广州管圆线虫致幼儿嗜酸粒细胞性脑膜脑炎(附2例报告及文献复习)
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摘要
目的提高临床医生对广州管圆线虫致幼儿嗜酸粒细胞性脑膜脑炎的认识及诊疗水平。方法回顾性分析2例广州管圆线虫致幼儿嗜酸粒细胞性脑膜脑炎患儿的临床资料、影像学和基因检测等结果,结合文献探讨其临床特点、诊断方法及治疗措施。结果 2例患儿年龄分别为1岁10个月和1岁3个月、无明确接触史,主要临床症状表现为发热、精神疲倦,2例在外院均误诊治疗。外周血嗜酸粒细胞增高,脑脊液细胞数增高、嗜酸粒细胞> 10%;高通量基因检测到广州管圆线虫。阿苯达唑联合小剂量泼尼松治疗后病情恢复。结论幼儿广州管圆线虫嗜酸粒细胞性脑膜脑炎容易误诊、病死率高,早期完善头颅影像、脑脊液检查和分子基因测序可明确广州管圆线虫嗜酸粒细胞性脑膜脑炎的诊断。阿苯达唑辅以小剂量泼尼松治疗效果良好。
Aim To improve clinicians ' understanding and diagnosis and treatment of eosinophilic meningoencephalitis in Guangzhou. Methods The clinical data,imaging and gene detection of 2 cases of infantile eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis were retrospectively analyzed,and the clinical features,diagnosis and treatment measures were discussed. Results All of 2 cases were 1 to 2 years old with no definite contact history,fever and mental fatigue are the main manifestations. Two cases were misdiagnosed in other hospitals. Increased eosinophils in peripheral blood,the number of increased CSF cells and eosinophils were more than 10%,detection of a high-throughput gene of A. cantonensier. The cases recovered after albendazole treatment with low dose prednisone.Conclusion Eosinophilic meningoencephalitis in children in Guangzhou is easily misdiagnosed and the mortality rate is high. Early improvement of head imaging,cerebrospinal fluid examination and molecular of A. cantonensier can be used for diagnosis. Albendazole combined with low dose prednisone treatment achieved good effect.
Aim To improve clinicians ' understanding and diagnosis and treatment of eosinophilic meningoencephalitis in Guangzhou. Methods The clinical data,imaging and gene detection of 2 cases of infantile eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis were retrospectively analyzed,and the clinical features,diagnosis and treatment measures were discussed. Results All of 2 cases were 1 to 2 years old with no definite contact history,fever and mental fatigue are the main manifestations. Two cases were misdiagnosed in other hospitals. Increased eosinophils in peripheral blood,the number of increased CSF cells and eosinophils were more than 10%,detection of a high-throughput gene of A. cantonensier. The cases recovered after albendazole treatment with low dose prednisone.Conclusion Eosinophilic meningoencephalitis in children in Guangzhou is easily misdiagnosed and the mortality rate is high. Early improvement of head imaging,cerebrospinal fluid examination and molecular of A. cantonensier can be used for diagnosis. Albendazole combined with low dose prednisone treatment achieved good effect.
引文
[1]Graeff-Teixeira C,da Silva AC,Yoshimura K.et al.Update on eosinophilic meningoencephalitis and its clinical relevance[J].Clin Microbiol Rev,2009,22:322-348
[2]李雍龙.人体寄生虫学[M].第7版.北京:人民卫生出版社,2013:183-184
[3]Binder S,Levitt AM,Sacks JJ,et al.Emerging infections diseases:public health issue for the 21st century[J].Science,1999,284:1311-1313
[4]朱静,谢雯.广州管圆线虫病的诊断与治疗[J].中国临床医生,2006,34:26-27
