儿童A族链球菌致链球菌中毒性休克综合征4例临床分析及文献回顾

目的 提高临床医生对A族链球菌(group A streptococcus,GAS)所致链球菌中毒性休克综合征(streptococcal toxic shock syndrome,STSS)的认识.方法 对首都医科大学附属北京儿童医院儿童重症监护病房(PICU)2011年1月至2016年12月明确诊断为GAS感染相关性STSS患儿的临床病例进行回顾性分析;同时对国内相关疾病的文献报道进行总结回顾.结果 我院PICU共收治4例GAS致STSS患儿,均发生于2013-2014年冬季,年龄0.6～6岁.初诊时均无特异性临床表现,第2次就诊时已进展至失代偿性休克且合并多脏器损害.本组4例GAS均对β内酰胺类药物敏感,对大环内酯类、林可霉素类药物耐药.最终3例患儿痊愈出院,1例患儿死亡.结论 STSS的诊断依赖临床医生对其高度的警惕性,并重视在疾病早期收集可疑感染部位的病原学证据,存在休克、脏器损害表现的可疑GAS感染患儿应立即开始治疗.

Streptococcal toxic shock syndrome of Streptococcus A in children: a clinical analysis of 4 cases and review of the literatures

Objective To analysis the clinical manifestations and therapeutic methods of Streptococcal Toxic Shock Syndrome caused by Group A Streptococcus (STSS) in children.Methods:The clinical data of STSS between 2011 and 2016 were retrospectively analyzed.Results There were 4 cases of STSS in our study,but all occurred in the winter of 2013-2014.The patient's age ranged from 6 month to 6 years old.These 4 cases had progressed to decompensated shock period already when they were back to the hospital in the second visit,but without specific clinical manifestations in the first visit.The culture and drug sensitivity result were consistent,Group A Streptococcus (GAS) were sensitive to lactam antibiotics,resistant to macrolides and lincomycin.3 patients were cured without sequel but 1 died finally.Conclusion Early detection and pathogens identification were both crucial to the diagnosis of STSS.Treatment should be given immediately,once shock and organ injury signs occur in the patient who suspected to GAS infection.