小儿脑型肺吸虫病的诊治

Diagnosis and treatment for children with cerebral paragonimiasis

目的探讨小儿脑型肺吸虫病的临床特点和诊治。方法59例患儿中生食淡水蟹或饮用疫水52例，高颅压症状49例，肢体偏瘫19例，偏盲10例，癫痫发作19例，合并肺部症状6例；外周血嗜酸性粒细胞升高45例，白细胞升高36例；肺吸虫抗原皮试阳性55例，ELISA试验阳性15例。CT或MRI检查均发现脑内病灶。结果所有病例均口服吡喹酮治疗，其中14例手术开颅切除病灶。痊愈41例，好转18例。43例患儿随访6～12个月预后良好。结论小儿脑型肺吸虫病临床表现多样，早期易误诊。流行病学资料、外周血嗜酸性粒细胞升高、肺吸虫免疫学检查和MRI有助于早期诊断。根据病情采用药物及手术治疗效果满意。

Objective To explore the clinical features, diagnosis and treatment for children with cerebral paragonimiasis. Methods Among all the 59 patients, 52 had a history of consuming raw crabs or drinking contaminated water, 49 got intracranial hypertension, 10 suffered hemiparalysis or hemiablepsia, 19 had epileptic seizure, and 6 complicated with pulmonary symptoms. Forty-five got increased eosinophilic leukocytes in peripheral blood, 36 had increased leucocytes. Skin test of Paragonimus westernami antigen was positive in 45 cases and ELISA test was positive in 15 cases. Intracerebral lesions were found in all the cases by CT or MRI examination. Results All patients underwent oral administration of Praziquantel, and 14 got craniotomy. Forty-one cases were cured and 18 cases partially recovered. Forty-three patients who were followed up for 6 months to 2 years had good prognosis. Conclusions Cerebral paragonimiasis in children has complex clinical manifestations, which is often misdiagnosed in the early stage. Epidemiology, increased eosinophilic leukocytes in peripheral blood, positive results of paragonimiasis immunology test and MRI contribute to early diagnosis. Drug or surgical treatment according to patient＇s different conditions can promise the good prognosis in children with cerebral cerebral paragonimiasis.