儿童脑型肺吸虫病合并脑脓肿的临床分析

Clinical analysis on cerebral paragonimiasis with concurrent brain abscess in children

目的分析儿童脑型肺吸虫病合并脑脓肿的临床特点和诊治,提高对该疾病的认识。方法回顾性分析9例脑型肺吸虫病合并脑脓肿患儿的临床资料,对其临床表现、辅助检查、诊断、治疗及预后进行分析总结。9例患儿,均来自疫区,男6例,女3例;年龄4~9.8岁,平均7.1岁;以头痛、呕吐、发热起病,以颅内高压和脑膜脑炎为主要表现,肺吸虫抗体(+),血和脓液嗜酸性粒细胞计数增高,6例脓液细菌培养(+),2例坏死组织的病理检查见较多的嗜酸性粒细胞。结果1例首诊为脑型肺吸虫病,治疗过程发现脑脓肿,8例首诊为脑脓肿,治疗过程中发现脑型肺吸虫病。MRI增强扫描见薄壁均匀的环形强化的脑脓肿征像、"隧道征"以及串珠样改变的肺吸虫感染征像。给予手术、抗感染和抗寄生虫治疗效果好,随访5个月至3年无复发。结论儿童脑型肺吸虫病合并脑脓肿较为少见,易漏诊,病情更为危重,及时获取详细的病史、血和脓液的嗜酸粒细胞计数、脓液培养的结果、影像学诊断以及特异性抗体的检查结果有助于早期诊断和积极有效的治疗,获得良好愈后。

Objective To explore the clinical characteristics, diagnosis and treatment of cerebral paragonimiasis with concurrent brain abscess in children and enhance its awareness. Methods Clinical data from 9 patients with cerebral paraponimiasis with concurrent brain abscess were retrospectively analyzed. Their clinical manifestations, examinations, diagnosis, treatment and prognosis were analyzed. There were 6 boys and 3 girls with a median age of 7.1 (4-9.8) years and all of them came from epidemic regions. With an onset of headache, vomiting and fever, the predominant symptoms were intracranial hypertension and meningoencephalitis. And sera samples were positive for paragonimus antibodies. The counts of eosnophils were elevated markedly in blood and abscess. Bacterial growth was detected in 6 cases of abscess. Two of them had an elevation of eosinophils in necrotic tissue. Results One case was initially diagnosed as cerebral paragonimiasis and brain abscess detected during treatment. Eight cases were treated initially for brain abscesses. Enhanced scans of magnetic resonance imaging (MRI) revealed thin uniform circular intensifications as brain abscesses, Tunnel sign and changes of bead-like paragonimiasis. Surgery, anti-infection and anti-parasite treatments were effective and there was no recurrence during a follow-up period of 5-36 months. Conclusions Children of cerebral paragonimiasis with concurrent brain abscess are rare and easily missed with a grave disease course. Detailed medical history, blood/pus elevated eosinophils, bacterial culture of pyogenic fluids, imaging studies and specific antibody may enable early diagnosis and timely and effective treatment.