百日咳感染在儿童慢性咳嗽中的地位及其临床特征研究
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摘要
目的调查慢性咳嗽患儿百日咳感染情况及百日咳患儿的临床特征。方法采集2016年1月1日至2017年5月31日门诊及住院的106例慢性咳嗽患儿的鼻咽拭子、静脉血标本,进行百日咳鲍特菌培养、多重PCR检测及血清抗百日咳毒素抗体检测,根据检测结果分为百日咳组(n=26)和对照组(n=80)。分析比较两组患儿的临床特点;采用E-test法检测分离百日咳鲍特菌菌株对红霉素、阿奇霉素、多西环素、左氧氟沙星、复方新诺明和阿莫西林的敏感性。结果 106例慢性咳嗽患儿中,共26例(24.5%)被检出百日咳阳性。百日咳组与对照组患儿百日咳经典症状发生率比较差异均无统计学意义(P>0.05)。E-test检测显示红霉素、阿奇霉素对分离的5株百日咳鲍特菌的最小抑菌浓度(MIC)均>256 mg/L,阿莫西林的MIC为0.5～1.0 mg/L。结论临床工作者应重视慢性咳嗽患儿当中百日咳感染的存在,百日咳感染的慢性咳嗽患儿可能不出现百日咳经典症状而只表现为慢性咳嗽。阿莫西林可能成为大环内酯类抗生素耐药菌株感染的备选药物。
Objective To investigate the prevalence of Bordetella pertussis infection in children with chronic cough and its clinical features.Methods A total of 106 children who were treated at the outpatient service or hospitalized from January 1,2016 to May 31,2017 were enrolled.Their nasopharyngeal swabs and venous blood samples were collected for Bordetella pertussis culture,multiple PCR and serum anti-pertussis toxin antibody detection.According to these results,the children were divided into pertussis group with 26 children and control group with 80children,and clinical features were analyzed for both groups.E-test stripes were used to determine the sensitivity of Bordetella pertussis strains to erythromycin,azithromycin,doxycycline,levofloxacin,sulfamethoxazole/trimethoprim and amoxicillin.Results Of the 106 children with chronic cough,26(24.5%)were found to have Bordetella pertussis infection.There were no significant differences in the incidence rates of typical symptoms of pertussis between the pertussis and control groups(P>0.05).E-test showed that erythromycin and azithromycin had a minimal inhibitory concentration(MIC)of>256 mg/L against five Bordetella pertussis strains,while amoxicillin had an MIC of 0.5-1 mg/L.Conclusions The presence of Bordetella pertussis infection in children with chronic cough should be taken seriously by clinicians,and children with chronic cough and Bordetella pertussis infection may not have the typical symptoms of pertussis and are mainly manifested as chronic cough.Amoxicillin may be an alternative drug for macrolide-resistant Bordetella pertussis infection.
Objective To investigate the prevalence of Bordetella pertussis infection in children with chronic cough and its clinical features.Methods A total of 106 children who were treated at the outpatient service or hospitalized from January 1,2016 to May 31,2017 were enrolled.Their nasopharyngeal swabs and venous blood samples were collected for Bordetella pertussis culture,multiple PCR and serum anti-pertussis toxin antibody detection.According to these results,the children were divided into pertussis group with 26 children and control group with 80children,and clinical features were analyzed for both groups.E-test stripes were used to determine the sensitivity of Bordetella pertussis strains to erythromycin,azithromycin,doxycycline,levofloxacin,sulfamethoxazole/trimethoprim and amoxicillin.Results Of the 106 children with chronic cough,26(24.5%)were found to have Bordetella pertussis infection.There were no significant differences in the incidence rates of typical symptoms of pertussis between the pertussis and control groups(P>0.05).E-test showed that erythromycin and azithromycin had a minimal inhibitory concentration(MIC)of>256 mg/L against five Bordetella pertussis strains,while amoxicillin had an MIC of 0.5-1 mg/L.Conclusions The presence of Bordetella pertussis infection in children with chronic cough should be taken seriously by clinicians,and children with chronic cough and Bordetella pertussis infection may not have the typical symptoms of pertussis and are mainly manifested as chronic cough.Amoxicillin may be an alternative drug for macrolide-resistant Bordetella pertussis infection.
