手足口病患儿合并颅内感染的临床特征及病原学分析

Clinical characteristics of intracranial infections in children with hand,foot,and mouth disease and etiological analysis

目的分析手足口病合并颅内感染患儿的临床特点以及病原学特征,为早期诊断和治疗该类疾病提供理论依据。方法选取医院2014年1月-2015年1月接受治疗45例手足口病合并颅内感染患者作为观察组和相同时期内住院治疗45例未发生颅内感染的手足口病患者为对照组,对比分析两组患者的临床特征和病原学现象。结果合并颅内感染患者均有头痛、发热、精神不集中等临床表现,生化检查和脑脊液常规检查结果显示异常;观察组患儿发热天数大于3天占93.33%,明显高于对照组,差异具有统计学意义(P<0.05);观察组患儿在疾病的高峰期前出现典型皮疹占88.89%,明显低于对照组;观察组血压明显高于对照组;观察组的空腹血糖测定值和外周WBC计数均明显低于对照组,且两组差异均有统计学意义(P<0.05);手足口病合并颅内感染患儿脑脊液压力均有增高的现象,脑脊液细胞数目均有不同程度的增高;病原学检测结果中,EV71感染占66.67%,A16感染占13.33%,EV71感染的发生率在脑干脑炎患儿和其他非脑干脑炎患者中无明显差异。结论手足口病患儿出现高烧不降、外周血白细胞数、血压和血糖升高等现象,应特别重视。手足口病合并颅内感染患者中主要的病原体感染是EV71。

OBJECTIVE To investigate the clinical features of children with hand,foot,and mouth disease complicated with intracranial infections and analyze the etiological characteristics so as to provide theoretical basis for early diagnosis and treatment of the disease.METHODS Totally 45 hand,foot,and mouth disease patients complicated with intracranial infections who were treated in hospitals from Jan 2014 to Jan 2015 were assigned as the observation group,meanwhile,45 hand,foot,and mouth disease patients without intracranial infections were set as the control group.The clinical characteristics and etiological features were observed and compared between the two groups of patients.RESULTS The patients with intracranial infections had the clinical manifestations such as headache,fever,and lack of concentration;the results of biochemical test and cerebrospinal fluid routine examination were abnormal.The proportion of the children with duration of fever more than 3days was 93.33%in the observation group,significantly higher than that in the control group（P〈0.05）.The proportion of the children who presented with typical rash before peak of the disease was 88.89% in the observation group,significantly lower than that in the control group.The blood pressure of the observation group was significantly higher than that of the control group.The fasting blood glucose values and peripheral WBC counts were significantly lower in the observation group than in the control group（P〈0.05）.The cerebrospinal fluid pressure rose in all of the hand,foot,and mouth disease children complicated with intracranial infections,and the cerebrospinal fluid cells were increased in varying degrees.The result of etiological test showed that the children with EV71 infection accounted for 66.67%,the children with A16 infection accounted for 13.33%,and there was no significant difference in the incidence of EV71 infection between the children with brainstem encephalitis and the children with non-brainstem encephalitis.CONCLUSION It is necessary to pay great attention to the children who have sustained high fever,increased WBC counts in peripheral blood,and elevated levels of blood pressure and blood glucose.The EV71 is the predominant pathogen in the hand,foot,and mouth disease patients complicated with intracranial infections.