小儿SARS临床特点及诊断探讨

象很多其他疾病一样 ,小儿与成人SARS的临床表现明显不同。通过综合国内外有关文献 ,结合对酷似SARS患儿的详细检查、治疗观察、流行病学调查等鉴别诊断的实践经验 ,分析总结了小儿SARS临床特点。小儿SARS发病率低 ,仅占SARS病例的 1%3%;病情轻、病程短、病死率低 ,很少出现严重呼吸困难、ARDS ,一般不需人工机械通气辅助呼吸 ,病程较短 ,平均住院 10 14d ,预后良好 ,迄今无 1例SARS患儿死亡。由于小儿SARS临床表现不典型以及缺乏儿童SARS诊断标准 ,使得小儿SARS的诊断比较困难。应特别重视流行病学证据、SARS CoV病毒学、血清学检测以及排他性诊断在小儿SARS的诊断与鉴别诊断中的重要性。提出《小儿SARS诊断标准》与同道们探讨。

Clinical features and diagnostic problem of SARS in childhood

The Differences in clinical presentation of SARS are common in many other infectious diseases between children and adults. Compared with adults and teenagers, younger children have striking characteristics in clinical presentation of SARS.Insidence of pediatric SARS is lower than that in adults,which accounts for 1~3%. The clinical course was much milder and shorter than that of adults and teenagers. The younger children with SARS seldom required oxygen therapy or assisted ventilation. The period of hospitalization is 10~14 days. SARS seems to have a less aggressive clinical course in younger children. So far, no one children died of SARS in the world. It is difficult to be diagnosed in time for its atypical presentation and lack of diagnostic criteria for pediatric SARS. The diagnostic significances should be emphasized in the epidemiological data, isolation of SARS-CoV in tissue culture, detection of the SARS-CoV antibody by IFA or ELISA, detection of SARS-CoV RNA by RT-PCR, and ruling out of other causes of the illness.