引文
[1]中华医学会儿科学分会呼吸学组慢性咳嗽协作组,《中华儿科杂志》编辑委员会.中国儿童慢性咳嗽诊断与治疗指南(2013年修订)[J].中华儿科杂志,2014,52(3):184-188.
[2]王静敏,沈叙庄,袁林,等.细菌培养、血清学与分子流行病学方法对百日咳诊断价值的评价[J].中国实用儿科杂志,2004,19(12):720-723.
[3]Guiso N,Berbers G,Fry NK,et al.What to do and what not to do in serological diagnosis of pertussis:recommendations from EU reference laboratories[J].Eur J Clin Microbiol Infect Dis,2011,30(3):307-312.
[4]Guiso N,Wirsing von K?nig CH,Forsyth K,et al.The Global Pertussis Initiative:report from a round table meeting to discuss the epidemiology and detection of pertussis,Paris,France 11-12January 2010[J].Vaccine,2011,29(6):1115-1121.
[5]WHO.Pertussis vaccines:WHO position paper,August2015-recommendations[J].Vaccine,2016,34(12):1423-1425.
[6]Surridge J,Segedin ER,Grant CC.Pertussis requiring intensive care[J].Arch Dis Child,2007,92(11):970-975.
[7]中华预防医学会疫苗可预防疾病儿童百日咳临床调查研究协作组.持续性咳嗽儿童百日咳临床多中心调查研究[J].中华儿科杂志,2010,48(10):748-752.
[8]Pimentel AM,Baptista PN,Ximenes RA,et al.Pertussis may be the cause of prolonged cough in adolescents and adults in the interepidemic period[J].Braz J Infect Dis,2015,19(1):43-46.
[9]中华医学会儿科学分会感染学组,《中华儿科杂志》编辑委员会.中国儿童百日咳诊断及治疗建议[J].中华儿科杂志,2017,55(8):568-572.
[10]许红梅,郑佳佳.百日咳临床特点及流行病学研究进展[J].中华实用儿科临床杂志,2014,29(22):1681-1682.
[11]张晓芳,刘小乖,李瑞娜,等.慢性咳嗽患儿百日咳感染与非感染临床特征分析[J].中国医药,2018,13(1):51-54.
[12]许红梅.儿科医生应高度重视百日咳再现[J].中华儿科杂志,2017,55(8):564-567.
[13]黄建琼,马卓娅,郑跃杰,等.婴幼儿百日咳的临床特征[J].中华实用儿科临床杂志,2014,29(22):1724-1727.
[14]王传清,朱启镕.百日咳与非百日咳迁延性慢性咳嗽儿童及青少年临床特征分析[J].临床儿科杂志,2010,28(6):542-544.
[15]李丽君,叶金艳,姚开虎.百日咳的实验室诊断方法研究进展[J].中华传染病杂志,2017,35(12):765-768.
[16]Funaki T,Miyairi I.Lymphocytosis in a baby with pertussis[J].Lancet Infect Dis,2015,15(1):130.
[17]姚开虎.在临床实践中再认识百日咳[J].中华实用儿科临床杂志,2017,32(22):1681-1684.
[18]李亚绒.百日咳治疗研究进展[J].中华实用儿科临床杂志,2017,32(22):1696-1698.
[19]Trollfors B.Effect of erythromycin and amoxycillin on Bordetella pertussis in the nasopharynx[J].Infection,1978,6(5):228-230.
[20]Hoppe JE,Haug A.Treatment and prevention of pertussis by antimicrobial agents[J].Infection,1988,16(3):148-152.
[21]Wang Z,Cui Z,Li Y,et al.High prevalence of erythromycinresistant Bordetella pertussis in Xi'an,China[J].Clin Microbiol Infect,2014,20(11):825-830.
