摘要
目的了解肺炎链球菌致急性化脓性心包炎的主要表现,加强对该病的认识。方法报道1例肺炎链球菌所致的急性化脓性心包炎患儿的临床表现及预后,并结合文献复习。结果 14月龄患儿,既往体健,因"呼吸急促7d,咳嗽3d"入院。血常规WBC、CRP显著升高。肺CT和超声心动图均提示心包积液。心包积液培养为肺炎链球菌100%,确诊为肺炎链球菌化脓性心包炎,血清型鉴定为6A型。予利奈唑胺抗感染治疗,好转后出院,随访6个月超声心动图仅提示心包膜稍增厚。检索PubMed数据库发现16例该病患儿报道,结合本文报道的1例,男9例,女7例,另1例性别不详;年龄4月至17岁,其中2岁以下10例;3例有基础疾病。血常规提示WBC明显升高,以多核细胞为主,CRP明显升高。心包积液外观为黄棕色脓性,常规及生化表现为典型化脓性积液改变;超声心动图及肺CT/X线检查均提示中至大量心包积液;合并肺炎2例,胸腔积液4例,心包填塞3例。9例报道药物敏感试验结果,其中8例为青霉素敏感菌株,1例为青霉素耐药菌株。7例报道血清型,其中6A、14、23F型各2例,34型1例。2/6例换用万古霉素,16例行心包穿刺引流。15例预后较好,2例死亡。结论肺炎链球菌化脓性心包炎病例有增多趋势,儿童既往常健康,通过积极治疗,预后较良好。
Objective To improve the understanding to acute purulent pericarditis caused by Streptococcus Pneumoniae （PPSP） ,to report a case of acute PPSP serotype 6A in a Chinese child and 16 reported cases by English literature on this topic up to now. Methods Clinical manifestation and prognosis of 17 patients （ including our reported case in this article） with acute purulent pericarditis caused by Streptococcus Pneumoniae were retrospectively analyzed. Results A 14-month-old previously healthy boy had a history with 7-day-tachypnea and 3-day-cough. The levels of white blood cell （WBC） and C-reactive protein （CRP） were significantly high. A computed tomographic imaging of the chest and echocardiographic study showed massive pericardial fluid. Streptococcus Pneumoniae serotype 6A was recovered from pericardial fluid and was found to be sensitive to penicillin. The patient was diagnosed as PPSP and treated with intravenous infusion of cefamandole and linezolid successively. On the 19th day of hospitalization the patient was discharged in good general condition and with hemodynamically stable. Over 6 months follow-up, ultrasound cardiography only revealed a little thickening cardiac pericardium. Since 1990, only 16 cases of PPSP have been reported in children in the PubMed databases. 17 cases （9 males,7 females, 1 unknown） aged from 4 months to 17 years, 10 cases were younger than 2 years old. Children were healthy without previous medical conditions and only 3cases had underlying diseases. Its clinical recognition was difficult due to insidiously subtle and varied presentations,but most of cases had fever, dyspnea and cough. The levels of WBC, neutrophil and C-reactive protein were very high. Pericardial fluid was often yellowish-brown and revealed typical manifestation of purulent pericarditis. Echocardiogram and chest CT/X ray showed a large amount of pericardial effusion, many cases showed pneumonia pleural effussion. 8 cases were with penicillin susceptible strains, 1 case with penicillin drug resistant strains of S. pneumoniae. 1 case of serotype 34, 2 cases of serotype 6A , 14 and 23F were reported respectively. 3 cases were with cardiac tamponade. Effective drainage of the pericardium in combined with high dose intravenous antibiotics offered the best results. Most of cases were treated with vancomycin finally. In general, there was often a good outcome without sequelae, but 2 cases died. Conclusions In near 20 years, PPSP has been reported in the English literature, and tended to increase in the past 2 years. Its clinical recognition is difficult due to atypical and varied presentations, especially in pediatirc department. Children wereoften healthy in the past. Despite the serious morbidity, PPSP patients who received prompt treatment could achieve good prognosis without sequelae.
出处
《中国循证儿科杂志》
CSCD
2013年第2期145-148,共4页
Chinese Journal of Evidence Based Pediatrics
关键词
肺炎链球菌
化脓性心包炎
儿童
Streptococcus pneumoniae
Purulent pericarditis
Children
