36例幼女化脓性链球菌外阴阴道炎临床分析

目的 探讨幼女化脓性链球菌感染所致外阴阴道炎的临床特点、治疗及预后。方法 选取2020年1月至2020年12月西安市儿童医院小儿妇科门诊就诊的经分泌物培养确诊为化脓性链球菌感染的外阴阴道炎患儿,并对患儿临床资料进行回顾性分析。结果 36例患儿均为幼女,年龄最大为10岁1月,最小为2岁9月,平均年龄6.24岁（74.89月）。临床首发症状为外阴瘙痒者18例（50.0%）,外阴疼痛、小便灼痛者10例（27.78%）,家长发现患儿内裤脏伴异味者8例（22.22%）;阴道分泌物涂片检查结果均为清洁度Ⅲ、Ⅳ度,革兰氏阳性球菌中至大量者29例（80.56%）。36例患儿化脓性链球菌株药敏试验结果显示,其对红霉素耐药性达到100.00%,对克林霉素耐药达到86.11%,对青霉素、氨苄西林、头孢曲松、头孢噻肟、头孢吡肟、左氧氟沙星、万古霉素均100.00%敏感,诱导克林霉素耐药试验100.00%阴性。36例患儿均给予盐酸左氧氟沙星滴眼液外用治疗,全部患儿阴道及外阴不适症状消失,无严重不良事件发生。结论 幼女化脓性链球菌感染所致的外阴阴道炎,建议常规行血常规、尿常规、抗链球菌溶血素O等检查,应警惕合并关节、心脏、肾脏等其他系统临床表现;左氧氟沙星滴眼液是安全有效的外用治疗药物,可快速有效地控制阴道症状,可作为临床一线治疗方案。

Clinical analysis of 36 prepubertal girls with Streptococcus pyogenes vulvovaginitis

Objective To summarize the clinical characteristics, treatment and outcome of vulvovaginitis caused by suppurative streptococcus infection in prepubertal girls. Methods The medical records of 36 cases suppurative streptococcus vulvovaginitis in prepubertal girls who were hospitalizde in Xi'an Children's Hospital from January 2020 to December 2020 were retrospectively analyzed. Results There were 36 prepubertal girls in this study. The age ranged from 2.75 years old to 10. 08 years old, and the average age was 6.24 years old （74.89 months）. The initial clinical symptoms of vulva pruritus were in 18 cases （50.0%）, vulva pain and burning pain in 10 cases （27.78%）, dirty underwear with peculiar smell found by parents in 8 cases （22.22%）. The results of vaginal secretion smear were all grades Ⅲ and Ⅳ, and 29 cases （80.56%） of Gram-positive cocci were moderate-to-large. The drug susceptibility test of Streptococcus pyogenes in 36 children showed that the resistance to erythromycin reached 100.00%, and the resistance to clindamycin reached 86.11%. It was 100.00% sensitive to penicillin, ampicillin, ceftriaxone, cefotaxime, cefepime, levofloxacin and vancomycin, and 100.00% negative for clindamycin-induced resistance test. All 36 children were given levofloxacin hydrochloride eye drops topical treatment, all the children's vaginal and vulvar discomfort disappeared, and no serious adverse events occurred. Conclusion For vulvovaginitis caused by suppurative streptococcus infection in prepubertal girls, highly recommended routine blood, urine, anti-streptolysin O and other examinations and should be vigilant for clinical manifestations of joint, heart, kidney and other systems. Levofloxacin eye drops is a safe and effective topical treatment, which can quickly and effectively control vaginal symptoms, and can be used as a first-line clinical treatment.