[5]Chen MX,Zhang RL,Ai L,et al.Seroprevalence of Angiostrongylus cantonensis infection in humans in China[J].JParasitol,2011,97:144-145
[6]张仪,吕山,杨坤,等.我国广州管圆线虫自然疫源地分布首次调查[J].中国寄生虫学与寄生虫病杂志,2009,27:508-512
[7]Al Hammoud R,Nayes SL,Murphy JR,et al.Angiostrongylus cantonensis Meningitis and Myelitis,Texas,USA[J].Emerg Infect Dis,2017,23:1037-1038
[8]张榕燕,李莉莎,林金祥.幼儿重症广州管圆线虫1例[J].中国寄生虫与寄生虫病杂志,2010,5:703-706
[9]苏嬿莉,黄建军,谭丽梅.儿童广州管圆线虫病死亡原因分析[J].临床儿科杂志,2004,22:429-430
[10]New D,Little MD,Cross J.Angiostrongylus cantonensis infection from eating raw snails[J].N Engl J Med,1995,332:1105-1106
[11]Weller PF,Liu LX.Eosinophilic meningitis[J].Semin Neurol,1993,13:161-168
[12]胡亚美.诸福棠.实用儿科学[M].北京:人民卫生出版社,2015:1162
[13]Wilson MR,Naccache SN,Samayoa E,et al.Actionable diagnosis of neuroleptospirosis by next-generation sequencing[J].N Engl J Med,2014,370:2408-2417
[14]Yao M,Zhou J,Zhu Y,et al.Detection of Listeria monocytogenes in CSF from Three Patients with Meningoencephalitis by NextGeneration Sequencing[J].J Clin Neurol,2016,12:446-451
[15]蒋雨平,汪寅,初曙光.貌似“颅内肿瘤”的病例讨论(四)[J].中国临床神经科学,2011,5:556-559
[16]Li Y,Tang JP,Chen DR,et al.The use of albendazole and diammonium glycyrrhizinate in the treatment of eosinophilic meningitis in mice infected with Angiostrongylus cantonensis[J].J Helminthol,2013,87:1-11
[17]朱静,谢雯.广州管圆线虫病的诊断与治疗[J].中国临床医生,2006,34:26-27
[18]王婧,郑晓燕,阴赪宏,等.阿苯达唑致广州管圆线虫病患者肝损害的临床分析[J].中国病原生物学杂志,2008,20:209-211
[2]李雍龙.人体寄生虫学[M].第7版.北京:人民卫生出版社,2013:183-184
[3]Binder S,Levitt AM,Sacks JJ,et al.Emerging infections diseases:public health issue for the 21st century[J].Science,1999,284:1311-1313
[4]朱静,谢雯.广州管圆线虫病的诊断与治疗[J].中国临床医生,2006,34:26-27
[5]Chen MX,Zhang RL,Ai L,et al.Seroprevalence of Angiostrongylus cantonensis infection in humans in China[J].JParasitol,2011,97:144-145
[6]张仪,吕山,杨坤,等.我国广州管圆线虫自然疫源地分布首次调查[J].中国寄生虫学与寄生虫病杂志,2009,27:508-512
[7]Al Hammoud R,Nayes SL,Murphy JR,et al.Angiostrongylus cantonensis Meningitis and Myelitis,Texas,USA[J].Emerg Infect Dis,2017,23:1037-1038
[8]张榕燕,李莉莎,林金祥.幼儿重症广州管圆线虫1例[J].中国寄生虫与寄生虫病杂志,2010,5:703-706
[9]苏嬿莉,黄建军,谭丽梅.儿童广州管圆线虫病死亡原因分析[J].临床儿科杂志,2004,22:429-430
[10]New D,Little MD,Cross J.Angiostrongylus cantonensis infection from eating raw snails[J].N Engl J Med,1995,332:1105-1106
[11]Weller PF,Liu LX.Eosinophilic meningitis[J].Semin Neurol,1993,13:161-168
[12]胡亚美.诸福棠.实用儿科学[M].北京:人民卫生出版社,2015:1162
[13]Wilson MR,Naccache SN,Samayoa E,et al.Actionable diagnosis of neuroleptospirosis by next-generation sequencing[J].N Engl J Med,2014,370:2408-2417
[14]Yao M,Zhou J,Zhu Y,et al.Detection of Listeria monocytogenes in CSF from Three Patients with Meningoencephalitis by NextGeneration Sequencing[J].J Clin Neurol,2016,12:446-451
[15]蒋雨平,汪寅,初曙光.貌似“颅内肿瘤”的病例讨论(四)[J].中国临床神经科学,2011,5:556-559
[16]Li Y,Tang JP,Chen DR,et al.The use of albendazole and diammonium glycyrrhizinate in the treatment of eosinophilic meningitis in mice infected with Angiostrongylus cantonensis[J].J Helminthol,2013,87:1-11
[17]朱静,谢雯.广州管圆线虫病的诊断与治疗[J].中国临床医生,2006,34:26-27
[18]王婧,郑晓燕,阴赪宏,等.阿苯达唑致广州管圆线虫病患者肝损害的临床分析[J].中国病原生物学杂志,2008,20:209-211
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