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目的:探讨手足口病住院患儿二次发热的原因及其临床意义。方法:回顾性调查2010年7月～2011年6月576例手足口病及1 028例急性上呼吸道感染住院患儿,选取出现二次发热的病例(157例),对二次发热病例在两种病房的发生率、病原学及临床特点进行分析。结果:手足口病病房二次发热的发生率为15.45%(89/576),同期普通病房为6.61%(68/1 028),两组病例差异有统计学意义(χ2=32.645,P<0.001);病原学分析,普通病房二次发热的68例(100%,68/68)、手足口病病房50例(56.18%,50/89)中发现新的病原体,确诊为院内感染,手足口病另39例(43.82%,39/89)未发现新的病原体,且此部分患儿均为肠道病毒71型(EV71)感染,无院内感染证据;临床特点分析,39例EV71感染在第二次热峰时均表现为神经系统感染症状。结论:住院病例出现二次发热的发生率,手足口病病房高于上呼吸道感染病房;手足口病不同型肠道病毒间存在院内交叉感染;部分EV71感染可能有“双峰热”特点,出现第二次发热可能提示神经系统开始受累。
Objective: To investigate the causes and clinical significance of secondary fever in HFMD children. Methods: A total of 576 cases of HFMD and 1,028 cases of acute upper respiratory tract infection hospitalized from July 2010 to June 2011 were retrospectively studied. Fifty-seven cases of secondary fever were selected, The incidence of ward, etiology and clinical features were analyzed. Results: The incidence of secondary fever was 15.45% (89/576) in hand, foot and mouth disease ward and 6.61% (68/1 028) in common ward in the same period. The difference between the two groups was statistically significant (χ2 = 32.645, P <0.001) ); Etiological analysis, common ward fever in 68 cases (100%, 68/68), HFMD ward in 50 cases (56.18%, 50/89) found new pathogens, diagnosed as nosocomial infection, hand, foot and mouth The other 39 cases (43.82%, 39/89) did not find any new pathogens, and this part of children were all infected with enterovirus 71 (EV71) without any evidence of nosocomial infection. According to the clinical features, Secondary hot peak showed symptoms of nervous system infections. Conclusions: The incidence of secondary fever in hospitalized patients is higher than that in upper respiratory tract wards in hand-foot-mouth disease and cross-infection in different hand-foot-mouth disease enteroviruses. Some EV71 infections may have the feature of “bimodal fever” , A second fever may prompt the nervous system to begin to get involved.