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Objective:To understand the epidemiological and clinical characteristics of children with severe and critical hemorrhagic fever with renal syndrome(HFRS), and to accumulate experience in the diagnosis and treatment of severe and critical HFRS in children.Methods:A retrospective analysis method was used to collect the clinical data of 49 children diagnosed with HFRS, who were admitted to the Department of Infectious Diseases, Children′s Hospital Affiliated to Xi′an Jiaotong University from January 2019 to December 2021 and classified as severe or critical group.The epidemiological data, characteristics, clinical manifestations, laboratory examinations, diagnosis and treatment outcomes of the children were analyzed.Results:Among the 49 children with severe HFRS, the ratio of male∶female was 3.45∶1(38∶11), the median age was 10 years and 8 months old, and the highest proportion was 6-12 years old.The peak incidence was in November and December(75.51%).Most of them lived in rural areas, with a total of 39 cases(79.59%).All patients had fever onset, gastrointestinal symptoms(vomiting, abdominal pain, diarrhea, 81.63%)and hyperemia of skin and mucous membranes(77.55%)were common, but typical headache, backache pain and orbital pain(three pains)only accounted for 15 cases(30.6%).Laboratory test results: the white blood cells in routine blood increased in 42 cases(85.71%), while the platelets decreased in 47 cases(95.91%).The procalcitonin was increased in 48 cases(97.95%).The alanine aminotransferase was elevated in 49 cases(100%), while the albumin of 38 cases(77.55%)were lower than 30 g/L.The urea nitrogen increased in 34 cases(69.38%), and the creatinine increased in 47 cases(95.91%).The creatine kinase isozyme was elevated in 41 cases(83.67%).Forty-nine children had different degrees of electrolyte imbalance, among which low sodium(91.83%)and low calcium(85.71%)were the most common.The urine protein was positive in 47 cases(95.91%), and the urine red blood cell was positive in 38 cases(77.55%).Ultrasonography of the urinary system revealed abnormalities in the kidneys and surrounding kidneys in 43 cases(91.48%).Twenty-eight(58.33%)patients had abnormal electrocardiogram.All the 49 patients were clinically cured.Conclusion:Severe HFRS is mainly in rural male children aged 6-12 years, mainly with fever and gastrointestinal symptoms, lack of typical three pain symptoms.When white blood cell count and procalcitonin significantly increased, platelet count significantly decreased, liver and kidney function impaired and electrolyte imbalance, severe cases should be highly suspected.Early identification of critically ill children and active treatment are critical to their prognosis.
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Objective:To summarize the clinical characteristics, causes of misdiagnosis and preventive measures of infectious mononucleosis (IM) in children, and to improve the ability of clinicians in early diagnosis of IM in children.Methods:The clinical data of 468 children with IM in Xi′an Children′s Hospital from January 2018 to December 2021 were retrospectively analyzed, including general situation, disease onset, diagnosis and misdiagnosis.Results:Among the 468 children, 33 cases were clinically diagnosed and 435 cases were a definitely diagnosed; 281 males (60.04%) and 187 females (39.96%); the incidence rate was highest in preschool children (43.80%, 205/468) and in autumn (33.12%, 155/468). The first symptoms were fever (52.99%, 248/468), eyelid edema (15.38%,72/468) and neck mass (14.96%, 70/468). The fever rate was 90.38% (423/468), and the median time of first fever appearance was on the first (first, second) day of disease course, and the median duration of fever was 6 (4, 8) d. The median time of first visit was on the third (first, fifth) day of disease course, and the time of diagnosis was on the seventh (fifth, ninth) day of disease course. Blood routine examination showed that the proportion of white blood cell count increased was 51.92% (243/468), the proportion of lymphocytes increased was 61.75% (289/468), and the proportion of abnormal lymphocytes increased (≥10%) in peripheral blood was 58.97% (276/468). The lymphocyte subsets of 364 children were detected, the rate of helper T lymphocytes (Th cells) decreased was 80.22% (292/364), the rate of suppressor T lymphocytes (Ts cells) increased was 99.45% (362/364), the value and decreased rate of Th cells/Ts cells were 0.24 (0.16, 0.40) and 100.00% (364/364), rate of B lymphocytes decreased was 93.96% (342/364), rates of natural killer cells decreased and increased were 35.16% (128/364) and 0.55% (2/364). The misdiagnosis rate was 55.13% (258/468), and the misdiagnosis time was on the fifth (fourth, seventh) day of disease course. Among the 258 misdiagnosed children, 105 cases (40.70%) were misdiagnosed as upper respiratory tract infection, 65 cases (25.19%) as acute suppurative tonsillitis, 27 cases (10.47%) as acute cervical lymphadenitis or neck mass.Conclusions:Due to the complex and diverse clinical manifestations of IM in children, it is easy to be misdiagnosed in the early stage of the disease. So, it is necessary for clinicians to master the clinical characteristics of IM in children, constantly improve the level of diagnosis and treatment, and reduce the misdiagnosis rate.
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Objective To investigate the effect of traumatic lumbar puncture (TLP) on central nervous system leukemia (CNSL) in children with acute lymphoblastic leukemia and the related factors of TLP. Methods A retrospective analysis was performed from the medical records of 106 children with ALL who were diagnosed and treated from January 2010 to December 2014. The factors affecting the occurrence of TLP and the effect of TLP on the prognosis of children with ALL were analyzed. Results A total of 106 patients were treated for ALL during the study period, of which 21 cases (19.8 %) experienced TLP, median platelet count in 85 patients (80.2%) without TLP and in 21 patients with TLP was (72.50 ± 69.53) × 109/L and (31.10 ± 19.82) × 109/L (t= 2.69, P= 0.008). A receiver operating characteristic curve was constructed for predicting the risk of TLP based on platelet count. Platelet count of 34 ×109/L at the time of TLP had a sensitivity of 76%and specificity of 66%in predicting TLP. According to cerebrospinal fluid type, 1 case (4.8%) of TLP type had CNSL, and 2 cases (2.9%) of CNS1 type had CNSL (P>0.05). The 3-year event-free survival (EFS) rate in TLP group and CNS1 group had no significant difference [(82.8 ± 4.8) % vs. (74.7 ± 9.9)%, P>0.05]. Conclusions In the diagnostic lumbar puncture, platelet count<34 × 109/L is significantly associated with risk of TLP. TLP type does not contribute to inferior EFS and increase the incidence of CNSL.
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Given the existence of the blood brain barrier when combined with chemotherapy in acute leukemia treatment, leukemia cells are ultimately resulted in the occurrence of central nervous system leukemia (CNSL)by escaping the damage of chemotherapy drugs.At present,CNSL diagnostic criteria mainly relies on cerebrospinal fluid examination, clinical presentation and imaging examination.There are many means that contribute to early diagnosis of CNSL, which comprise cerebrospinal fluid cytology, CT and MRI and other imaging, monitoring minimal residual disease (MRD) in cerebrospinal fluid, monitoring hydrogen sulfide in cerebrospinal fluid, testing molecular biomarker indicators.There are several methods of achieving the goal of prevention of CNSL, including direct intrathecal administration of chemotherapy, systemic administration of chemotherapy able to penetrate the blood-brain barrier, and cranial radiation.The treatment of CNSL includes chemotherapy and radiotherapy, allogeneic hematopoietic stem cell transplantation and targeted therapy.