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目的 了解上海地区 2 0世纪 90年代儿童伤寒的特点。方法 回顾性分析 1990年 1月至 1999年 12月 2 5 1例临床确诊为伤寒的住院儿童的临床资料。结果 所有患儿均有发热 ,伴随消化道症状 136例(5 4 18% ) ,其次可伴呼吸道等症状 ,193例 (76 89% )患儿肝脏肿大 ,73例 (2 9 0 8% )肝脾均肿大。 10 9例(43 4 3% )患儿出现并发症 ,并发伤寒肝炎 6 1例 (5 5 96 % )、心肌炎 5 2例 (47 71% ) ,肠出血、肠穿孔很少见。白细胞在正常范围 198例 (78 88% ) ,嗜酸粒细胞绝对计数为零者 2 2 2例 (88 4 5 % )。药敏报告显示伤寒杆菌对氯霉素的耐药性明显下降 ,对氨基糖苷类抗生素几乎不耐药 ,而对氨苄青霉素尤其是复方新诺明耐药较多 ,几乎所有菌株对第 3代头孢菌素、氟喹诺酮类敏感。结论 上海地区儿童伤寒全年散发 ,夏秋季多发 ,6岁以上学龄儿童为主要患病人群。临床表现不典型且复杂。嗜酸性粒细胞为零仍是儿童伤寒的一个特点。治疗儿童伤寒以第3代头孢菌素、氟喹诺酮类药物疗效好。
Objective To understand the characteristics of typhoid in children in Shanghai in the 1990s. Methods The clinical data of 25 cases of hospitalized children diagnosed as typhoid fever from January 1990 to December 1999 were analyzed retrospectively. Results All children had fever, accompanied by 136 cases of gastrointestinal symptoms (54.18%), followed by respiratory symptoms, 193 cases (76.89%) had enlarged liver and 73 (29.8% Liver and spleen are swollen. Complications were found in 109 (43.4%) children with 61 cases of typhoid hepatitis (55 59%), 52 cases of myocarditis (47 71%), intestinal bleeding and intestinal perforation. There were 198 (78 88%) leukocytes in the normal range and 222 (88.45%) cases with absolute eosinophil count. Drug susceptibility reports showed that the typhoid bacilli resistance to chloramphenicol decreased significantly, almost no resistance to aminoglycoside antibiotics, and ampicillin, especially cotrimoxazole more resistant to almost all strains of third-generation cephalosporins Mycotoxins, fluoroquinolones sensitive. Conclusion The distribution of typhoid fever in Shanghai is distributed throughout the year, with frequent occurrence in summer and autumn. School-aged children over 6 years old are the main affected persons. Clinical manifestations are not typical and complex. Zero eosinophil is still a feature of childhood typhoid fever. Treatment of typhoid in children with the third generation cephalosporins, fluoroquinolones good curative effect.