【摘要】 目的提高对儿童链球菌中毒休克综合征(STSS)的认识。方法回顾性分析2例分别由A族链球菌(GAS)和B族链球菌(GBS)引起的STSS患儿的临床表现及诊疗过程,同时,对2株菌株进行9种链球菌超抗原基因检测,对GAS菌株进行emm分型,并复习相关文献。结果 2例STSS患儿既往体健,除发热外,早期临床表现各异。病例1以咳嗽、进行性呼吸困难为主要症状;病例2以烦躁不安为突出表现。但2例患儿的疾病进展均急骤、凶险;病例1死亡,病例2放弃治疗。2例患儿的白细胞计数正常,中性粒细胞及C-反应蛋白明显升高;伴凝血功能异常及显著低蛋白血症;呼吸衰竭发生早。GBS菌株的9种超抗原基因均阴性;GAS菌株系emm1型,携带speA、speC和SMEZ毒力基因。GBS菌株引起STSS患儿以神经系统异常、弥散性血管内凝血(DIC)、肾损害为显著特征,无皮疹。结论 STSS是一种少见的严重感染性疾病,儿科医师应提高对该病的警惕性,早期识别、及时诊断、充分治疗是改善预后的关键。更多还原

【Abstract】 Objective To further understand childhood streptococcal toxic shock syndrome(STSS).Methods Clinical feature and treatment progress of 2 cases of STSS caused by group A Streptococcus(GAS) and group B Streptococcus(GBS) infection individually were analyzed retrospectively.Nine superantigen were analyzed in the 2 isolates and emm-typing was processed in the GAS isolate.The related literatures were reviewed.Results In addition to high fever,the initial clinical picture of STSS children varies.In case 1,cough and progressive breathing difficulty was remarkable.In case 2,irritability-restlessness was early manifestation.In contrast with the initial nonspecific clinical picture,it was remarkable that a rapid clinical deterioration was observed in the two cases.One case died and another one gave up treatment.The white blood cell count was normal in both cases.However,there were significant increase in neutrophils and C-reactive protein with coagulation disorder and remar-kable hypoproteinemia.Respiratory failure developed in the early stage of disease.The invasive GBS isolate was negative for all nine superantigens genes.The GAS was emm-typing 1 with virulence genes of speA,speC and SMEZ.STSS infants caused by GBS were characterized with nervous system abnormality,DIC and kidney impairment.No skin rash was observed.Conclusions STSS is a rare and severe form of invasive streptococcal infection in children.Pediatricians and emergency physicians should keep alent on STSS and immediatel aggressive treatment is crucial for treatment of this disease.更多还原