浙江省仙居县2004-2007年感染性腹泻流行病学分析

感染性腹泻病在我国发病率高,位居其他各种法定报告传染病之首.为了解近年来浙江省仙居县感染性腹泻病的流行情况,将2004-2007年该病的流行病学特征分析如下.     

传染性单核细胞增多症患儿CD3+CD4-CD8-T细胞与T淋巴细胞亚群变化情况及临床意义

Objective To study on the changes of the DNT cells and T lymphocyte subtype in children with infectious mononucleosis (IM) and its clinical significance.Methods The flow cytometry (FCM) was used to detected the DNT cells and other T lymphocyte subtype in 48 cases of IM.Results The study showed that DNT cells( 9.39 ± 4.89 )% were greatly increased in comparison with normal controls (NC) (4.26 ± 1.68)% ( P ＜0.01 ).CD4 cells(21.45 ±9.87)% were decreased ( P ＜0.01 ) and CD8 cells increased in comparison with NC (32.43 ± 5.07) % ( P ＜ 0.01 ).Conclusion DNT cells and T lymphocyte subtype can be used to evaluate the immune function of children with infectious mononucleosis (IM) and provide guidance for adoptive immunotherapy.     

超敏C反应蛋白联合血常规检测的临床应用

目的：探讨超敏C反应蛋白联合血常规检测的临床应用意义。方法：选取2013年1月至2013年5月间我院同时检测超敏c反应蛋白与血常规的患者500例作为研究对象,并将血常规、超敏C反应蛋白与患者目前病情联合分析。结果：细菌感染性组患者的中性粒细胞百分比及超敏C反应蛋白水平较非细菌感染性组患者明显升高,差异显著（P〈0．05）,具有统计学意义。结论：血常规联合超敏C反应蛋白的检测对细菌感染性患者的临床诊治有重要的指导意义,值得在临床上推广应用。     

受血者输血前传染病标志物检测的意义

目的：：输血前检测受血者传染病标志物,明确临床诊断,避免因输血造成的医疗纠纷。方法：输血前采用酶联免疫吸附实验（ELISA）法对受血者进行乙型肝炎表面抗原（HBsAg）、丙型肝炎病毒抗体（Anti-HCV）、梅毒螺旋体抗体（Anti-TP）和人类免疫缺陷病毒抗体（Anti-HIV）检测。结果：①传染病标志物总阳性率为13.59%;②HBsAg阳性率为11.97%,Anti-HCV阳性率为0.41%,Anti-TP阳性率为1.12%,Anti-HIV阳性率为0.10%;③男性HBsAg阳性率高于女性,差异有统计学意义（P<0.05）,男性、女性Anti-HCV阳性率和Anti-TP阳性率差异无统计学意义（P>0.05）;④986例受血者中混合感染2例。结论：通过对传染病标志物检测,有利于患者的治疗,避免因输血造成的医疗纠纷,同时防止交叉感染。进一步加强了输血管理,保证输血安全。     

妇产科患者输血前血液传染病标志物的检测

目的对本院妇产科患者输血前进行HBsAg、抗-HCV、抗-HIV、抗-TP检测,了解专科医院输血前患者传染病感染状况。方法对630例妇产科患者输血前采用ELISA法检测其血清乙型肝炎病毒表面抗原(HBsAg)、丙型肝炎病毒抗体(抗-HCV)、人类免疫缺陷病毒抗体(抗-HIV)及梅毒螺旋体抗体(TP)实验。结果检出HBSAg阳性6例(0.95%)、抗HCV阳性1例(0.16%)、梅毒阳性2例(0.32%)、抗HIV初筛阳性后按规定送确认实验室用免疫印迹法确认无1例阳性。结论本院输血前患者血清4项传染病指标阳性率较低,明显低于综合医院,通过对患者进行输血前传染病标志物的检测,及时发现潜在传染源,为新生儿提早做好预防保健,有利于患者治疗及医院内感染的预防。对传染病感染的辅助诊断、区分责任、减少医疗责任纠纷的发生,提醒医务人员有针对性的加强自我防护,防止或减少职业感染具有十分重要的意义。     

