2011—2018年北京市中心城区儿童中耶尔森菌病流行特征及临床诊断

The surveillance of Yersiniosis among children in central area of Beijing from 2011 to 2018

目的分析北京市中心城区儿童耶尔森菌病流行特征以及临床诊断的准确性。方法选取北京市中心城区一家儿童医院在2011—2018年开展连续性腹泻病例的病原学监测,共3493例;收集患者的流行病学和临床特征信息,分析患者耶尔森菌病、细菌性痢疾临床诊断与病原学诊断情况,比较不同特征患者小肠结肠炎耶尔森菌检出情况。结果3493例患者年龄为6 d至13岁,M(P25,P75)为1.50(0.75,3.17)岁,28例检出小肠结肠炎耶尔森菌,病原学诊断为耶尔森菌病,检出率为0.80%,月份峰值出现在2和5月。耶尔森菌病患者中,5岁以下占85.71%(24例),3~4岁组的检出率最高(1.52%),0~1岁组的检出率最低(0.18%),差异有统计学意义(P=0.025)。出现黏液便、伴随发热症状、便常规中检出白细胞以及红细胞症状体征的患者小肠结肠炎耶尔森菌检出率均高于无该症状体征患者(P>0.05)。28例耶尔森菌病患者中,9例临床诊断都被错诊为细菌性痢疾。结论北京市中心城区14岁以下儿童耶尔森菌病患者以5岁以下为主,腹泻症状以黏液便、伴随发热、便常规镜检可见白细胞、红细胞为特点,临床初步诊断容易与细菌性痢疾相混淆。

Objective To illuminate the epidemic characteristics of Yersiniosis among children in the central city of Beijing and the accuracy of current clinical diagnosis towards Yersiniosis.Methods Etiological surveillance of diarrheal patients,a total of 3493 cases,was performed in a children hospital in central area of Beijing from 2011 to 2018 continuously.Collected the epidemiological and clinical information of the cases,analyzed the clinical and etiological diagnosis for Yersiniosis and bacterial dysentery and compared the distribution of Yersiniosis cases with the different symptoms.Results A total of 3493 acute diarrhea cases distributed from the age of 6 months to 13 years old,M(P25,P75)was 1.50(0.75,3.17)years old.The 28 cases were isolated Yersinia enterocolitica(isolation rate of 0.80%)and they could be diagnosed as Yersiniosis by etiology.The isolation peaked in May and February.A total of 85.71%(24/28)of Yersiniosis cases were under 5-year old.The children of 3-4 age group had the highest isolation rate(1.52%)while the rate(0.18%)of 0-1 age group was the lowest(P=0.025).The Yersinia enteroclitica isolation rates of diarrheal patients with the symptoms including mucus feces,fever,white blood cell(WBC)and red blood cell(RBC)in feces were higher than the patients without these symptoms(P>0.05).The 9 of 28 Yersiniosis cases by etiology diagnosis were clinical diagnosed as bacillary dysentery.Conclusion The infants and young children under 5-year old were the main population of Yersiniosis adolescent patients under 14-year old.The typical symptoms characterized with mucus stool,fever,WBC and RBC by routine microscopic examination.The preliminary clinical diagnosis of Yersiniosis is easily confused with bacterial dysentery.