第4例新生儿咳嗽5天,发热3天

1 病历摘要 患儿,男,江西郊区(县)人,出生25 d.患儿因"咳嗽5d,发热3 d,加重半天"为主诉入本院.患儿于入院前5 d出现咳嗽,为阵发性单声咳,痰少;3 d前开始发热,T 38℃左右,外院予"头孢拉定、退热剂"等治疗,疗效不显著;入院当日晨起咳嗽加剧,为连声咳,伴面色发绀、呼吸急促.     

他巴唑致抗中性粒细胞胞浆抗体相关性血管炎一例

患儿,女,7岁,因“肉眼血尿1周,发热3d”入院。患儿入院前1周无明显诱因出现肉眼血尿,无尿急、尿频、尿痛,家人未在意。入院前3d出现发热,体温最高38．5℃,伴有单声咳嗽,于院外肌注药物2次（具体不详）,效果差,     

非典型性肌营养不良1例

患儿,男,3岁。因反复咳嗽2个月余,发现肝功能异常5 d入院。患儿2个月前无明显诱因下出现咳嗽,呈单声咳,无咳痰及咯血,无发热及气促。在家服用感冒药(具体用药不详)咳嗽仍时有时无。5 d前在当地就诊时发现ALT 80 U/L,1d前复查ALT 305 U/L。既往史及个人史无殊。其祖父有肝病史。     

呕吐咳嗽气促昏迷发热

1　病历摘要患儿女,2 0个月。主因“呕吐3d ,咳嗽气促2d ,嗜睡1d ,发热18h”于2 0 0 2年8月入院。患儿于入院前3d无诱因非喷射性呕吐,2d前阵咳伴气促,1d前嗜睡,18h前发热,体温38 8℃,并渐转为昏睡,即收入院。病来无抽搐,尿量可,无腹泻。否认病前不洁饮食,毒物、药物接触史及头颅外伤史。患儿足月顺产,生后无窒息,出生体重32 0 0g ,新生儿期体健,母乳喂养,4个月起添加辅食,智力体力发育同正常同龄儿。生后11个月时曾患“肺炎”,表现咳嗽气促,在当地住院治疗7d好转出院。家族史:父母非近亲结婚,均体健。母G2P1,第1胎自然流产,第2胎为本患儿,…     

第111例--胸壁包块破溃、发热、咳嗽

病历摘要患儿 ,女 ,1岁 ,主因“左侧胸壁包块破溃 2 4d ,发热 17d ,咳嗽 7d”再次入院。患儿于入院前 2 4d左侧锁骨下淋巴结破溃结痂处再度破溃 ,流黄色脓液 ,自予PAS软膏外涂无明显好转。入院前 17d出现发热 ,体温波动于 38 5～ 39 0℃ ,无其他不适 ,于当地医院住院治疗 ,先后予先锋必 ,菌必治 ,头孢拉定抗感染 ,皮损处结痂 ,但仍持续发热。入院前 7d出现咳嗽 ,为阵发性干咳 ,咳后有痰鸣 ,体温波动于 39 0～4 0 0℃ ,治疗中曾出现鹅口疮 ,为进一步诊治收入院。发育营养史 :G1 P1 ,足月顺产 ,出生体重 3kg ,母乳喂养 ,5月起添加辅食。既…     

严重感染与器官支持

第一次查房主治医师查房,入院后8h. 住院医师汇报病史:患儿,女,1岁3个月,因"咳嗽3d,发热2d"入院,入院前3d患儿无明显诱因出现咳嗽,阵发性咳,无气促发绀,无发热,无吐泻等,自服易坦静,效果不明显.2d前患儿咳嗽加重,伴发热,热峰39.5℃,予退热药后体温不易下降,患儿精神逐渐萎靡,面色苍灰,但无喘憋及口唇青紫,无抽搐,无吐泻,无出血点等皮疹,收入病房.既往史:否认传染病接触史及食物、药物过敏史.按时按序预防接种.足月顺产,出生体重3.1kg.生长发育同同龄儿童.否认家庭成员中有慢性咳嗽患者.否认异物吸入史.     

