儿童伤寒125例临床分析

Clinical analysis of 125 children with typhoid fever from 1993 to 2008 in Chongqing area

目的总结儿童伤寒临床特点,以利于其临床早期诊治。方法对1993—2008年重庆地区125例儿童伤寒临床资料进行回顾性分析。结果每年均有散发病例,77例(61.6%)发生于夏秋季,110例(88.0%)为5～14岁儿童。主要表现为发热124例(99.2%)、肝肿大91例(72.8%)、脾肿大65例(52.0%)、消化道症状103例(82.4%)和呼吸道症状71例(56.8%)。外周血白细胞97例(77.6%)正常、16例(12.8%)减少,28例(84.8%)嗜酸性粒细胞减少或消失。血培养、骨髓培养、粪培养和肥达反应阳性率分别为68.2%、55.0%、7.4%和42.7%,临床分离株对头孢他啶、头孢吡肟、头孢曲松、头孢噻肟、头孢哌酮、环丙沙星、左氧氟沙星敏感率分别为100%(26/26)、100%(33/33)、93.3%(14/15)、96.9%(62/64)、66.7%(10/15)、100%(49/49)和100%(6/6)。27例细菌培养阴性者肥达反应阳性。根据药物敏感试验选用抗生素,123例治愈,2例小婴儿误诊死亡。结论重庆地区儿童伤寒散发,5～14岁儿童好发,夏秋季稍多;临床表现不典型,以发热、肝脾大、消化道和呼吸道表现为主。肥达反应阳性率较低,但对细菌培养阴性者仍有重要意义。第3代头孢菌素和喹诺酮类仍是该地区儿童伤寒的敏感药物。

Abstrat：Objective To summarize the clinical characteristics of typhoid fever in children and to provide the clinical experiences for early diagnosis and treatment. Methods A retrospective analysis was made on the clinical data of 125 children with typhoid fever in Chongqing from 1993 to 2008. Results 110 cases（88.0%） were from 5 to 14 years old. The cases were more common in summer or autumn （77, 61.6%）. The common clinical features were fever （124, 99.2%）, hepatomegaly （91, 72.8%）, splenomegaly （65, 52.0%）, gastrointestinal manifestations （103, 82.4%） and respiratory manifestations （71,56.8%）. WBC was in the normal range in 97（77.6%）, and only 16（12.8%） presented leucopenia. Eosinophils reduced or disappeared in 28/33 （84.8%）. Anemia existed in 85（68.0%）, 84/85（98.8%） of whom presented mild or moderate. The overall positive rate of bacterial cultures was 77.0%. The positive rate of blood cultures, marrow cultures, stool cultures and Widal test were 68.2% （75/110）, 55.0% （22/40）, 7.4% （5/68） and 42.7% （50/117）, respectively. Widal test was positive in 27 cases with negative bacterial cultures. The susceptibilities of clinical strains to ceftazidime, cefepime, ceftriaxone, cefotaxime, cefoperazone, levofloxacin （6/6） and ciprofloxacin were 100%（26/26）、100%（33/33）、93.3%（14/15）、96.9%（62/64）、66.7%（10/15）, 100% and 100%, respectively. Basing on the results of antimicrobial susceptibility testing, the patients with poor therapeutic effect initially were treated by sensitive antibiotic and the curative effect were prominent：123 children cured while 2 died because of misdiagnosis. Conclusions Typhoid fever is sporadic in Chongqing. The peak age of onset ranges from 5 to 14 years old. It is more common in summer and autumn. The clinical manifestations of typhoid fever in children are atypical. The positive rate of Widal test is low, but it is still of great significance to the cases with negative bacterial culture. The third-generation cephalosporins and quinolones remain susceptible to the treatment for children with typhoid fever in Chongqing.