急性腹泻患儿艰难梭菌感染检测与临床分析
摘要
目的了解疑似病毒感染的急性腹泻患儿中是否合并艰难梭菌(CD)感染,并分析其临床特点。方法收集急性腹泻患儿大便标本1 590例份,筛查其诺如病毒(NoV)感染情况,并采用聚合酶链反应方法检测艰难梭菌毒素A/B(Tcd-A/B)基因。结果 1 590例份大便标本中,NoV阳性410例份,阳性率25.79%;Tcd阳性79例份,阳性率为4.97%;二者合并感染21例份,混合感染率为26.58%(21/79)。在79例份Tcd阳性标本中,CD毒素A、B均阳性(A~+B~+)16例份,仅毒素B阳性(A~-B~+)63例份,未检测到仅毒素A阳性(A~+B~-)标本;CD阳性检出率在性别、年龄、季节等方面差异均无统计学意义。在Tcd检测阳性的患儿标本中,65例(82.28%)患儿入院前后曾使用抗生素,同时伴有呕吐的患儿38例(48.10%)、发热70例(88.61%)、贫血31例(39.24%)、C反应蛋白(CRP)增高27例(34.18%)、白蛋白降低10例(12.66%)、粒细胞减低29例(36.71%),将阳性患儿分为A~+B~+组16例与A~-B~+组63例,两组在性别、年龄、病程、腹泻次数、抗生素使用比例、发热患儿比例、贫血患儿比例、CRP、白细胞等方面比较差异均无统计学意义。79例Tcd检测阳性患儿标本中,检测到腺病毒阳性4例(5.06%),轮状病毒阳性11例(13.93%),NoV阳性21例(26.58%),博卡病毒阳性0例。结论急性腹泻患儿中存在致泻病毒及CD的合并感染,且Tcd阳性以A~-B~+为主,阳性患儿多有抗生素使用史,同时可伴有发热、呕吐、贫血、低蛋白血症、CRP增高、粒细胞减低等症状。
引文
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[2]苗瑞雪,汪志凌,周伟,等.艰难梭菌在儿童肠道定植和感染的研究进展[J].重庆医学,2019,48(1):134-137.
[3]Kim J,Smathers SA,Prasad P,et al.Epidemiological features of Clostridium difficile-associated disease among inpatients at children's hospitals in the United States 2001-2006[J].Pediatrics,2008,122(6):1266-1270.
[4]Cheng VC,Yam WC,Chan JF,et al.Clostridium difficile ribotype 027 arrives in Hong Kong[J].Int J Antimicrob Agents,2009,34(5):492-493.
[5]李英杰,杨波,汤全英,等.腹泻患儿艰难梭菌感染的调查研究[J].中华医院感染学杂志,2015,25(19):4516-4518.
[6]冯云,王传清,金嘉琳,等.上海部分地区儿童艰难梭菌相关性腹泻的临床分析[J].微生物与感染,2010,5(3):151-155.
[7]程国平,李自华,戴昕,等.抗生素相关性腹泻患儿艰难梭菌感染分析[J].中华儿科杂志,2015,55(3):220-224.
[8]郭姝,徐樨巍,董方.儿童难辨梭状芽孢杆菌相关性腹泻的危险因素[J].中华医学杂志,2012,92(26):1836-1840.
[9]赵春娜,徐樨巍.儿童艰难梭菌相关性腹泻致病基因及临床特点研究[J].中华儿科杂志,2015,55(7):522-527.
[10]穆小萍,唐玲玲,周才,等.住院腹泻患儿粪便艰难梭菌毒素检测与分析[J].中国热带医学,2014,14(9):1124-1126.
[11]陈日炳,李小峰,胡琴,等.血清中艰难梭菌毒素A&B检测在腹泻诊断中的应用[J].国际检验医学杂志,2015,36(24):3641-3643.
[12]王瑞莲,林丽娟,付亮,等.艰难梭菌在腹泻患者中感染情况的调查[J].实用医学杂志,2015,31(1):144-146.
[13]Lemee L,Dhalluin A,Testelin S,et al.Multiplex PCR targeting tpi(triose phosphate isomerase),tcdA(Toxin A),and tcd B(Toxin B)genes for toxigenic culture of Clostridium difficile[J].JClin Microbiol,2004,42(12):5710-5714.
[14]Kim H,Jeong SH,Roh KH,et al.Investigation of toxin gene diversity,molecular epidemiology,and antimicrobial resistance of Clostridium difficile isolated from 12 hospitals in South Korea[J].Korean J Lab Med,2010,30(5):491-497.
[15]Sammons JS,Toltzis P,Zaoutis TE.Clostridium difficile Infection in children[J].JAMA Pediatr,2013,167(6):567-573.
[16]王小燕,吴晓明,沈一燚,等.儿童迁延性和慢性腹泻中艰难梭菌感染的检测[J].国际儿科学杂志,2017,44(3):219-222.