儿童少见肺炎链球菌病的临床特征

Clinical characteristics of rare Streptococcal pneumonia disease in children

肺炎链球菌病(SPD)临床表现多样,一些少见类型预后较差,其中肺炎链球菌(SP)相关凶险性脾切除术后感染(SP-OPSI),在发病48~72 h病死率高达70%.SP暴发性紫癜(SP-PF)常表现为大面积紫癜、发热、低血压和弥散性血管内凝血等,无前驱症状者预后差.SP相关心血管疾病中,感染性心内膜炎病死率为20.7%,其中奥地利综合征更高达43.5%.细菌性心包炎病死率为13.56%,目前SP疫苗不能完全覆盖报道的7种血清型.血管炎主要见于胸腹部主动脉及其分支、脑部中等动脉等.文献检索到的8例噬血细胞综合征中2例死亡.早期抗感染、甲泼尼龙冲击、外科治疗等可改善预后.有基础疾病,如脾功能缺陷者,疫苗接种及药物预防有助于降低SPD如SP-OPSI等的发病率.

The clinical manifestations of Streptococcus pneumoniae disease(SPD)are various,and some patients with rare SPD types have a worse prognosis.Among them,the mortality is up to 70%after 48-72 hours of the onset of Streptococcus pneumoniae(SP)-related overwhelming post-splenectomy infection(OPSI).Purpura fulminans of SP(SP-PF)is often characterized by extensive purpura,fever,hypotension and disseminated intravascular coagulation,and prognosis of the patients without prodromal symptoms is poor.Infectious endocarditis has a mortality rate of 20.7%in SP-related cardiovascular diseases,and Austrian syndrome has a fatality rate of 43.5%.The mortality rate of bacterial pericarditis was 13.56%.At present,SP vaccine can not completely cover the 7 serotypes reported.Vasculitis mainly occurs in the thoracic and abdominal aorta and its branches,middle cerebral artery and so on.Of the 8 cases of hemophagocytic syndrome,2 cases died.Early anti-infection,methylprednisolone shock and surgical treatment can improve the prognosis.Vaccination and drug prophylaxis can help those with under-lying diseases such as splenic dysfunction to reduce the incidence of SPD,such as SP-OPSI.