儿童莱姆病30例临床特点分析

Clinical manifestations of 30 cases with Lyme disease

目的 探讨儿童莱姆病的临床特点。方法 1995年 5月～ 2 0 0 0年 10月在内蒙古林业总医院儿科确诊为儿童莱姆病的患儿 3 0例 ,男 2 1例 ,女 9例 ,年龄在 2～ 14岁。总结分析其临床特点。结果 3 0例患儿均有一次或多次被蜱叮咬史。潜伏期为 1～ 14d。 3 0例 ( 10 0 % )均有典型的特征性皮肤损害 :皮肤被蜱叮咬处出现游走性红斑 ,2 1例 ( 70 % )出现类似流感样症状 ,4例 ( 13 % )有循环系统症状及心肌损害体征 ,3例 ( 10 % )累及关节 ,1例 ( 3 % )出现眼部症状 ,1例 ( 3 % )出现神经系统症状。 3 0例患儿均测得血清抗莱姆病螺旋体抗体IgG阳性 ,滴度≥ 1∶12 8。青霉素或头孢唑啉治疗有效。结论 儿童莱姆病是在内蒙古大兴安岭林区多发的一种自然疫源性蜱媒传染病 ,病原体是螺旋体 ,经蜱叮咬后传播给人类。潜伏期 1～ 14d。临床表现复杂多样 ,经合理治疗后 ,潜伏期短者症状轻 ,预后较好 ,潜伏期长者症状重 ,预后差。

Objective To understand the clinical characteristics of Lymes disease in children. Methods Case records of 30 children with Lyme disease who were admitted to the pediatric department of Forest Hospital, Inner Mongolia from May 1995 to Oct. 2000, were reviewed. Twenty-one cases were male and 9 were female. Their age ranged from 2 to 14 years. The possible factors associated with the onset, incubation period, clinical manifestations of the organ systems and response to treatment were analyzed. Results Each of the 30 cases had a history of tick bite for one time or more. The incubation period was 1 to 14 days. All of them were hospitalized for typical erythema migrans. Among the 30 cases, 21(70%) showed symptoms of acute upper respiratory tract infection; 4 (13%) showed circulatory system symptom and manifestations of myocardial lesion; 3(10%) had joint pain; 1 case (3%) had eye symptom and another case (3%) had nervous system symptoms, such as headache, vomiting, drowsiness, neck stiffness and so on. EEG and spinal fluid test showed some abnormal results. All the 30 cases were positive for IgG antibody to Lyme spirochetes with titers higher than 1∶128. Penicillin or cefazolin was effective in treatment of the patients. Conclusion The incubation period of the disease observed among this series of patients was 1-14 d. Lyme disease in this group of patients involved multiple organ systems while erythema migrans and arthralgia were the most frequently seen manifestations. Most of the patients had a favorable outcome with no sequelae.