一例死于重症手足口病少年的病例分析(英文)  

A ataasof andooand mouth disease in an adolescent

作　　者：逯军[1] 邓勇[1] 

机构地区：[1]中南大学附属海口市人民医院儿科,海南海口570208

出　　处：《中国热带医学》2014年第6期740-742,共3页China Tropical Medicine

基　　金：the radiologic department and the research laboratory for their support

摘　　要：目的探讨1例15岁少年因EV-71感染所诱导的手足口病从发生到死亡的过程,揭示年长儿致死性手足口病诊断的复杂性。方法采集该少年患者咽拭子标本,进行实时荧光PCR(RT-PCR),分析致病病原体,同时结合其临床表现及相关的实验室检查,如头颅及胸部CT、胸片、血常规、电解质、血气等,得出致死性手足口病的诊断。结果该患者在就诊前3天开始出现咽痛、头痛、呕吐等症状,并在家口服药物治疗,症状未见缓解,遂来院就诊,拟"上呼吸感染"给予静滴抗生素及补液等对症处理。当天夜间患者即出现剧烈头痛、呼吸、心跳加快,并伴有口吐粉红色泡沫样痰、抽搐、意识丧失等症状,遂转入重症监护室,予以呼吸机辅助呼吸等高级生命支持积极治疗,但患者最终因多器官衰竭而死亡。其间,除咽部可见数个疱疹外,其手、足、口腔等皮肤粘膜均未见皮疹及疱疹。入院后查血常规、电解质、C-反应蛋白均未见明显异常。脑脊液除压力稍低(60mmH2O)外,其他也未见异常。血气分析提示II型呼吸衰竭。而头颅CT示颅内弥漫性水肿并少量枕叶出血灶,胸片及胸部CT示肺水肿,且以左肺为主。咽拭子标本实时荧光RTPCR提示其致病病原体为EV71。结论通过该病例分析,认为即使是少年也可因EV71感染而导致死亡的手足口病情况发生。由于这类病人早期未出现手、足疱疹,因而对该病的及时诊断和治疗是一个重大的挑战。Objective To reveal the complexity of diagnosing fatal hand, foot and mouth disease（HFMD） in older children by investegating the process from occurrence to death of a severe HFMD case induced by EV-71 in a 15-year-old boy. Methods After collecting throat swab specimens from the teenager patient, real-time fluorescence PCR （RT-PCR） was conducted to analyze the relevant pathogen. At the same time, with combination of clinical manifestations and laboratory tests, such as blood routine, electrolyte, blood gas , chest X-rays and a computerized tomography （CT） scan, the diagnosis of this fatal HFMD case was confirmed. Results The patient was admitted to our hospital after three days with a sore throat, headache and vomiting. Oral medications were ineffective at home prior to the patient＇ s admission to the hospital. After admission, the patient was diagnosed as upper respiratory tract infection and treated with intravenous antibiotics and fluid supplementation. At night on the same day of his admission, the patient developed an exacerbated headache, tachycardia, tachypnea with pink puffy phlegm, convulsions and became unconsciousness. He was then transferred to the intensive care unit for further treatment, including advanced life support with mechanical ventilation to maintain brain and cardiopulmonary function. At last, the patient died from multiple organ dysfunction syndrome. In the process, no rashes and vesicles on the palms of the hands or the bottoms of the feet were observed, no ulcers in the oral cavity and only a few vesicles in the throat. After admission, laboratory evaluations revealed normal blood counts and normal levels of serum electrolyte and C-reactive protein. Cerebrospinal fluid （CSF） was normal but with low pressure （60 cm H20）. Analysis of blood gas showed respiratory failure type I1 with acidosis. Chest X-rays and a computerized tomography （CT） scan showed pulmonary edema, which was more severe on the left side. A brain CT scan demonstrated intracranial suffused edema

关 键 词：手足口病(HFMD) 肠道病毒71(EV71) 少年 

分 类 号：R512.5[医药卫生—内科学]