重症肠道病毒71型感染早期误诊的临床分析

Early Severe Enterovirus 71 Infection:A Clinical Analysis of Misdiagnoses

目的提高对重症肠道病毒71型(EV71)感染的认识,分析总结救治的经验教训,减少误诊,提高抢救成功率,及早做好消毒隔离,防止疾病扩散流行。方法选择2011—2012年县级医院及我院收治的6例重症EV71感染患儿,均早期误诊为重症肺炎并发中毒性脑病及感染性休克,回顾性分析其临床表现、实验室检查结果、影像学结果、抢救经过及治疗转归。结果 6例患儿均有较明显的临床特征,如高热不退、心动过速、血压过高、高血糖、无典型的皮疹,咽拭子EV71病毒特异性核酸检测阳性。颅脑及颈椎MRI检查,延髓区,颈段及上胸段脊髓内可见长T1、T2高信号影。6例患儿均给予大剂量丙种球蛋白等治疗,其中4例痊愈,2例死亡。结论对临床出现高热不退、心动过速、血压过高、高血糖等表现的危重患儿,应及早做咽拭子EV71病毒抗体检测,减少误诊、漏诊;早诊断,尽早使用机械通气;早隔离,防止EV71感染传播流行。

Objective To deepen the understanding of severe enterovirus 71 （EV71） infection and summarize the lessons from treatments to reduce misdiagnoses, increase success rate of rescue and prevent the spread of the disease. Methods A retrospective analysis was performed on data of 6 severe EV71 children misdiagnosed as severe pneumonia complicated by tox- ic encephalopathy and septic shock. The clinical manifestations, laboratory findings, rescue process and prognosis were ana- lyzed. Results All patients had obvious clinical features, such as high fever, tachycardia, high blood pressure, high blood sugar, without typical rash, and positive throat swab EV 71 virus - specific nucleic acid testing. MRI of cerebral and cervical spine showed high signal on T1 and T2 -weighted image in medulla oblongata area, cervical spinal cord and thoracic segment of the spinal cord. All of 6 cases were given the treatment with high - dose Gamma globulin. 4 cases were healed, and 2 cases died. Conclusion For children presenting with high fever, tachycardia, high blood pressure, high blood sugar etc. , throat swab EV 71 virus -specific nucleic acid testing should be performed as soon as possible to reduce misdiagnoses, missed diagno- ses; mechanical ventilation be used early, and isolation be done early to prevent the spread of EV71 infection.