摘要
目的:探讨儿童惠普尔养障体(TW)肺炎的临床表现、诊断及治疗,提高儿科医师对该病的认识。方法:回顾性分析2020年8月至2022年1月收治于温州医科大学附属第二医院育英儿童医院儿童呼吸科的3例TW肺炎患儿的临床资料。以“惠普尔养障体”和“肺部感染”或“肺炎”为关键词在中国知网、万方数据库,以“Trophery whipplei”和“pneumonia”为关键词在PubMed数据库检索自建库至2022年7月的相关文献。总结TW肺炎的临床特点、辅助检查、诊疗经过及预后。结果:本组3例患儿中,男2例,女1例,平均年龄(7.3±2.3)岁。肺泡灌洗液宏基因组二代测序(BALF mNGS)除例3合并检出流感嗜血杆菌,余2例仅检出TW,3例均应用头孢曲松针抗感染,联合或续用TMP-SMZ,除例2预后不佳(出现较严重的间质性肺病,运动耐量下降),余2例预后良好。检索符合条件的中文文献3篇,英文文献15篇,共23例,加上本组3例共26例,该病临床特征无特异性,主要表现为咳嗽(14例)、呼吸困难/气促(12例)、胸痛(6例)等。结论:TW肺炎多为慢性肺部感染,临床特征及影像学表现均不典型,临床上极易误诊,早期行BALF mNGS有助于明确病原体,协助诊断,合理抗感染治疗可迅速缓解症状,但易复发,预后大多良好。
Objective:To investigate the clinical features,diagnosis and treatment of Trophery whipplei(TW)pneumonia in children and to improve the understanding of the disease.Methods:The clinical data of 3 children with TW pneumonia admitted to the Department of Pediatric Respiratory of the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University from August 2020 to January 2022 were analyzed retrospectively.The keywords“Trophery whipplei”and“lung infection”or“pneumonia”were used in China Knowledge Network and Wanfang database,and the keywords“Trophery whipplei”and“pneumonia”were used as keywords to search the relevant literature in PubMed database since the establishment of the database until July 2022.The clinical features,ancillary examinations,treatment and prognosis of TW pneumonia were summarized.Results:Of the three children in this paper,two were male and one was female,with a mean age of(7.3±2.3)years.TW was detected by macrogenomic second generation sequencing(BALF mNGS)of alveolar lavage fluid in all cases,and Haemophilus influenzae was detected in case 3 combined.All 3 cases were treated with ceftriaxone injection anti-infection,combined or renewed with TMP-SMZ,and the prognosis was good in the remaining 2 cases except case 2,which had a poor prognosis.Three Chinese literature articles and 15 English literature articles were searched for eligible cases,totaling 23 cases.Together with the 3 cases in our group,a total of 26 cases,the clinical features of the disease were non-specific,mainly presenting as cough(14 cases),dyspnea/shortness of breath(12 cases),and chest pain(6 cases).Conclusion:Whipple’s feeder pneumonia is mostly a chronic lung infection with atypical clinical features and imaging manifestations,which is very easy to be misdiagnosed clinically.Early BALF mNGS can help to clarify the pathogen and assist in the diagnosis,and reasonable anti-infective treatment can rapidly relieve the symptoms,but it is easy to recur,and the prognosis is mostly good.
作者
李嫦嫦
潘晓宇
任锡凯
贾晓慧
苏苗赏
LI Changchang;PAN Xiaoyu;REN Xikai;JIA Xiaohui;SU Miaoshang(Department of Pediatric Respiratory Medicine,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou 325027,China)
出处
《温州医科大学学报》
CAS
2023年第3期240-244,共5页
Journal of Wenzhou Medical University
基金
国家自然科学基金项目(81870075)
浙江省医药卫生科技计划项目(2019317659)。
关键词
儿童
惠普尔养障体肺炎
惠普尔病
宏基因组二代测序
children
Trophery whipplei pneumonia
Whipple’s disease
metagenomic next generation sequencing
