儿童链球菌中毒性休克综合征1例并文献复习  

Streptococcal toxic shock syndrome in children: one case report and literature review

作　　者：韩书珍[1] 俞蕙[1] 叶颖子[1] 陈伟明[2] 陆铸今[2] HAN Shuzhen;YU Hui;YE Yingzi;CHEN Weiming;LU Zhujin(Department of Infectious Diseases,Children's Hospital of Fudan University,Shanghai 201101,China)

机构地区：[1]复旦大学附属儿科医院感染科,上海201101 [2]复旦大学附属儿科医院ICU,上海201101

出　　处：《中国感染与化疗杂志》2018年第6期579-584,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨儿童链球菌中毒性休克综合征(streptococcal toxic shock syndrome,STSS)的临床特征、治疗及预后。方法回顾性分析上海复旦大学附属儿科医院收治的1例STSS患儿的临床资料。对中文数据库维普、万方、中国知网和英文Pub Med数据库,分别以"链球菌中毒性休克综合征""儿童"和"streptococcal toxic shock syndrome""children""case report"作为检索词,检索1996年1月1日-2017年5月1日的文献,对病例资料进行总结。结果该例为11岁女性患儿,以发热、右下肢红肿热痛伴行走障碍及低血压为主要表现,影像学提示右侧大腿软组织弥漫性异常信号,穿刺液检查提示为A群链球菌即化脓链球菌感染,经积极纠正休克及抗感染治疗后好转。检索出中文文献5篇,6例病例,加上该院1例,共7例,年龄15个月～13岁,均有发热、皮疹,并快速进展出现休克表现,其中4例伴有呼吸衰竭,给予呼吸机支持;3例死亡,其中2例在入院24h内死亡。英文文献27篇,共38例患者,年龄40d～18岁,其中以呼吸道或消化道症状及皮肤软组织感染为主要表现,此外还发现3例水痘,2例川崎病,1例新生儿大疱性脓疱病,1例胰腺炎,1例传染性单核细胞增多症,1例淋巴组织细胞增生症;38例患者中,22例存活,死亡16例。结论 STSS是一种少见的严重感染综合征,早期表现无特异性,可以表现为上呼吸道感染、消化道功能障碍症状,亦可以皮肤软组织感染、肌肉/关节病变为首发,甚至与川崎病相似或伴随存在,大多迅速进展为休克及多脏器功能衰竭,严重威胁患儿生命。儿科医师应提高对该病的警惕性,早期识别、及时诊断、充分治疗是改善预后的关键。Objective To investigate the clinical manifestations,treatment and prognosis of streptococcal toxic shock syndrome(STSS)in children.Methods One case of STSS was reported in a child who was admitted to Children’s Hospital of Fudan University.Search terms such as“streptococcal toxic shock syndrome”,“children”and“case report”were used to identify relevant reports from PubMed database,as well as Chinese databases including Chongqing VIP,Wanfang,and China National Knowledge Infrastructure for further review.Results The patient in this report was a 11-year-old female.The main clinical manifestations were fever,red,swelling,and pain in the right lower extremity,associated with impaired walking and hypotension.Imaging examination suggested diffuse abnormal signals in the soft tissue of right thigh.Group A Streptococcus(namely Streptococcus pyogenes)was isolated from the puncture fluid.The patient was improved after active shock-correcting and anti-infective treatment.A total of 6 STSS cases were identified from Chinese databases between January 1,1996 and May 1,2017.All the 7 cases(including this one,4 males and 3 females,15 months to 13 years of age)reported fever and skin rashes,and rapidly progressed to shock.Respiratory failure was reported in 4 cases and supported with a ventilator.Three patients died,including 2 within 24 hours after hospital admission.A total of 38 STSS cases(40 days to 18 years of age)were identified from PubMed database.The main clinical manifestations of these cases were respiratory tract or digestive tract symptoms,and skin and soft tissue infection.In addition,chickenpox was found in 3 cases,Kawasaki disease in 2 cases,neonatal bullous impetigo,pancreatitis,infectious mononucleosis,and lymphohistiocytosis in one case each.Of the 38 patients,22 survived and 16 died.Conclusions STSS is a rare and severe form of invasive streptococcal infection in children.The early manifestations are not specific,which may be mistaken for upper respiratory tract infection,gastrointestinal dysfunct

关 键 词：链球菌中毒性休克综合征 儿童 治疗 

分 类 号：R378.12[医药卫生—病原生物学]