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儿童中疥疮的诊断
原作者: Jennifer Guyther,江利冰 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2014-07-09

 

Title: Scabies diagnosis in kids
题目:儿童中疥疮的诊断
Author 作者: Jennifer Guyther
江利冰 译 肖锋 校

 

Scabies is considered by the WHO to be one of the main neglected diseases with approximately 300 million cases worldwide each year. One third of cases of scabies seen by dermatologists are in kids less than 16 years old. The belief had been that presentation varies by age.  One French study reported a first time miss rate of more than 41% and an overall diagnostic delay of 62 days.
 
疥疮已经被世界卫生组织(WHO)定为主要被忽视的疾病之一,全球每年有30亿的疥疮患者。皮肤科医师接诊的疥疮患者中三分之一是小于16岁的儿童。一直以来都认为疥疮的临床症状随着年龄的不同而变化。法国的一项研究指出第一次漏诊率在41%以上,使整个疾病诊断延迟了62天。
A prospective, multicenter observational study of patients with confirmed scabies sought to determine common phenotypes in children. All patients were seen by dermatologists in France and administered standard questionnaires.  They were divided into 3 age groups, <2 years, 2-15 years and > 15 years.  323 patients were included.
一项对323已经确诊的疥疮儿童患者的前瞻性,多中心,观察性研究,旨在确定儿童疥疮患者的共同表型。在法国,所有的患者都接受皮肤科医师的诊治,并使用标准的问卷。这些患者被分成了3个年龄组,<2岁,2-15岁和>15岁。
The study found that: 
-infants were more likely to have facial involvement and nodules, especially on the back and axilla
-relapse was more common in < 15 year olds - this was hypothesized to be due to poor compliance with treatment to the head
-family members with itch, or planter or scalp involvement were independently associated with diagnosis of scabies in kids < 2 years
-burrows were seen in 78%, nodules in 67% and vesicles of 43% of patients
-itching was absent in up to 10% of patients


研究发现:婴幼儿脸部受累的可能性更大,且更易发生结节,尤其是在背部和腋窝。<15岁的疥疮患者更易复发,推断其原因可能是因为不能很好的配合头部的治疗。家庭成员皮肤瘙痒或者其他接触部位或者头皮受累和<2岁儿童疥疮的诊断独立相关。78%的患者可见皮下沟,67%的患者可见结节,43%的患者可见小水泡。10%以上的患者可以不出现瘙痒。
Bottom line:  Have a high suspicion for scabies in any rash.
要点:出现任何皮疹都要高度怀疑疥疮。

 

文章来源:《中华急诊医学杂志》编辑部