某嬰兒室新生兒流行性下痢症之疫情報告

An Outbreak of Neonatal Diarrhea Due to Enteropathogenic E. Coli O119B14 in a Nursery

蔡清詩(Chin-Su Tsai)

《Acta Paediatrica Sinica》 16卷1期 (1975/03) Pp. 7-10

摘要

兹報告在民國63年夏季發生於臺北市某醫院嬰兒室，由致病性大腸菌O119B14引起之新生兒流行下痢症疫情。共計13例（流行期間在該室住院過的新生兒共243人）。患兒當中，男女之比為9比4。10例只餵食醫院供應之牛奶，另3例再加上母奶。發病日齡自3天至27天不等（其中77%介于3至6天）。有病期間自1天至16天不等（其中61%介于3至7天）。最高每日排便次數由5至11次，平均8次。絕大多數病人之大便為黃色或黃綠色水狀。除1例有低度發燒外，均無發燒。5例(40%)有脫水及酸血症。所有病例培養出之O119B14大腸菌均對Colistin, Garamycin及Keflin有感受性。全部病例均以Colistin（每公斤體重每天用20萬單位，一天分四次服用）治療一星期，70%病例于2至6天內痊癒。全部病例在病期中有明顯的體重滅輕，平均失重404公克。7例(54%)在下痢症之前曾因黃胆明顯做過日光燈治療，至於下痢症與日光燈之關係，在本文中加以討論。嬰兒室工作人員之大便或肛門拭子培養，有3位培養出O119B14大腸菌，但都無症狀，由種種跡象顯示，似乎不是感染源。其他的培養，包括牛奶，首先發病嬰兒之母親的肛門拭子，以及桌上灰塵之取樣培養，均無發見O119B14大腸菌。

並列摘要

An outbreak of diarrhea due to Enteropathogenic E. Coli O119B14 involving 13 newborns in a newborn nursery in Taipei during the summer of 1974 is reported. During the epidemic, 242 babies were hospitalized in this nursery.
Sex ratio of the patients was 9 to 4 for males to females. 10 cases were fed with hospital formula alone and 3 cases with hospital formula and breast milk in combination. The day of onset varied from the 3rd to 27th day after birth (77% of total cases started to have diarrhea in the 3rd to 6th day of age). The duration of illness varied from 1 to 16 days (61% from 3 to 7 days).
Peak frequency of daily stool passage varied from 5 to 11 times with the average of 8 times daily. Stool of the patients was mostly yellowish or yellow greenish watery in character. No fever was noted except 1 case with mild fever. There were 5 cases (40%) with dehydration and acidosis. All strains of E. Coli O119B14 were sensitive to Colistin, Garamycin, and Keflin. All patients were successfully treated with Colistin 200 thousand units per Kg daily divided into 4 doses over 1 week and 70% were cured within 2-6 days. All of them had prominent decrements of body weight during the illness, the average weight loss was 404 Gm. 7 cases (54%) received phototherapy for hyperbilirubinemia before the onset of diarrhea.
Stool or rectal swab culture from nursery personnels showed E. Coli O119B14 in 3 symptomless nurses, but they seemed not likely to be the source of this epidemic.