基本一致,一致性指数（C-index）为0.960,具有良好的区分度;预测模型ROC曲线的曲线下面积（AUC）...     

难治性肺炎支原体肺炎患儿院内感染危险因素分析

目的：探讨难治性肺炎支原体肺炎（RMPP）患儿发生院内感染的危险因素,指导临床预防与控制院内感染。方法：回顾性分析我院2012年3月至2014年3月收治的132例RMPP患儿的临床资料,以其中发生院内感染的13例为观察组,未发生院内感染的119例为对照组,对院内感染相关因素进行分析（先行单因素分析,再对有统计学意义的因素进行多因素非条件Logistic回归分析）。结果：132例RMPP患儿中发生院内感染13例（9.85%）。单因素分析显示,RMPP患儿发生院内感染与年龄、住院时间、特殊体质、侵入性操作、季节、C-反应蛋白（CRP）水平及补体C3水平相关（P<0.05）;多因素Logistic回归分析显示,年龄<2岁、住院时间≥20 d、侵入性操作、高CRP水平、低补体C3水平是RMPP患儿发生院内感染的独立危险因素（P<0.05）。结论：RMPP患儿有发生医院内感染风险,医院需加强院内感染监控力度,针对其危险因素及时采取有效的防控措施,以降低院内感染发生率。     

Clinical evaluation of ciprofloxacin in pulmonary infections in the patients with chronic respiratory diseases

The clinical efficacy of ciprofloxacin (CPFX) was investigated in pulmonary infections in patients with chronic respiratory diseases. Out of 58 cases collected, 54 were evaluable for utility of CPFX including 20 with pneumonia, 34 with chronic bronchial infection. CPFX was given orally at 200 mg 3 times per day. In 20 cases of pneumonia, the mean age was 62.0 years underlying diseases were chronic bronchitis 9, bronchiectasis 6, inactive pulmonary tuberculosis 4, and diffuse panbronchiolitis 1. The efficacy rate of CPFX in this group was 90.0%. In 34 cases of chronic bronchial infection, the mean age was 59.8 years, underlying diseases included bronchiectasis 10, chronic bronchitis 8, inactive pulmonary tuberculosis 7, diffuse panbronchiolitis 5, and pulmonary emphysema 4. The efficacy rate of CPFX in this group was 70.6%. The overall efficacy rate in the entire cases was 77.8%, and we consider CPFX to be effective in the treatment of patients with chronic respiratory diseases.     

Hepatitis C virus infection in children coinfected with HIV: epidemiology and management

Mothers with hepatitis C virus (HCV) and HIV coinfection are the major source of HCV/HIV coinfection in infancy and childhood. There is no known intervention capable of interrupting HCV spread from mother to child, while the majority of infant HIV infections occurring in the developed world can be prevented by antiretroviral prophylaxis in the mother and child, elective caesarean section, and formula-feeding. In the era preceding treatment of HIV infection with highly active antiretroviral therapy, HCV coinfection was of little concern because the short-term survival of patients with HIV infection prevented the slowly developing consequences of chronic hepatitis C. As the life expectancy of patients with HIV infection increased with therapy, HCV has emerged as a significant pathogen. Several lines of evidence in adult patients suggest that liver disease may be more severe in patients coinfected with HIV and that progression of HIV disease may be accelerated by HCV coinfection. Whether coinfected children may share these clinical patterns remains a matter of speculation. Chronic hepatitis C in otherwise healthy children is usually a mild disease; liver damage may be sustained and fibrosis may increase over the years, suggesting slow progression of the disease. Interferon-alpha has been the only drug used in the past decade to treat hepatitis C in children and adolescents, with average response rates of 20%. Preliminary results of treatment with interferon-alpha and ribavirin suggest that the efficacy would be greater with combined therapy. These treatment protocols have not yet been applied to children coinfected with HIV, but the increasing number of long-term survivors will probably prompt further investigation in the near future. At present, treating HIV disease and monitoring HCV infection and hepatotoxicity induced by antiretroviral drugs seem to be the more reasonable approach to HCV/HIV coinfection in childhood.     

