收稿日期: 2021-10-27
修回日期: 2022-08-16
网络出版日期: 2022-10-26
Clinicial analysis of 12 cases of angiostrongyliasis cantonensis in children
Received date: 2021-10-27
Revised date: 2022-08-16
Online published: 2022-10-26
回顾分析2018年1月至2020年12月广州市妇女儿童医疗中心收治的12例广州管圆线虫病患儿实验室及影像学检查资料。患儿中广东9例、广西2例、云南1例,男女比例1 ∶ 1,年龄范围1岁3月~12岁,有流行病学史4例（食生田螺、进食蜗牛、接触福寿螺、接触蛞蝓各1例）。主要临床症状依次为发热（12例,幼儿均为高热）、呕吐（9例）、精神疲倦（7例）等。血常规外周血白细胞升高12例[（18.4 ± 4.1）× 109/L],嗜酸粒细胞百分比（EOS%）升高12例[（26.9 ± 10.5）%],嗜酸粒细胞绝对值（EOS#）升高12例[（3.4 ± 2.0）× 109/L];脑脊液白细胞升高12例[（656 ± 424）× 106/L],蛋白升高12例[（1.1 ± 0.59）g/L],脑脊液EOS%升高12例[（25.7 ± 15.5）%],其中8例脑脊液EOS%高于外周血。9例行广州管圆线虫IgG抗体检测,7例阳性;9例行脑脊液广州管圆线虫IgG抗体检测,3例阳性;11例行脑脊液宏基因组高通量测序（mNGS）,10例检出广州管圆线虫DNA序列。12例行头颅MRI,8例异常,表现为软脑膜强化及脑实质多发结节状强化;9例行胸部CT,均异常,表现为胸膜下磨玻璃影或多发小结节状影。1例患儿入院时昏迷,最终死亡;余11例接受阿苯达唑治疗（疗程为10~14 d）,10例联合糖皮质激素治疗,治疗后均治愈,随访2个月至半年均未见后遗症。儿童广州管圆线虫病流行病学及临床症状不典型,应结合实验室检查及影像学等资料综合判断,高通量测序技术可帮助早诊断。
潘火云 , 谭丽梅 , 徐翼 , 李旭芳 , 叶家卫 , 房春晓 , 杨峰霞 , 陈敏霞 , 杨花梅 , 曾凡森 . 12例儿童广州管圆线虫病临床分析[J]. 中国寄生虫学与寄生虫病杂志, 2022 , 40(5) : 668 -672 . DOI: 10.12140/j.issn.1000-7423.2022.05.016
Retrospective analysis of laboratory tests and imaging examination of 12 children hospitalized for angiostrongyliasis cantonensis infection in Guangzhou Women and Children’s Medical Center from January 2018 to December 2020. Nine cases came from Guangdong, 2 cases came from Guangxi and 1 case came from Yunnan. There were 6 males and 6 females. The age ranged from 1 year and 3 months to 12 years old. There were 4 children with epidemiological histories (1 case of eating river snails, 1 case of eating snails, 1 case had contacted golden apple snail, 1 case of contacting slugs). The most common symptoms were fever (12 cases, all infants have high fever), followed by vomiting (9 cases), and fatigue (7 cases). The peripheral white blood cell count increased in 12 cases [(18.4 ± 4.1) × 109/L], the eosinophil percentage (EOS%) increased in 12 cases [(26.9 ± 10.5)%], the eosinophils absolute count increased in 12 cases [(3.4 ± 2.0) × 109/L]. CSF WBC count increased in 12 cases [(656 ± 424) × 106/L], CSF protein increased in 12 cases [(1.1 ± 0.59) g/L], CSF EOS% increased in 12 cases [(25.7 ± 15.5)%], of which 8 cases were higher than that in peripheral blood. Seven of the 9 children were positive for serum angiostrongyliasis cantonensis antibodies. Three of the 9 children were positive for Angiostrongylus cantonensis antibodies in CSF. Metagenomic next-generation sequencing (mNGS) of the CSF was performed in 11 cases, and Angiostrongylus cantonensis DNA sequence was detected in 10 cases. Imaging examination revealed abnormal head MRI in 8 cases. The main findings were enhancement in leptonmeninges and multiple nodular enhancement in brain. Chest CT showed abnormality in 9 cases, suggesting that ground-glass opacity lesions and multiple small nodular lesions located in the subpleural area were the main manifestations. One child was in coma at admission and died. The other 11 cases were treated with albendazole, and steroids were administrated for 10 cases. The 11 cases were cured after treatment, and there were no sequelae after being followed-up for 2-6 months. The epidemiological history and clinical symptoms of Angiostrongyliasis cantonensis in children were atypical. It should be comprehensively diagnosed by combining laboratory tests, imaging findings, and high-throughput sequencing technology can assist the early diagnosis.
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