儿童中枢神经系统肺炎支原体感染26例

Central Nervous System Infection of Mycoplasma Pneumoniae in 26 Children

目的探讨肺炎支原体(MP)引起的中枢神经系统(CNS)感染的临床表现、诊断、疗效及预后。方法分析26例MP导致的CNS感染患儿的临床资料,按起病原因不同分为2组,第1组10例,以发热、头痛、呕吐等为首发症状,病程中始终无咳嗽;第2组16例,以发热、咳嗽等为首发症状,病程第7-12天出现神经系统症状。2组患儿均应用PCR法检测脑脊液(CSF)MP-DNA,采用颗粒凝集试验检测其血清MP特异性IgM和IgG抗体,并行脑电图及头颅影像学检查。总结小儿CNSMP感染的临床特点。结果1.MP导致的CNS感染多见于5岁以上儿童,以发热(26/26例)、头痛(15/26例)、嗜睡(15/26例)及呕吐(12/26例)等为主要表现,惊厥(3/26例)少有发生;有呼吸道症状者在病程的7～12d出现神经系统症状。2.第1组患儿,CSFMPDNA阳性,同期血MP特异性IgM和IgG抗体均阴性;第2组患儿出现神经系统症状后,CSFMPDNA阴性,MP特异性IgM和IgG抗体均阳性。3.脑电图异常(慢波)18例,4例患儿MRI呈脑灰质多灶异常信号,脑室旁斑片状高信号,经阿奇霉素、丙种球蛋白及脱水降颅压、止痉等治疗,患儿均痊愈出院。结论MP是引起儿童CNS感染的病原体之一,CNS症状可在肺炎病程中或无肺部症状时出现,其临床症状与病毒性脑炎鉴别困难。CSFMPDNA检测阳性及血清MP特异性IgM和IgG抗体增高,对确诊MP感染、指导治疗预后评估有重要意义。MPCNS感染通常预后良好。

Objective To investigate the clinical manifestations, diagnosis, curative effect and prognosis of central nervous system （CNS） infection caused by Mycoplasma pneumoniae （MP）. Methods Twenty - six children with CNS infection of MP were included for the observation. The characteristics of children were determined by clinical symptoms. The children were classified into 2 groups according to cause of disease. All the children were classified again into 2 groups according to the clinical symptoms：Group 1 （ 10 cases） and group 2 （ 16 cases）. Children in group 1 had fever, headache and vomiting as the initial symptoms, but cough didn＇t appear during the whole course of disease. Children in group 2 had fever and cough as the inital symptoms, and symptoms of central nervous system were found after 7 -12 days. Specific IgM and IgG antibody from serum was assayed by particle agglutination test and MP DNA from cerebrospinal fluid （CSF） was detected by polymerase chain reaction（PCR） in all children. Electroen -cephalogram and cranial imaging examinations were performed. Resuits 1. The majority children with MP infection in CNS were older than 5 years. The clinical manifestations included fever （26/26 cases）, headache （ 15/26 cases） ,lethargy （ 15/26 cases） and vomiting （ 12/26 cases）. However,convulsion （3/26 cases） was rare. 2. MP DNA in CSF was positive and specific IgM, lgG antibody in serum was negative in group 1 ; children in group 2 had fever and cough as the inital symptoms, and neural symptoms appeared afterwards. However, MP DNA in CSF was negative and specific IgM and IgG antibody of serum was positive in group 2.3. Other founding included abnormal electroencephalogram （slow wave） in 18 children,muhi -focus abnormal signal in ectocinerea and patching high signal near encephalocoelemain in MRI in 4 children. All children recovered completely after treatment with antibiotics, immunoglobin 7, dehydration therapy and antispasmodism. Conclusions MP is one of the pathogens causing CNS infection in childhood. CNS symptoms can occur with or without respiratory infection. The etiopathogenisis of encephalitis is difficult to distinguish MP from vlros. Positive MP DNA in CSF and positive specific IgM and lgG antibody in serum is helpful to diagnosis MP infections and its treatment. Children with MP infection in CNS usually recover well and have a good prognosis.