0～3岁儿童缺铁性贫血与感染性疾病的相关性分析

目的 筛查东莞城区0～3岁易患肺炎、腹泻儿童的贫血状况,了解这些儿童缺铁性贫血与感染性疾病的关系,探讨简便易行的防治方法.方法 随机对城区0～3岁儿童(易患肺炎、腹泻)240例进行缺铁性贫血调查分析及防治.结果 血红蛋白35％,缺铁性贫血有85人,指导合理膳食,并由硫酸亚铁颗粒防治.结论 缺铁性贫血儿童易患肺炎、腹泻等感染性疾病,定期儿童保健及合理干预,对防治儿童感染性疾病有积极的效果.     

结核菌、艾滋病病毒双重感染的预防管理探讨

目的了解结核菌、艾滋病病毒双重感染患者的情况,探讨有利于双重感染预防的管理模式为建立TB/HIV双重感染患者的监测系统,制定治疗和管理机制提供依据。方法在同一单位整合AIDS/TB医疗负责小组,负责患者的诊断治疗管理工作,对结核患者进行AIDS咨询及人类免疫缺陷病毒(HIV)抗体检测,具体为结核患者抽取静脉血4mL,进行艾滋病病毒抗体检测,如两次酶联免疫吸附试验(ELISA)检测阳性,再做蛋白印迹试验(WB)确认,WB阳性者确认为艾滋病病毒阳性。另一方面对有咳嗽、咳痰、发热的AIDS患者筛查TB,检测上述化验的准确性。根据户籍、年龄、性别等因素统计分析TB/HIV双重感染者的分布特征。结果临湘市疾病预防控制中心提供300例结核患者中检出HIV阳性5例,双重感染为1.67%,男女无显著性差异(P>0.05),市区与农村也没有统计学意义(P>0.05)。结论同一单位小组管理模式有利于提高检测率和及时确诊,减少患者丢失、中断治疗、提高治愈率、降低病死率,对隔离治疗有益,值得进一步推广。     

潍坊地区住院儿童肺炎支原体感染状况分析

目的调查分析潍坊地区住院儿童肺炎支原体感染情况，为肺炎支原体感染的预防、临床诊断及治疗提供依据。方法对2011年1月至2012年12月在潍坊医学院附属医院儿科住院治疗的4560例呼吸道感染患儿的血清肺炎支原体抗体（Mp—lgM）检测结果进行统计分析。结果在4560例患儿中肺炎支原体引起的呼吸道感染率达29．5％，性别间感染率差异无统计学意义（P〉0．05）。在各年龄段儿童中，4～6岁的学龄前儿童的感染率达47．9％，1岁以内患儿感染率亦有升高趋势。秋季感染率最高，达35．2％，各季节肺炎支原体感染发病率明显不同，差异有统计学意义（P〈0．05）。结论肺炎支原体现已成为儿童呼吸道感染的主要病原体之一，学龄前儿童易感性强，有感染幼龄化趋势，且高发季节已有原来的秋冬季变为全年多发。     

婴幼儿社区获得性肺炎支原体肺炎的临床特征

目的探讨婴幼儿社区获得性肺炎支原体（MP）肺炎的临床特征。方法对228例婴幼儿肺炎患儿血清采用ELISA法进行肺炎支原体抗体（MP-IgM）检测,MP—IgM阳性为MP感染组,MP—IgM阴性为对照组,并进行比较分析。结果感染组与对照组发病年龄差异有高度统计意义（P〈0．01）,发病季节无明显差异（P〉0．05）。2组患儿均有咳嗽、喘鸣及呼吸困难,感染组高热、肺部X线片状阴影、C反应蛋白（CRP）阳性、WBC升高、肺外并发症等均高于对照组,差异均有高度统计意义（P〈0．01）。结论MP感染的婴幼儿肺炎以高热为主,且持续时间较长;WBC和CRP增高,肺部X线有肺气肿伴单侧片状阴影;肺外表现多见。对高度怀疑MP感染的患儿,应及时做MP抗体的检查以确诊。     

