儿童A族链球菌感染致中毒性休克综合征临床分析

Clinical analysis of streptococcal toxic shock syndrome caused by Group A Streptococcus infection in children

目的分析儿童A族链球菌(GAS)中毒性休克综合征(STSS)的临床特点。方法通过电子病历系统调取2015年1月至2022年3月深圳市儿童医院住院的10例STSS患儿的临床资料,回顾性分析其临床特点,总结治疗经验。结果本组10例中男5例,女5例,年龄(5.29±2.87)岁。既往均体健。2例血培养阳性,5例脓液培养阳性,3例血宏基因组学二代测序确诊;其中7例咽拭子GAS快速检测阳性。患儿均有发热,其中病毒感染后发生9例,肺炎7例,皮肤软组织感染6例,坏死性筋膜炎3例,化脓性脑膜炎1例。患儿均有休克,其中弥散性血管内凝血7例,肝功能损伤6例,急性肾损伤4例,感染相关脑病4例,呼吸衰竭2例,横纹肌溶解2例。3例入院时血白细胞数降低,余7例升高;中性粒细胞比例均升高;7例血小板降低,恢复后均血小板升高。患儿C反应蛋白、降钙素原均升高。患儿均发生低白蛋白血症、低钠血症和低钙血症。培养阳性的10例菌株均对青霉素、头孢曲松/头孢噻肟和万古霉素敏感。8例患儿入院后采取了联合抗生素治疗,8例接受静脉注射免疫球蛋白治疗。10例患儿均治愈出院。结论儿童STSS进展迅速,应引起临床医师重视。早期识别、感染源的快速诊断、抗生素的及时应用及外科治疗是管理的关键。

Objective To analyze the clinical characteristics of Group A Streptococcal(GAS)toxic shock syndrome(STSS)in children.Methods The clinical data of 10 STSS children hospitalized in Shenzhen Children′s Hospital from January 2015 to March 2022 were downloaded from the electronic medical record system.The clinical manifestations were analyzed and treatment experience was summarized respectively.Results There were 5 males and 5 females,with an average age of(5.29±2.87)years.All the patients were healthy in the past.The diagnoses were confirmed by blood culture in 2 cases,pus culture in 5 cases,and blood metagenomics next generation sequencing in 3 cases.The rapid detection of GAS antigen was positive in 7 cases.All cases had fever,and 9 cases of them developed fever after viral infection,including pneumonia in 7 cases,skin and soft tissue infections in 6 cases,necrotizing fasciitis in 3 cases,and purulent meningitis in 1 case.All cases also presented with shock.Six cases had liver function injury,and 4 cases suffered from acute kindey injury.Four cases had infection-related encephalopathy,and 7 cases were afflicted with disseminated intravascular coagulation.Two cases had respiratory failure,and 2 cases had rhabdomyolysis.There were 3 cases with a decreased white blood cell(WBC)count and 7 cases with an increased WBC count on admission.Seven cases were found to have thrombocytopenia,but their platelet levels were all elevated after recovery.C-reactive protein and procalcitonin and the proportion of neutrophils were markedly increased in all cases.All cases suffered from hypoalbuminemia,hyponatremia and hypocalcemia.All the 10 positive strains were sensitive to Penicillin,Ceftriaxone/Cefotaxime and Vancomycin.Eight cases were treated with combined antibiotics after admission.Eight patients received intravenous immunoglobulin.All cases were cured and discharged.Conclusions The STSS progresses rapidly in children,so pediatricians should pay great attention to the disease.Early identification,diagnosis of infection sources,infusion of antibiotics and surgical treatment are the keys to disease management.