深部真菌在儿童消化道的定植与感染

Clinical analysis of children′s digestive tract deep fungal infection

目的 了解儿童消化道深部真菌感染的临床特点,避免临床误诊及漏诊.方法 回顾性分析总结自2005年1月至2016年5月在广州市妇女儿童医疗中心消化科住院治疗,确诊为儿童消化道深部真菌感染患儿的临床特征及治疗效果.结果 总计确诊为消化道深部真菌感染6例,所有患儿均出现真菌性食管炎,其中合并真菌性胃肠病2例.主要临床表现为呕吐、喂养或进食困难.其中2例患儿伴有间歇性胸痛、腹痛.病程4~12周.起病前应用广谱抗生素1例;诊断先天性免疫缺陷1例;因先天性食管闭锁经历手术治疗3例.食管造影均提示食管狭窄.胃镜检查均出现食管黏膜损伤,散在成簇的灰白色斑点或豆腐渣样附着物3例,食管全周被灰白色豆腐渣样物覆盖,范围1/3~1/2食管全长,伴有食管腔堵塞3例.多发巨大的浅表溃疡2例.病变累及胃、十二指肠2例,其中1例累及范围自口腔至肛门整个消化道.6例患儿经黏膜病理检查或分泌物涂片检查确定为白色念珠菌感染.3例轻症患儿选择制霉素片口服,疗程2~3周.3例重症患儿予伊曲康唑口服,疗程3~4周.胃镜复查见食管、胃、十二指肠黏膜光滑,食管溃疡表面未见附着物.1例患儿结肠及末端回肠黏膜豆腐渣样附着物及溃疡明显减少.4例临床痊愈,1例确诊免疫缺陷病,因肺部感染死亡;1例全消化道感染者,3月后复发,目前仍在随诊中.结论 儿童消化道深部真菌感染主要表现为反复呕吐,进食困难及腹痛,病变范围可累及食管以至全消化道.食管黏膜损伤可能是诱因之一,同时应注意排除先天性免疫缺陷.确诊依赖于消化内镜检查、黏膜活检.抗真菌治疗有效.

Objective To understand the clinical characteristics of children′s digestive tract deep fungal infection,avoid clinical misdiagnosis and missed diagnosis. Methods We analyzed the clinical characteristics and treatment effect in the children who were diagnosed with gastrointestinal tract deep fungus infection from January 2005 to May 2016 in guangzhou women and children′s hospital. Results Digestive tract deep fungal in-fection in 6 cases. All children are fungal esophagitis,fungal gastrointestinal diseases in 2 cases. The main clinical feature is vomiting,dysphagia and abdominal pain which lasted 4 ~12 weeks. Broad-spectrum antibiotics in 1 case,congenital immunodeficiency in 1 case,congenital esophageal atresia in 3 case. Gastroscopy found clusters of gray spots or jerry-built attachments (3 cases),Esophageal the week covered by gray jerry-built content, scope of 1/3-1/2 esophageal length,with esophageal lumen jams in 3 case. Large superficial ulcer in 2 cases. Le-sions involving the stomach and duodenum in 2 cases,one of which lesions involving the whole digestive gut. 6 cases by mucosa pathological examination or secretions smears identified as candida albicans infection. 3 cases of children with mild choose doxycycline tablets,treatment 2-3 weeks. 3 cases of children with severity choose Itra-conazole Capsules,treatment 3-4 weeks. Gastroscope review the digestive gut which was better than before. But 1 case was diagnosed immunodeficiency disease,death from lung infection. 1 case of whole digestive tract infec-tion,relapse after 3 month,at present is still in follow-up. Conclusion Children′s digestive tract of deep fungal infection is mainly characterized by vomiting,dysphagia and abdominal pain. Fungal can invade the whole diges-tive tract. Esophageal mucosa injury may be one of causes,and at the same time should pay attention to rule out congenital immunodeficiency. Diagnosis is dependent on the digestive endoscopy,mucosal biopsy.