2010 年太和县艾滋病高危人群哨点监测分析

目的：为了解暗娼人群中艾滋病（acquired immune deficiency syndrome,AIDS）病毒的感染状况、行为特征及相关信息,分析本县艾滋病流行趋势,为艾滋病疫情估计及预测提供信息;为评价艾滋病预防与控制效果提供依据。方法：调查暗娼人群354名,主要来源于桑拿洗浴中心和美容洗脚屋。按年龄统计,最小的为17岁,最大的为55岁,平均年龄为29.8岁,主要年龄分布为21～40岁;按婚姻状况统计,以再婚和未婚的为主;按文化程度统计,以初中为主;按户籍所在地统计,本省和外省人数各占55.4%和44.6%,分布于17个省市自治区;按民族统计,共有9个民族,其中以汉族为主,占92.1%。结果：曾做过艾滋病检测的有125名,知道检测结果的有107名。本次调查共抽血354份,HIV抗体筛查采用ELISA法,检测结果均为阴性;梅毒采用RPR法筛查,筛查阳性4例,阳性率为1.1%;丙肝抗体筛查采用ELISA法,筛查阳性4例,阳性率为1.1%。结论：要全面落实各项艾滋病预防控制措施,进一步扩大监测检测覆盖面,最大限度发现艾滋病病毒感染者。     

0～7岁流动儿童与户籍儿童疾病谱分析

目的 分析0～7岁流动儿童与户籍儿童疾病谱,为疾病控制提供依据.方法 对0～7岁户籍儿童及流动儿童各120例进行疾病调查,按年龄不同分为3组,每组40例.婴儿组(1～ 12月),幼儿组(1～3岁),儿童组(3～7岁),调查近一年的患病情况.结果 户籍婴儿组(1～12月)常见疾病前五位为:上呼吸道感染、肺炎、小儿肠炎、中枢神经系统感染、泌尿道感染.流动婴儿组(1～12月)疾病谱相同,但发病频率较高.户籍幼儿组(1～3岁)常见疾病前五位为:上呼吸道感染、肺炎、小儿肠炎、过敏性疾病、意外伤害.流动幼儿组(1～3岁)疾病前五位:上呼吸道感染、肺炎、小儿肠炎、意外伤害、过敏性疾病.户籍儿童组(3～7岁)前五位疾病:上呼吸道感染、小儿肠炎、过敏性疾病、肺炎、意外伤害.流动儿童组(3～7岁)前五位疾病:上呼吸道感染、小儿肠炎、意外伤害、肺炎、过敏性疾病.结论 婴儿组(0～ 12月)户籍儿童与流动儿童疾病谱相同,但发病频率不同,幼儿组(1～3岁)和儿童组流动儿童意外伤害明显增加,户籍儿童过敏性疾病明显增加.     

儿童肺炎支原体感染大叶性肺炎的临床特点浅析

目的 了解影像学呈大叶性肺炎改变的肺炎支原体性肺炎(Mycoplasma pneumoniae pneumonia,MPP)的临床特点,帮助早期识别和诊治.方法 收集2014年10月至2016年10月期间住院部诊断为大叶性肺炎儿童173例,分为肺炎支原体(mycoplasma pneumoniae,MP)感染大叶性肺炎1 15例和非MP感染大叶性肺炎58例,分别进行临床症状、影像学、炎症指标等分析比较.结果 MP感染大叶性肺炎男55例,女60例,非MP感染大叶性肺炎男34例,女24例,两组间差异无统计学意义(P＞0.05).MP感染大叶性肺炎中3岁以内婴幼儿15例,3岁以上儿童100例,非MP感染大叶性肺炎中3岁以内婴幼儿22例,3岁以上儿童36例,两组间比较差异有统计学意义(P＜ 0.01).临床表现如高热、气促、呼吸困难等比较差异均无统计学意义(均P＞ 0.05);肺外表现差异有统计学意义(P＜0.05),主要表现为非MP感染大叶性肺炎心肌损害明显多于MP感染大叶性肺炎.影像学上非MP感染大叶性肺炎中累及2个及以上肺叶多于MP感染大叶性肺炎,差异有统计学意义(P＜0.01).血清炎症指标C反应蛋白(CRP)在非MP感染大叶性肺炎高于MP感染大叶性肺炎,差异有统计学意义(P＜0.05),外周血常规白细胞(WBC)和血清降钙素原(PCT)差异无统计学意义.经系统治疗后,172例患儿(99.4％)预后良好,1例转上级医院.结论 在大叶性肺炎早期,MP-IgM抗体滴度未增高前,可通过发病年龄、肺外表现、影像学差异以及CRP等帮助早期明确MP感染大叶性肺炎和非MP感染大叶性肺炎的诊断,并予合理及时治疗,改善患儿预后.