儿童广州管圆线虫病一例及文献复习

Angiostrongyliasis cantonensis in children:a case report and literature review

目的探讨儿童广州管圆线虫病的临床特征,加深对该病的认识,避免误诊。方法对1例广州管圆线虫病患儿的临床资料进行回顾性分析,并以"广州管圆线虫病/angiostrongyliasis cantonensis"为检索词在中国期刊全文数据库(CNKI)、万方数据知识服务平台及Pub Med收集并分析相关文献作复习讨论。结果该例患儿以反复头痛伴发热、多次查血常规示嗜酸性粒细胞增多为主要特点,使用抗生素期间热退、头痛缓解,但易激惹、攻击行为明显,脑脊液白细胞及蛋白仍偏高,不能用细菌性脑膜炎来解释。结合脑脊液迈格吉染色提示嗜酸性粒细胞增高,将脑脊液送检行广州管圆线虫特异性检查后,确诊为广州管圆线虫所致儿童嗜酸性粒细胞增多性脑膜炎。停用抗生素并使用阿苯达唑驱虫、醋酸泼尼松后病情得以改善。分析文献显示该病易被误诊,部分病例死亡后经尸检才确诊,及早确诊后采用驱虫治疗可获良好效果。结论广州管圆线虫病相对少见,可引起嗜酸性粒细胞增多性脑膜脑炎或脑膜炎,完善头颅MRI、脑脊液广州管圆线虫特异性抗体及分子基因测序有助于诊断,阿苯达唑辅以小剂量糖皮质激素对本病有良好疗效。

Objective To investigate the clinical characteristics of one child diagnosed with angiostrongyliasis cantonensis to deepen the understanding of this disease and avoid the misdiagnosis.Methods Clinical data of one child with angiostrongyliasis cantonensis were retrospectively analyzed.Literature review was performed using the keywords of angiostrongyliasis cantonensis in both English and Chinese from the CNKI,Wanfang database and Pub Med.Results The child mainly presented with recurrent headache accompanied with fever.Eosinophilia was noted through repeated routine blood tests.The symptoms of headache and fever were mitigated after administration of antibiotics,whereas the patient was easily irritable and tended to display aggressive behaviors.The levels of the white blood cells and protein in the cerebrospinal fluid were relatively high,which could not be explained by bacterial meningitis.MGG staining of the cerebrospinal fluid prompted the signs of eosinophilia.The cerebrospinal fluid was prepared for the specific examination of angiostrongylus cantonensis.The child was eventually diagnosed with eosinophilic meningitis caused by angiostrongyliasis cantonensis.Relevant symptoms were alleviated after terminating usage of antibiotics,administration of albendazole to expel intestinal parasites and use of prednisone.Literature analysis demonstrated that it was likely to make a misdiagnosis of angiostrongyliasis cantonensis.The diagnosis of angiostrongyliasis cantonensis was confirmed even after autopsy in certain cases.Effective measures should be taken to expel intestinal parasites after the diagnosis was validated.Conclusion Angiostrongyliasis cantonensis is relatively rare in clinical practice.It can cause eosinophilic meningitis or meningitis.Comprehensive cranial MRI,specific antibody detection and molecular gene sequencing of the cerebrospinal fluid contribute to accurate diagnosis.Albendazole combined with a low dosage of glucocorticoid achieves high clinical efficacy in the treatment of angiostrongyliasis cantonensis.