儿童肺吸虫病21例临床分析

Clinical Analysis of 21 Cases of Children Paragonimiasis

目的分析肺吸虫病的临床特征,以提高临床诊治水平,减少误诊误治。方法回顾1998～2012年在温州医学院附属育英儿童医院确诊的21例不同类型的儿童肺吸虫病,分析其临床表现及诊疗情况。结果 21例患儿中15例有明确生食、醉吃或烤吃溪蟹、淡水虾史,6例有常饮用生溪水或捕捉溪蟹史。11例为多浆膜腔积液,表现为不同程度的胸腔积液、腹腔积液和心包积液。3例为肺吸虫脑病,1例同时存在多浆膜腔积液和肺吸虫脑病。1例皮下结节,1例同时存在多浆膜腔积液和皮下结节。21例患儿外周血嗜酸性粒细胞绝对数及百分比均升高(最高达72%),14例行血清总IgE检测患儿其数值明显高于正常。6例肺吸虫抗原皮试阳性,11例肺吸虫血清抗体阳性,4例肺吸虫抗原皮试和血清抗体均阳性。结论儿童肺吸虫病临床表现复杂多样,应详细询问病史尤其是生活饮食习惯,结合血嗜酸性粒细胞计数、影像学及免疫学检查做到早诊断早治疗。

Objective To analyze the clinical characteristics of children＇s paragonimiasis in order to enhance the level of clinical diagnosis and treatment to reduce misdiagnosis. Methods The medical history, conditions of diagnosis and treatment of 21 confirmed different types children paragonimiasis from 1998 to 2012 in our hospital were retrospectively analyzed. Results Fifteen cases had eaten raw or undercooked freshwater crab or crayfishes, and 6 eases often drank raw stream or canght crabs. There were 11 cases of polyserositis such as pleural effusion, ascites and perieardial effusion in different degrees. There was 3 cases of cerebral paragonimiasis, and one ease who had both polyserositis and cerebral Paragoniminsis. There was one case of subcutaneous nodules, and one both had polyserositis and subcutaneous nodules. Peripheral blood eosinophilia of 21 cases inoreased, and in 14 eases,their serum IgE were signifieandy higher than normal. Paragonimiasis antigen intradermal test of 6 cases was positive, and paragonimiasis serum antibody 11 cases was positive, and 4 cases were both positive. Conclusion The clinical manifestations of paragonimiasis is complex and non - specific in children. The diagnosis should be determined by inquiring the patients in detail about the history, especially the eating habits of life, combining with eosinophil count, radiologic findings and immunological test in order to avoid misdiagnosis.