儿童传染性单核细胞增多症临床特点与发病年龄的关系:附312例分析

目的 探讨儿童传染性单核细胞增多症(IM)的临床特点与发病年龄的关系.方法 312例IM儿童分成0 ～ 3岁、～ 6岁、～ 15岁3组,进行回顾性分析.结果 IM儿童中6岁以下占74.4%,春季和秋季高发.0 ～ 3岁组发热天数平均(7.08 ± 3.31)d,～ 6岁组平均(7.91 ± 3.78)d,～ 15岁组平均(12.38 ± 4.14)d,～ 15岁组与其他组差异有统计学意义(P ＜ 0.01).各年龄组咽峡炎(100%)、淋巴结肿大(82.69%)、肝肿大(66.7%)、脾肿大(62.5%)、鼻塞(42.3%)组之间差异无统计学意义(P ＞ 0.05);眼睑浮肿(36.2%)～ 15岁组明显低于其他组(P ＜ 0.05),皮疹(23.1%)在0 ～ 3岁组多见(P ＜ 0.05).外周血白细胞年幼儿升高明显,异型淋巴细胞年幼儿偏低,血清ALT、AST在年长儿偏高,血清LDH在各年龄组均呈高值,血清嗜异凝集试验年长儿阳性率高.结论儿童IM某些临床特点与发病年龄有关,应予以重视,以提高确诊率.     

2009年北京地区儿童感染性腹泻病原学及耐药性分析

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2009年1月～10月肠道门诊疑诊为细菌性腹泻病者便标本做细菌培养和血清分型鉴定,药敏试验采用纸片扩散法,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 256份标本检出病原菌4种87株(有1份便标本同时检出2种菌),检出率为34.0%.男女检出比为1.69∶1,2岁以下患儿55例(64.0%).沙门菌40株(46.0%),志贺菌23株(26.4%),致泻性大肠杆菌2株(2.3%),金黄色葡萄球菌22株(25.3%).志贺菌中D群13株(56.5%),22株金黄色葡萄球菌有20株发生于＜1岁婴儿.沙门菌和志贺菌的耐药率分别为:氨苄西林(65.0%;95.7%)、复方新诺明(20.0%;78.3%)、环丙沙星(7.5%;8.7%)、头孢曲松(15.0%;73.9%).256份标本中A群轮状病毒检测阳性47份,其中同时便培养阳性者13份.结论 2009年北京地区儿童细菌性腹泻的病原菌以非伤寒沙门菌为主,志贺菌以D群为主要流行株,二者的易感人群以2岁以下婴幼儿为主,金黄色葡萄球菌感染以1岁以下婴儿为主,阳性检出男孩居多.多重耐药仍以志贺菌明显,细菌与轮状病毒混合感染的比例上升.

Abstract：

Objective To investigate the etiology, epidemiologic features and drug resistance tendency of acute infectious diarrhea among children in Beijing area. Methods Enteric pathogenic bacteria were isolated, cultured and identified for serotype from the stool specimens of children with the initial clinical diagnosis of acute bacterial diarrhea in the intestinal clinic from January to October in 2009 ,and the antibiotic susceptibility of bacteria was tested by disk diffusion method. The cluster A rotavirus antigen was also detected by the qualitative technique of immunochromatographic double-antibody sandwich assay. Results Of the 256 stool specimens, 87 strains of 4 species of pathogenic bacteria were detected with the detectable rate of 34. 0% ,of which 2 strains were detected in one stool sample ,including 40 strains of salmonella (46. 0%) ,23 strains of shigella (26. 4%) ,2 strains of diarrheogenic escherichia coli (2. 3%) and 22 strains of staphylococcus aureus (25.3%). The positively detected patients consisted of 54 males and 32 females with the ratio of 1.69∶1 ,of whom 55 cases (64. 0%) were under 2 years of age. Of the 13 strains of shigella, 13 were sonnei shigella (56. 5%). And of the 22 strains of staphylococcus aureus,20 were detected among the infants under 1 year of age. The rates of crug resistance to certain antibiotics were lower in salmonella than in shigella (ampicillin :65. 0% vs. 95.7% ;compound sulfamethoxazole:20. 0% vs. 78. 3% ;ciprofloxacin:7.5% vs.8. 7% ;ceftriaxone: 15.0% vs. 73.9%). Of the 256 stool specimens ,47 were found positive for cluster A rotavirus,of whom 13 were also positive in stool bacteria culture. Conclusion Salmonella is the major pathogen among children with bacterial diarrhea in Beijing in 2009, and sonnei shigella is the main epidemic strains of shigella diarrhea. lnfants under 2 years of age are the susceptible population of the above two species of bacteria, while staphylococcus aureus mainly infect the infants under 1 years of age. Multi-resistance in shigella is still serious. The incidence of mixed infections of bacteria and rotavirus increases in children with infectious diarrhea.     

