摘要
目的探讨慢性肉芽肿病患儿肺部感染的临床特点。方法回顾性分析5例以肺部感染为首发症状的慢性肉芽肿病患儿的临床资料,总结其症状、体征、实验室检查结果、影像学表现及治疗转归情况。结果 5例患儿均因发热就诊,病程4～60d,体温37.8～40.1℃,伴轻微咳嗽,无明显感染中毒症状,无发绀、呼吸急促、喘息等症状,3例肺部体征无明显异常,2例有少许中湿性啰音;外周血中性粒细胞计数明显增多;肺部CT表现为多发结节、不规则、球形或类球形高密度影;下呼吸道分泌物细菌、真菌涂片及培养、真菌D-葡聚糖试验均阴性;抗生素治疗无效,抗真菌药物治疗1～2d发热好转,约1个月肺部病灶明显吸收。结论以肺部感染为首发症状的慢性肉芽肿病患儿可有不同程度发热,呼吸道症状及体征较轻,但影像学表现重,肺部CT可见多发结节、不规则、球形或类球形高密度影;真菌病原常见,抗真菌治疗有效。
Objective To investigate the clinical features of pulmonary infection in children with chronic granulomatous disease（CGD）.Methods The clinical data of 5 CGD children with the initial symptom of pulmonary infection were retrospectively analyzed to summarize the symptoms,physical signs,auxiliary examination results,radiographic images,treatment and turnover.Results Five children visited hospital due to fever ranged from 37.8 to 40.1℃ for 4 to 60 days,complicated with slight cough,and with no infection,toxic symptom,wheezing,tachypnea or cyanosis.The signs of lung were normal,except two patients with a little of rale,and the neutrophil count was remarkable increased.Chest CT revealed multiple pulmonary nodules,or irregular,spherial or oval-shaped high-density lesions.Bacterial and fungal culture was negative in secretions of the lower respiratory tract,and serum（1-3）-beta-D-glucan assay was negative.The broad-spectrum antibiotics were inefficient,and the body temperature was lowered one or two days after the treatment with antifungal agent.The lesions in lung were mostly absorbed in one month.Conclusion CGD patients with the initial symptom of pulmonary infection usually present fever,mild respiratory symptoms and signs,and obviously abnormal chest imaging.Chest CT shows multiple pulmonary nodules or irregular,spherial or oval shaped high-density lesions.Fungi is one of the most common pathogens,and antifungal therapy is effective.
出处
《中华实用诊断与治疗杂志》
2016年第6期589-591,共3页
Journal of Chinese Practical Diagnosis and Therapy
基金
深圳市医学重点学科建设基金(2005C05)
关键词
慢性肉芽肿病
肺炎
真菌
儿童
Chronic granulomatous disease
pneumonia
fungi
child
