广州地区儿童2019新型冠状病毒感染筛查/疑似病例129例临床特征分析

Analysis of clinical characteristics of 129 children screening/suspected 2019-nCoV infection in Guangzhou

目的探讨广州地区儿童2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染筛查/疑似病例的流行病学特点、发病特点、可能的原因及防控建议。方法回顾性分析2020年1月20日-2020年2月29日广州市唯一一家儿童2019-nCoV感染隔离定点医疗单位隔离病房收治住院的符合儿童2019-nCoV感染筛查/疑似病例129例,对其流行病学、发病特点、临床特征、实验室检查及转归、随访等进行总结分析。结果男79例,女50例,最小1个月,最大13岁,中位数2岁,51例(39.5%)有武汉疫区旅游或居住史,20例(15.5%)有与来自疫区有呼吸道症状人员接触史,17例(13.1%)周边或社区有确诊病例,3例(2.3%)有确诊病人接触史(其中2例为家庭确诊病例密切接触史),38例(29.5%)为临床符合或聚集性发病;临床症状:发热121例(93.8%),咳嗽92例(71.3%),流涕50例(38.8%),32例伴有腹泻、呕吐/腹痛(24.8%),102例(79.0%)白细胞降低或正常,C反应蛋白(C-reactive protein,CRP)<20 mg/L有103例(79.8%),57例(44.2%)胸片或CT示肺部斑片状影或实变;病原学检查:2019-nCoV实时荧光定量反转录PCR检测结果:所有患儿及陪同家属都有行咽拭子检查,只有21例患儿(16.3%)有行肛拭子检查,仅有1例(0.78%)家庭确诊病例密切接触者肛拭子阳性,但连续多次咽拭子结果阴性,余患者肛拭子和咽拭子及陪同家属咽拭子结果均阴性。其他病原学检查结果61例(47.3%),包括14例RSV阳性,9例流感病毒A,8例人偏肺病毒,6例肠道病毒,6例流感病毒B,6例肺炎支原体,4例副流感病毒1型,1例副流感病毒3型,2例人博卡病毒,3例腺病毒,1例肺炎克雷伯菌,1例人型葡萄球菌,其中1例合并副流感病毒1型及人博卡病毒。跟踪唯一1例确诊患者咽拭子多次检查均阴性,肛拭子持续19天后才转阴,一直无任何症状。其余患者好转出院后第3天、7天及14天进行随访,无异常发现。结论儿童2019-nCoV感染筛查/疑似病例临床多表现为呼吸道或消化道症状,确诊主要依靠核酸检测,新冠病毒感染确诊率极低,而其将近50%病例能找到除新冠病毒外的其它相关病原体;高危患者为密切接触者,但存在漏诊的可能,肛拭子阳性率或高于咽拭子。

Objective To explore the epidemiological characteristics,onset characteristics,pathogenic mechanism of 2019-nCoV infection in children,and its control and prevention in Guangzhou.Methods From January 20,2020 to February 29,2020,a retrospective analysis was carried out on 129 suspected cases of 2019-nCoV infection admitted to the isolation ward of the only medical unit designated for children in Guangzhou.The epidemiology,disease characteristics,clinical characteristics,laboratory examination,outcome and follow-up were summarized and analyzed.Results There were 79 males and 50 females,with a minimum age of 1 month and a maximum age of 13 years.Anong them,51 cases(39.5%)had a history of tourism or residence in the epidemic area of Wuhan,20 cases(15.5%)had a history of contact with people with respiratory symptoms from the epidemic area,17 cases(13.1%)with a confirmed case in the surrounding area or community,3 cases(2.3%)had a history of contact with a confirmed patient(2 of them were family clustering cases),38 cases(29.5%)were clinically suspected cases.Clinical symptoms:121 cases with fever(93.8%),92 cases with coughing(71.3%),50 cases with runny nose(38.8%),32 cases with diarrhea,vomiting or abdominal pain(24.8%).In 102 cases(79.0%),white blood cells were decreased or normal,103 cases(79.8%)with CRP<20 mg/L,and 57 cases(44.2%)showed focal infection on chest X-ray or CT scan.Etiological examination:only one case(0.78%)of the family confirmed cases had positive anal swab result,but the throat swab results were negative all the time.The anal swab and throat swab results of other patients and the throat swab results of their accompanying family members were negative.Other pathogens were detected in 61 cases(47.3%),including 14 RSV positive cases,9 influenza A positive cases,8 human metapneumovirus positive cases,6 enterovirus positive cases,6 influenza B positive cases,6 Mycoplasma pneumoniae positive cases,4 parainfluenza virus type 1 positive cases,1 parainfluenza virus type 3 positive cases,2 human bocavirus positive cases,3 adenovirus positive cases,1 Klebsiella pneumoniae positive cases,1 Human Staphylococcus positive case,and 1 case with parainfluenza virus type 1 and human bocavirus.The only confirmed patient was followed up while multiple pharyngeal swab results were negative,and the positive anal swab results lasted for 19 days before turning negative and remained asymptomatic.Other patients were followed up on the 3rd,7th and 14th day after discharge,and no abnormal findings were found.Conclusion Screening/suspected cases of 2019-nCoV infection in children were mostly clinically manifested as respiratory or gastrointestinal symptoms.The diagnosis rate of nucleic acids was extremely low,and there was a possibility of missed diagnosis.Nearly 50%of cases could find other relevant pathogens excluding the 2019-nCoV.The positive rate of anal swab results was higher than that of pharyngeal swab.