Acute Staphylococcal Infections in Childhood

小兒之急性嚴重葡萄菌感染症

王作仁(Tso-Ren Wang)

《Acta Paediatrica Sinica》 21卷3期 (1980/09) Pp. 135-147

摘要

葡萄球菌在不同的環境中能够快速突變等方式而隨時適應人類給予的各種攻擊，因此近年來對盤尼西林等抗生素發生相當程度的抗藥性，卽使在抗生素十分發達的今天，葡萄球菌感染症仍然是相當嚴重的課題。民國66年至68年共有24例急性嚴重葡萄球菌感染症病兒於國立臺灣大學醫學院小兒科接受治療，其中大部份（16例）為男孩，年齡分佈在2個月至14歲之間。最初的症狀多為發燒及各種皮膚症狀，如膿皰、膿瘍及各種皮疹，隨卽擴展至內部器官而引起敗血症、肺膿瘍、骨髓炎、心包炎等。83%的病例發病之初的中性白血球數超過10,000/mm^3，或杵狀核中性白血球數超過500/mm^3，著者曾對其中5例進行一連串的Nitroblue tetrazolium檢查，發現發病之初其值很低，但經治療而臨床症狀改善後，檢查值也就很快提高，顯示此時中性白血球的功能恢復正常。共有4例死亡，死亡率為16.75%。
著者認為最佳的治療方法是早期使用有效的抗生素（文中之敏感性試驗：Cephalothin為100%，Oxacillin為87.5%，宜使用到退燒後10-14天，如出現膿瘍時宜使用外科手術排膿法才可奏全功。

並列摘要

From 1977 to 1979 we have treated 24 children, 16 boys and 8 girls, with acute staphylococcal infections. Most of them had been well and their ages were between 2 months to 14 years. The initial signs and symptoms were fever and skin manifestations including pustules, abscesses, and urticarial, petechial or maculopapular rashes. Before appropriate treatment, 83% of them had either polymorphonuclear counts of more than 10,000/mm^3 or band-forms counts of more than 500/mm^3. Nitroblue tetrazolium test values in 5 cases were all extremely low. Serial follow-up revealed that clinical improvement coincided with an elevation of nitroblue tetrazolium test value. The overall mortality rate was 16.7%, and 3 of the deaths had underlying conditions possibly predisposing to the disease. Optimum therapy includes the proper choice of antimicrobial agents and surgical drainage of abscess cavities, if present.

並列關鍵字

staphylococcus aureus ； polymorphonuclear cells ； nitroblue tetrazolium (NBT) tests ； anti-microbial agents