[22]Yang Y,Yao KH,Ma X,et al.Variation in Bordetella pertussis susceptibility to erythromycin and virulence-related genotype changes in China(1970-2014)[J].PLoS One,2015,10(9):e0138941.
[2]王静敏,沈叙庄,袁林,等.细菌培养、血清学与分子流行病学方法对百日咳诊断价值的评价[J].中国实用儿科杂志,2004,19(12):720-723.
[3]Guiso N,Berbers G,Fry NK,et al.What to do and what not to do in serological diagnosis of pertussis:recommendations from EU reference laboratories[J].Eur J Clin Microbiol Infect Dis,2011,30(3):307-312.
[4]Guiso N,Wirsing von K?nig CH,Forsyth K,et al.The Global Pertussis Initiative:report from a round table meeting to discuss the epidemiology and detection of pertussis,Paris,France 11-12January 2010[J].Vaccine,2011,29(6):1115-1121.
[5]WHO.Pertussis vaccines:WHO position paper,August2015-recommendations[J].Vaccine,2016,34(12):1423-1425.
[6]Surridge J,Segedin ER,Grant CC.Pertussis requiring intensive care[J].Arch Dis Child,2007,92(11):970-975.
[7]中华预防医学会疫苗可预防疾病儿童百日咳临床调查研究协作组.持续性咳嗽儿童百日咳临床多中心调查研究[J].中华儿科杂志,2010,48(10):748-752.
[8]Pimentel AM,Baptista PN,Ximenes RA,et al.Pertussis may be the cause of prolonged cough in adolescents and adults in the interepidemic period[J].Braz J Infect Dis,2015,19(1):43-46.
[9]中华医学会儿科学分会感染学组,《中华儿科杂志》编辑委员会.中国儿童百日咳诊断及治疗建议[J].中华儿科杂志,2017,55(8):568-572.
[10]许红梅,郑佳佳.百日咳临床特点及流行病学研究进展[J].中华实用儿科临床杂志,2014,29(22):1681-1682.
[11]张晓芳,刘小乖,李瑞娜,等.慢性咳嗽患儿百日咳感染与非感染临床特征分析[J].中国医药,2018,13(1):51-54.
[12]许红梅.儿科医生应高度重视百日咳再现[J].中华儿科杂志,2017,55(8):564-567.
[13]黄建琼,马卓娅,郑跃杰,等.婴幼儿百日咳的临床特征[J].中华实用儿科临床杂志,2014,29(22):1724-1727.
[14]王传清,朱启镕.百日咳与非百日咳迁延性慢性咳嗽儿童及青少年临床特征分析[J].临床儿科杂志,2010,28(6):542-544.
[15]李丽君,叶金艳,姚开虎.百日咳的实验室诊断方法研究进展[J].中华传染病杂志,2017,35(12):765-768.
[16]Funaki T,Miyairi I.Lymphocytosis in a baby with pertussis[J].Lancet Infect Dis,2015,15(1):130.
[17]姚开虎.在临床实践中再认识百日咳[J].中华实用儿科临床杂志,2017,32(22):1681-1684.
[18]李亚绒.百日咳治疗研究进展[J].中华实用儿科临床杂志,2017,32(22):1696-1698.
[19]Trollfors B.Effect of erythromycin and amoxycillin on Bordetella pertussis in the nasopharynx[J].Infection,1978,6(5):228-230.
[20]Hoppe JE,Haug A.Treatment and prevention of pertussis by antimicrobial agents[J].Infection,1988,16(3):148-152.
[21]Wang Z,Cui Z,Li Y,et al.High prevalence of erythromycinresistant Bordetella pertussis in Xi'an,China[J].Clin Microbiol Infect,2014,20(11):825-830.
[22]Yang Y,Yao KH,Ma X,et al.Variation in Bordetella pertussis susceptibility to erythromycin and virulence-related genotype changes in China(1970-2014)[J].PLoS One,2015,10(9):e0138941.