| BackgroundExanthema Subitum（ES）, which is infected by Human Herpesvirus6(HHV-6) or Human Herpesvirus7（HHV-7）, is a acute eruptive diseaseswhich uauslly happened in neonatal and infant period. HHV-6is a kind ofaddicted double-stranded DNA viruses addicting human t-lymphocytes,which belongs to β subfamily of the herpes virus. HHV-6can invade thenervous system, and in some severe cases it can threaten our life or leftwith potential permanent damage, and associated with the a variety ofpediatric diseases closely. Since the immune functions gradually improveas children grow up, primary infection mainly occurs in6~12month and itrarely happen after2years old. The reactivation of the virus occurring aftera acute infection, HHV-6may be dormant in the salivary glands, liver,lymphatic system, central nervous system or other parts of the host for along-term, and it may outbreak when the immune function decreases or isinhibited, especially in a immunocompromised host.ObjectiveBy reviewing and analyzing the identification, clinical symptoms,laboratory examination, treatment methods, recovery situations, get thesummary of the clinical feature and experience, hoping to get moreinformation about exanthema subitum. Objects and Methods1.Research objects: inpatient children who were diagnosed with ES inChildren’s Hospital of Chong Qing Medical University from January2011to October2013.2. Methods: Retrospective analysis the clinical data of children withES.3.Statistical analysis:the clinical data was analyzed by the statisticalsoftware SPSS19.0and Microsoft Office Excel2003.Results1.523cases were collected, male(315)/female(208)=1.5/1.There hadno neonate cases,68cases (13.0%)in1~6month,247cases (47.2%) in6~12month,194cases (37.1%) in1~3years,14cases (2.7%) in more than3years in.2. ES happened all the year round, the amount of cases had a risingtrend by year,148cases in2011,189cases in2012,189cases fromJanuary to October in2013.3.All of them happened suddenly with fever.10/523cases had nobody temperature record，513cases had data of fever (37.5℃~42.0℃). thethermal spike ranging from39.1℃to41℃in354cases,average was (39.46±39.46)℃. Thermal processes ranged from1to9days,421(82.1%) cases’thermal process were3~5days,42(8.2%) cases’ thermal process less than3days,50(9.7%) cases’ thermal process more than5days.4. The rash appeared after the temperature returned to normal in463cases,410cases(89.38%) rash appeared within24hours. The rashappeared when still had a fever in55cases,81.8%of their temperaturereturned to normal within2days.5.82cases were complicated by febrile convulsion,501casesaccompanied by cough, sputum, runny nose and other respiratory symptoms,87cases were complicated by neutropenia, thrombocytopenia in19cases, myocardial enzymogram abnormal in159cases, transaminaseraise in287cases.6.The skin rash was red maculopapule, it became fade when pressured,between rashes the skin is normal. In some individual cases the rashescould fuse into big shape, but without itch. The rashes mostly sited in thetrunk, face and neck, but arms and legs were not common. The location ofrashes was unrelated to thermal spike (P>0.05). The rash faded in2~3days in285cases (76.61%), without pigmentation and desquamation.7.509cases (97.32%)with pharyngeal hyperemia,338cases (64.62%)with tonsillar enlargement,78cases (14.91%) with swollen lymph nodes,which mainly occurs in the neck, behind the ears, occipital part.8.Blood routine test:86cases white blood cells count increased.Classification of leukocytes was priority to lymphocytes in442cases(67.28%).87cases(16.63%) neutrophils count was less than1.5×109/L, theaverage was (0.745±0.325)×109/L, the second neutrophils count washigher than it at admission, the differences was statistically significant (P <0.05).19cases(4.85%) with thrombocytopenia. Normal CRP in494cases,8mg/L <CRP <20mg/L in18cases.9.Children with ES had merge multiple pathogenic infections, mostwere mixed infections of bacteria and viruses.30cases with cytomegalo-virus,24cases with streptococcus pneumoniae, coxsackie virus19cases.10. Chest radiography showed normal29/70cases, pneumonia in19/70cases, lung texture increased in18/70cases. Electroencephalogram(EEG) showed normal in61/102cases. Cranial Computed Tomography wasnormal in23/28cases,. ConclusionThe exanthema subitum mainly occur in6~12months babies,characterized by high fever for3~5days, rash is red maculopapule,distribute in the trunk, neck, upper limbs. Most patients with good mental,appetitive status. At prodromal stage the patients may have runny nose,pharyngeal hyperemia and similar to upper respiratory infection symptoms.Clinical manifestations may include convulsions, diarrhea, bregmadistention,we should pay attention to differential diagnosis. If childrenconfirmed ES with reduced neutrophil count, we can appropriately usesome drugs to rise the WBC, and observe closely.The neutrophil count willrecover in a short time. If children’ s aminotransferase or Myocardialenzymes is abnormal, we can use drugs to protecting liver and heart. |
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