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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 113 -116. doi: 10.3877/cma.j.issn.1674-1358.2024.02.008

病例报告

以神经系统症状为主诉的儿童肺吸虫病三例报道及文献复习
郭利琴1, 毛静2, 刘鑫华2, 刘康霄2, 杨军杰3, 钟炎平2, 赵琴4, 饶荣4, 李凤霞4, 雷旭2, 谭华炳5,†()   
  1. 1. 442000　十堰市，湖北医药学院附属人民医院（十堰市人民医院）感染性疾病科；442100　房县，房县人民医院儿科
    2. 442000　十堰市，湖北医药学院附属人民医院（十堰市人民医院）感染性疾病科
    3. 517001　河源市，河源市人民医院心血管内科
    4. 442100　房县，房县人民医院儿科
    5. 442000　十堰市，湖北医药学院附属人民医院（十堰市人民医院）感染性疾病科；442000　十堰市，湖北医药学院病毒学十堰市重点实验室；430062　武汉市，武汉科技大学附属紫荆医院医务科
  • 收稿日期:2023-06-11 出版日期:2024-04-15
  • 通信作者: 谭华炳
  • 基金资助:
    国家自然科学基金青年科学基金资助项目(No. 82002149); 2014年度湖北省教育厅科学研究计划(No. Q20142106); 2019年十堰市科学技术研究与开发项目计划(No. 19K67); 2021年十堰市科学技术研究与开发项目计划(No. 2021K65)

Three children of paragonimiasis with neurological symptoms as the chief complaint and literatures review

Liqin Guo1, Jing Mao2, Xinhua Liu2, Kangxiao Liu2, Junjie Yang3, Yanping Zhong2, Qin Zhao1, Rong Rao1, Fengxia Li4, Xu Lei2, Huabing Tan5,†()   

  1. 1. Department of Infectious Diseases, Hepatology Institute, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China; Department of Pediatrics, Fangxian Renmin Hospital, Fangxian 442100, China
    2. Department of Infectious Diseases, Hepatology Institute, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China
    3. Department of Infectious Diseases, Hepatology Institute, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China; Department of Cardiology, Heyuan People’s Hospital, Heyuan, 517001, China
    4. Department of Pediatrics, Fangxian Renmin Hospital, Fangxian 442100, China
    5. Department of Infectious Diseases, Hepatology Institute, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China; Shiyan Key Laboratory of Virology, Hubei University of Medicine, Shiyan 442000, China; Medical Department, Zijing Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430062, China
  • Received:2023-06-11 Published:2024-04-15
  • Corresponding author: Huabing Tan
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郭利琴, 毛静, 刘鑫华, 刘康霄, 杨军杰, 钟炎平, 赵琴, 饶荣, 李凤霞, 雷旭, 谭华炳. 以神经系统症状为主诉的儿童肺吸虫病三例报道及文献复习[J]. 中华实验和临床感染病杂志(电子版), 2024, 18(02): 113-116.

Liqin Guo, Jing Mao, Xinhua Liu, Kangxiao Liu, Junjie Yang, Yanping Zhong, Qin Zhao, Rong Rao, Fengxia Li, Xu Lei, Huabing Tan. Three children of paragonimiasis with neurological symptoms as the chief complaint and literatures review[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(02): 113-116.

目的

为临床早诊断、早治疗脑型肺吸虫病提供参考。

方法

回顾性分析2011年1月至2022年12月十堰市人民医院（湖北医药学院附属人民医院）3例分别以"3 d内抽搐2次""头晕、肢体麻木2 d""头痛、恶心、发热3 d"为主诉脑型肺吸虫病患儿临床资料。

结果

3例患儿均有生食疫区溪蟹史。肺吸虫抗原皮内试验（PAIT）均为阳性。患儿嗜酸性粒细胞（EOS）均显著增高。1例患儿头颅MRI检查显示"颅内血肿形成并有隧道征"，2例患儿头颅MRI检查无异常。肺吸虫病积分诊断量表均达到诊断肺吸虫病标准。吡喹酮驱虫（25 mg/kg、3次/d，服用2 d，间隔7 d进入下一疗程；2～5个疗程）治疗，3例患儿经治疗神经系统症状完全控制、EOS恢复正常，达到临床治愈。

结论

脑型肺吸虫病脑患儿MRI可无异常，EOS和肺吸虫病积分诊断量表在脑型肺吸虫病诊治中有重要价值。

关键词: 肺吸虫病, 脑型, 核磁共振, 嗜酸性粒细胞, 肺吸虫病积分诊断量表
Objective

To provide reference for early diagnosis and early treatment of cerebral paragonimiasis.

Methods

The clinical data of 3 children with cerebral paragonimiasis from January 2011 to December 2022 were analyzed, retrospectively, with "two convulsions within 3 days", "dizziness, limb numbness for 2 days" and "headache, nausea and fever for 3 days" as the main complaints in Renmin Hospital, Hubei University of Medicine.

Results

All children had a history of eating crabs in epidemic areas. Paragonimus antigen skin test (PAIT) were all positive. Eosinophils (EOS) of 3 children increased significantly. One child’s head MRI showed "intracranial hematoma with tunnel sign". There were no abnormality in MRI examination of the othoer 2 children’s heads. The clinical data of 3 children reached the standard of paragonimiasis diagnosis with the scale of paragonimiasis integral diagnosis. Praziquantel (25 mg/kg, taken three times a day for 2 days, with an interval of 7 days, entered the next course of treatment; totally 2-5 courses). After treatment, 3 children’s eurological symptoms were completely controlled, EOS returned to normal, and all achieved clinical cure.

Conclusions

Cerebral MRI examination of paragonimiasis can be normal, while EOS and paragonimiasis integral diagnostic scale are of impotpant value in the diagnosis and treatment of cerebral paragonimiasis.

Key words: Paragonimiasis, Cerebral, Magnetic resonance imaging, Eosinophils, Integrated diagnostic scale for paragonimiasis
图1 病例1患儿MRI注：A：右侧额顶叶血肿形成，内见斑片状不均匀强化灶，大小为33 mm × 66 mm；B、C：血肿外可见软化病灶，箭头指向显示在软化灶内有一条横向"隧道"影
图2 病例2患儿MRI注：脑MRI无异常
图3 病例2肺部MSCT注：A：MSCT正面显示左上肺感染灶；B：MSCT水平切面显示左上肺感染病灶与胸膜相连接
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