非典型性营养不良1例

患儿，男，3岁，因反复咳嗽2个月余，发现肝功能异常5d入院，患儿2个月前无明显诱因下出现咳嗽，呈单声咳，无咳痰及咯血，无发热及气促。在家服用感冒药（具体用药不详）咳嗽仍时有时无。5d前在当地就诊时发现ALT80U/L，1d前复查ALT 305U/L。     

第51例─咳嗽、呼吸急促

病历摘要患儿，男，２２天，因“咳嗽１２天加重２天”入院。患儿Ｇ４Ｐ２，孕４０＋３Ｗ，产院内自然分娩，否认窒息史，Ａｐｇａｒ评分和出生体重不详，羊水、胎盘及脐带未见异常。生后一般状况好，母乳喂养，未接种卡介苗，与咳嗽患儿有密切接触史（其姐）。入院前１２天出现咳嗽，初起为轻咳，伴吐沫和呛奶，未予治疗，近２天咳嗽加重、为阵发性痉挛性咳嗽，伴精神弱，偶吐奶，无喘憋发热。二便正常。母孕期体健，无上呼吸道及泌尿系感染史，家庭成员否认结核病史，其母、姐胸片未见结核征象。其姐既往体健，近期有反复呼吸道感染。查体…     

长期发热、肝脏脓肿

患儿，女，27d，因发热24h入院，患儿于入院前24h发热，体温达38．5℃，无咳嗽，无气促，无口区吐，患儿系G2P1，胎龄37^-6周，顺产，否认窒息抢救史，出生体重2650g，生后母乳喂养，1周后改为人工喂养。母孕史：母于孕中期常有咳嗽，分娩后出现发热，分娩后第9天因“胸腔积液”入住第四人民医院。第一胎人工流产。家族史无特殊。入院查体：T38．7℃，     

全身水肿皮疹伴色素沉着肝脾肿大

第一次查房 主治医师查房,入院后第2天. 住院医师 汇报病史:患儿,女,7岁,因"全身水肿4d,皮疹3d,面部、双手皮肤发黑2d"入院.患儿于入院前4d出现全身水肿,渐加重.入院前3d患儿面部出现皮疹伴瘙痒,当地医院给予硼酸水外洗、开瑞坦口服,无好转,家属又自行给予盐水外洗.入院前2d出现双手以及面部皮肤发黑,局部破溃,来我院就诊.病程中无发热、关节痛、咳嗽、气急、恶心、呕吐、抽搐、腹痛、血尿、鼻衄、皮肤出血点.既往史:否认传染病接触史,家长自述常有皮肤过敏(具体不详),食物、药物过敏史不详.     

Seven days vs. 10 days ceftriaxone therapy in bacterial meningitis

Ceftriaxone is recommended in children with acute bacterial meningitis (ABM) for 10 days. However, the drug is expensive, and shorter duration of therapy, if equally effective, would cut costs of therapy and hospitalization. The aim of this study was to compare the outcome of 7 days vs. 10 days' ceftriaxone therapy in children with ABM. Seventy-three children aged 3 months to 12 years with ABM, consecutively admitted to hospital were enrolled. Ceftriaxone was given for 7 days to all. Randomization to group I (7 days) and group II (10 days) therapy was done on the seventh day. At the end of 7 days' therapy in group I and 10 days in group II, children were evaluated using a clinical scoring system. Children with a score of more than 10 were labelled as 'treatment failures' and were continued on ceftriaxone. If a score was less than 10, the antibiotic was stopped. Complications were appropriately evaluated and managed. All children were followed-up 1 month after discharge: neurodevelopmental assessment, Denver Development Screening Tests, IQ and hearing assessment were done. After excluding four patients, there were 35 children in group I and 34 in group II. The two groups were comparable with respect to age, sex, nutritional status, presenting clinical features, and CSF parameters. Organism identification was possible in 38 per cent of children: (Streptococcus pneumoniae, 21 per cent; Haemophilus influenzae, 13 per cent; meningococcus, 4 per cent). Treatment failure rate was comparable in both groups (9 in group I and 8 in group II) as was the sequelae at discharge and at 1 month (9 in group I, 15 in group II,p > 0.1). Status epilepticus and focal deficits at presentation were significantly associated with treatment failures and sequelae in both the groups (p < 0.05). Length of hospital stay was shorter in group I (10.8 +/- 6.0 days) as compared with group II (14.4 +/- 7.2 days,p < 0.05) and frequency of nosocomial infection was significantly more in group II (p < 0.05). It was concluded that clinical outcome of patients treated with 7 days' ceftriaxone therapy is similar to that of 10 days' therapy, and is associated with lesser nosocomial infection and earlier hospital discharge. Seven days ceftriaxone therapy may be recommended for uncomplicated ABM in children in developing countries.     

腹痛7天、发现腹部包块伴发热2天

1 病史摘要 患儿,女,3岁.因腹痛7 d,发现腹部包块伴发热2 d入院.患儿7 d前无明显诱因出现腹痛,以上腹部为重,呈间断性钝痛,2 d前发现上腹部有一包块,腹痛加重,呈持续性胀痛,伴纳差、发热,体温最高38.5℃.查体:T 38.2℃,P 105次/min,R 23次/min,体质量11 kg.     

