摘要
儿童传染性单核细胞增多症(infectious mononucleosis,IM)合并手足口病(hand,foot and mouth disease,HFMD)病例较少见。本文报道1例儿童IM合并HFMD病例。患儿男,年龄为3岁8个月,因发热、皮疹入院。病原学检查结果:EB病毒(Epstein-Barr virus,EBV)早期抗原IgG阳性,EBV VCA抗体IgM阳性,EBV VCA抗体IgG阳性,EBV核心抗原IgG阴性。血清EBV DNA检测结果:1.31×10^(5)/ml。咽拭子HFMD病原体核酸检测结果:肠道病毒通用型定性检测阳性。血常规结果:白细胞计数20.47×10^(9)/L,淋巴细胞总数18.03×10^(9)/L,淋巴细胞比例88.1%,外周血细胞形态检测显示异性淋巴细胞约占20%。血ALT 248 U/L。肌酸激酶同工酶-MB 50 U/L,乳酸脱氢酶576 U/L,AST 128U/L。乳酸脱氢酶同工酶-1105 U/L。诊断为IM;HFMD;肝功能受损,心肌损害。患儿入院后予以头孢美唑抗感染、更昔洛韦抗病毒,同时给予护肝、营养心肌等对症支持治疗,住院治疗5 d,病情较前明显好转出院。出院后继续巩固治疗,出院1周后复查各项指标逐渐回复正常,出院3周后复查各项指标恢复正常,但是EBV DNA定量为5.98×10^(4)拷贝/ml。该个案提示:对于临床上确诊为HFMD的患儿,如果血常规显示白细胞计数较高,分类里以淋巴细胞比例高为主,需警惕合并IM;另外如果患儿反复发热时间长,也需要警惕合并IM的可能。
Children with infectious mononucleosis(IM)and hand,foot and mouth disease(HFMD)are rare.This article reports a case of IM combined with HFMD in a child.The male patient,aged 3 years and 8 months,was admitted due to fever and rash.Etiological examination results:Epstein-Barr virus(EBV)early antigen IgG positive,EBV VCA antibody IgM positive,EBV VCA antibody IgG positive,and EBV core antigen IgG negative.Serum EBV DNA test result:1.31×105/ml.Nucleic acid test result of HFMD pathogen in throat swab:Enterovirus universal qualitative test is positive.Routine blood test results:White blood cell count 20.47×109/L,total lymphocyte count 18.03×109/L,the proportion of lymphocytes is 88.1%,and the morphology of peripheral blood cells shows that heterologous lymphocytes account for about 20%.Blood ALT 248 U/L.Creatine kinase Isozyme MB 50 U/L,lactate dehydrogenase 576 U/L,AST 128 U/L.Lactate dehydrogenase Isozyme-1105 U/L.Diagnosed as IM;HFMD,impaired liver function and myocardial damage.After admission,the children were given cefmetazole anti infection,Ganciclovir anti-virus,and symptomatic support treatment such as liver protection and myocardial nutrition.After 5 d of hospitalization,the condition was significantly improved and discharged.Continue to consolidate treatment after discharge.After 1 week of discharge,all indicators gradually return to normal.After 3 weeks of discharge,all indicators return to normal,but the EBV DNA quantification is 5.98×104 copies/ml.This case suggests that for children diagnosed with HFMD in clinical practice,if the blood routine shows a high white blood cell count and the classification is mainly based on a high proportion of lymphocytes,it is necessary to be vigilant for the combination of IM;In addition,if the child has recurrent fever for a long time,it is also necessary to be vigilant about the possibility of merging with IM.
作者
曾文娟
方玉蓉
王丹丹
ZENG Wenjuan;FANG Yurong;WANG Dandan(Department of Infection,Wuhan Children’s Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,430000,China)
出处
《传染病信息》
2023年第4期382-384,共3页
Infectious Disease Information
关键词
传染性单核细胞增多症
手足口病
儿童
发热
皮疹
白细胞
淋巴细胞
infectious mononucleosis
hand,foot and mouth disease
children
fever
rash
white blood cells
lymphocytes
作者简介
通信作者:方玉蓉,E-mail:fangyurong@zgwhfe.com。