传染性单核细胞增多症及其相关疾病临床特点分析

目的探讨传染型单核细胞增多症(传单)、类传单和EB病毒(EBV)感染病例的临床特点。 方法对重庆医科大学附属儿童医院2003—2004年收治的602例传单、类传单和EBV感染患儿的相关资料进行回顾性分析。 结果传单组的临床表现较EBV感染组典型，淋巴结肿大和眼睑水肿的发生率显著高于类传单组，传单组眼睑水肿的发生率(62.7%)已接近常见的典型表现出现的比率；类传单组病例微小病毒(HPVB19)的感染率为54.8%，显著高于传单组；3组病例肝功能改变都以酶学改变为主，其中LDH改变最为明显；血液系统并发症表现为贫血、粒细胞减少和血小板减少，各组发生率没有统计学差异；类传单组病例肺炎发生率显著高于传单组；EBV感染组出现传单组没有的ITP病例和脑炎病例。 结论眼睑水肿对传单有着与其它典型表现同样重要的诊断意义；HPVB19是类传单的一个重要病原；EBV感染后部分病例发展为传单，部分病例仍以EBV感染状态存在，可能存在异常的免疫反应。     

糖尿病湿性坏疽细菌感染菌谱及耐药菌谱特点研究

目的 明确糖尿病湿性坏疽感染菌谱和耐药菌谱特点,有针对性的选择抗菌药物。方法 取糖尿病湿性坏疽分泌物进行需氧菌、真菌培养、药敏试验以及厌氧菌培养。结果 357例患者中,细菌培养结果阳性率为100%,共培养出469株细菌,其中感染率革兰阳性菌(G+)45.4%、革兰阴性菌(G-)26.0%、厌氧菌23.7%、真菌4.9%。G+菌中葡萄菌属有5种药物的耐药菌株大于50%、肠球菌属有11种药物的耐药菌株大于50%,G-菌中肠杆菌科有3种药物的耐药菌株大于50%,不动杆菌属和假单胞菌属有8种药物的耐药菌株大于50%,真菌中光滑念珠菌有3种药物的耐药菌株大于50%,其余菌属药物的耐药菌株均小于50%。结论 糖尿病湿性坏疽感染菌谱特点是革兰阳性菌>革兰阴性菌、厌氧菌>真菌,耐药菌谱特点是G+菌感染中的肠球菌属、G-菌感染中的不动杆菌属和假单胞菌属、真菌感染中的光滑念珠菌耐药性较高。     

Fulminant infectious endocarditis caused by Staphylococcus aureus with pseudoaneurysms in the superior mesenteric,hepatic, and popliteal arteries: a case report

Staphylococcus aureus infectious endocarditis has a high mortality, major causes of death being cardiac failure, systemic embolism, and sepsis. Pseudoaneurysms, a rare complication of this infection, are not invariably fatal with appropriate treatment. A previously healthy 32-year-old man was found to have multiple cerebral infarctions, and infectious endocarditis with mitral valve vegetation was diagnosed by echocardiography. Because methicillin-resistant Staphylococcus aureus (MRSA) was identified from blood cultures, vancomycin was administered. Massive intracerebral hemorrhage in the left temporo-occipital lobe occurred in the patient on the 3rd day after admission, and the hematoma was completely removed surgically. Another hemorrhage was identified in the right occipital region on the 7th hospital day, which led the patient deep coma. Blood cultures on the 10th day were negative for MRSA; however, imaging studies revealed pseudoaneurysms in the superior mesenteric, hepatic, and left popliteal arteries 3 weeks after admission. No surgical indication was applied to these pseudoaneurysms because the patient remained comatose. On the 78th day after admission, the patient''s blood pressure suddenly dropped and he died. Autopsy demonstrated massive bleeding in the abdominal cavity caused by rupture of the superior mesenteric artery pseudoaneurysm. Our patient''s clinical course was fulminant, his endocarditis being complicated by cerebral infarctions, intracranial hemorrhages, and multiple pseudoaneurysms within 3 weeks of admission. In retrospect, he may have survived if emergency resection of the mitral valve vegetation had been performed on the first or second day of admission; however, the in-hospital mortality rate after such surgery is high.