Treatment of shigellosis with cefixime: two days vs. five days

BACKGROUND: Although the recommended standard course of therapy for shigellosis is 5 days of oral ampicillin or trimethoprim-sulfamethoxazole therapy, successful outcome has been reported in adults treated with abbreviated courses of antibiotics. The purpose of this study was to compare short course (2-day) vs. 5-day therapy with cefixime for treatment of diarrheal disease caused by Shigella sonnei in children. METHODS: This was a prospective, randomized, double blind, placebo-controlled study. Patients were eligible if they were at least 6 months of age and presented to the Children's Hospital of Pittsburgh during an outbreak of diarrhea caused by S. sonnei, with (1) a history of fever and diarrhea (at least three loose or watery stools per day), (2) bloody diarrhea or (3) diarrhea and known exposure to an individual with documented shigellosis. Patients were randomized to receive either 2 days of cefixime (8 mg/kg(day) given once daily followed by 3 days of placebo or 5 days of cefixime. Telephone follow-up was performed on Days 3, 7 and 14 after enrollment. Follow-up stool cultures were obtained on Day 7 to assess bacteriologic cure. There were standardized definitions for cure, improvement, failure and relapse. RESULTS: Forty-seven patients were enrolled. Eleven were eliminated from analysis because their stool cultures were not positive for S. sonnei. There were 36 evaluable patients, 21 in the 2-day group and 15 in the 5-day group. Patients ranged in age from 6 months to 17 years. Forty-four percent of the subjects were male. Symptoms were improved or had resolved by Day 3 of therapy in all patients. There were 8 patients who experienced a clinical relapse: 5 of 21 (24%) patients in the 2-day treatment group and 3 of 15 (20%) in the 5-day group. There were 13 patients who experienced a bacteriologic failure (defined as the occurrence of a positive culture at the Day 7 follow-up visit), 11 of 20 (55%) in the 2-day group and 2 of 14 (14%) in the 5-day group (P < 0.02). CONCLUSION: Two- and 5-day treatment courses with cefixime for treatment of diarrheal disease caused by S. sonnei result in similar rates of clinical cure and clinical relapses; however, there was a higher rate of bacteriologic failure with shorter course therapy.     

66日龄婴儿发现多发皮下结节1月余

患儿,男,66?d,因发现皮下结节46?d,腹胀10?d入院。患儿主要临床表现为全身脂肪组织减少,皮下结节,胰岛素抵抗型糖尿病,高三酰甘油血症,肝脂肪变性,最终确诊为先天性全身性脂肪代谢障碍1型。经改用含中链脂肪酸比例高的配方奶及先后予胰岛素注射、二甲双胍口服后病情好转。基因检测显示AGPAT2基因存在c.646A > T纯合突变,其父母均为该突变的携带者。该病例为国内报道的起病年龄最小、且以多发皮下结节为首发症状的先天性全身性脂肪代谢障碍1型患儿。     

Two dosages of clarithromycin for five days, amoxicillin/clavulanate for five days or penicillin V for ten days in acute group A streptococcal tonsillopharyngitis

BACKGROUND: Short course antimicrobial therapy is suggested for group A streptococcal tonsillopharyngitis. METHODS: The bacteriologic and clinical efficacies of clarithromycin [30 or 15 mg/kg/day twice daily (b.i.d.)] or amoxicillin/clavulanate (43.8/6.2 mg/kg/day b.i.d.) for 5 days or penicillin V (30 mg/kg/day 3 times a day) for 10 days were compared. In a randomized, open label, parallel group, multicenter study, 626 children (2-16 years old) with tonsillopharyngitis were enrolled; 537 were evaluable for efficacy. Follow-up evaluations were performed at 4-8 and 21-28 days after therapy. RESULTS: At enrollment, 26% of the Streptococcus pyogenes isolates were clarithromycin-nonsusceptible. All regimens had an apparently similar clinical efficacy. The long term S. pyogenes eradication rates were 102 of 123 (83%) with amoxicillin/clavulanate and 88 of 114 (77%) with penicillin V. In the 30- and 15-mg/kg/day clarithromycin groups, eradication occurred in 71 of 86 (83%) and 59 of 80 (74%) of the clarithromycin-susceptible isolates (P = 0.33), and in 4 of 28 (14%) and 5 of 26 (19%) of the clarithromycin-resistant isolates, respectively (clarithromycin-susceptible versus -resistant, P < 0.0001). Both clarithromycin dosages were well-tolerated. CONCLUSIONS: In group A streptococcal tonsillopharyngitis, 5 days of clarithromycin or amoxicillin/clavulanate treatment had clinical efficacy comparable with that of 10 days of penicillin V treatment; however, amoxicillin/clavulanate and penicillin V were bacteriologically more effective than clarithromycin because of its failure to eradicate the clarithromycin-resistant S. pyogenes isolates. The 5-day clarithromycin regimens are not recommended for treatment of streptococcal tonsillopharyngitis in areas where in vitro resistance of group A streptococci to clarithromycin is common.