儿童脑寄生虫病9例临床分析  

Clinical analysis of 9 cases of parasitic encephalopathy in children

作　　者：陈连凤 陈文雄 李小晶 高媛媛 彭炳蔚 杨思达 CHEN Lianfeng;CHEN Wenxiong;LI Xiaojing;GAO Yuanyuan;PENG Bingwei;YANG Sida(Department of Neurology,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,Guangdong,China)

机构地区：[1]广州市妇女儿童医疗中心神经内科

出　　处：《临床儿科杂志》2019年第11期827-832,共6页Journal of Clinical Pediatrics

摘　　要：目的探讨儿童脑寄生虫病的临床特征。方法回顾分析2014年12月至2018年12月收治的9例脑寄生虫病患儿的临床资料。结果男6例、女3例,平均发病年龄(2.81±1.53)岁。5例有流行病学接触史。主要临床表现为发热8例,精神疲倦7例,呕吐5例,头痛2例,抽搐2例,左下肢瘫痪1例,共济失调1例,意识模糊伴精神行为异常1例,右上肢痛觉敏感1例。外周血嗜酸性粒细胞增高8例;脑脊液常规和生化异常8例,其中5例嗜酸性粒细胞增高;血清和脑脊液寄生虫抗体均阳性5例。脑脊液二代测序检出广州管圆线虫2例。头颅MRI显示软脑膜强化2例,脑实质信号异常4例。最终7例确诊脑寄生虫病,分别为广州管圆线虫病5例、脑弓形虫病1例、脑裂头蚴病1例;临床疑诊2例。7例给予阿苯达唑治疗,1例先后经乙酰螺旋霉素、复方新诺明治疗,另1例手术治疗。7例痊愈无后遗症,1例遗留左下肢跛行,1例失访。结论伴外周血嗜酸性粒细胞增高的儿童颅内感染性疾病应警惕脑寄生虫病,广东地区尤其应注意广州管圆线虫病。Objective To investigate clinical characteristics of parasitic encephalopathy in children.Methods A retrospective study was carried out to analyze the clinical data of 9 cases of parasitic encephalopathy from December 2014 to December 2018.Results There were 6 males and 3 females suffered from parasitic encephalopathy.The average age was(2.81±1.53)years.5 cases with epidemiological exposure history were identified.Main clinical manifestations included:fever(8),mental fatigue(7),vomiting(5),headache(2),convulsion(2),paralysis of the left leg(1),ataxia(1),confusion of consciousness with abnormal mental behavior(1),and hyperalgesia of the right upper limb(1).Routine test and biochemistry indicators of cerebrospinal fluid were abnormal in 8 cases,accompanied with increased eosinophil counting in 5 cases.Peripheral blood eosinophil increased in 8 cases.Specific antibodies in serum and cerebrospinal fluid were both positive in 5 cases.Angiostrongylus cantonensis in 2 cases was detected by Next-Generation Sequencing of cerebrospinal fluid.Magnetic resonance imaging showed leptomeningeal enhancement in 2 cases,and abnormal signals in brain parenchyma in 4 cases.7 cases were confirmed as parasitic encephalopathy:Angiostrongyliasis cantonensis(5),cerebral toxoplasmosis(5),cerebral sparganosis(1),and 2 suspected cases.7 cases were treated with albendazole,1 with SMZco followed by acetylspiramycin,and 1 treated with surgery.Finally,7 cases were cured and had no sequela,1 left a limp of the left leg,and 1 failed to follow up.Conclusion If children had intracranial infectious diseases accompanied with peripheral blood eosinophils increasing,parasitic encephalopathy should be considered,especially Angiostrongyliasis cantonensis in Guangdong.

关 键 词：脑寄生虫病 嗜酸性粒细胞 儿童 

分 类 号：S85[农业科学—兽医学]