摘要
目的探讨儿童内科重叠感染致多浆膜腔积液的临床特点、误诊原因,并提出防范对策。方法回顾分析我院收治1例结核、肺炎支原体重叠感染致多浆膜腔积液的临床资料。结果患儿因咳嗽、腹胀1月余入院。病程早期于外院诊为肺炎,我院诊断为肺炎支原体感染。予相应治疗后患儿咳嗽消失,心包积液和腹腔积液吸收,但右侧胸腔积液始终存在,停止上述治疗后又出现少量腹腔积液,胸腔积液增多。查血T-Spot.TB显示B抗原阳性。考虑为结核,给予异烟肼、利福平、吡嗪酰胺抗结核治疗3周,右侧胸腔积液未见明显吸收,加用泼尼松2mg/(kg·d)分次口服10天,复查X线胸片,胸腔积液明显吸收,支持结核的诊断。结论无典型病史、体征,胸腔积液单次结核菌培养阴性,ADA和T-Spot.TB浓度正常,是造成肺炎支原体、结核混合感染误诊的主要原因,反复检查胸腔积液、血ADA和T-Spot.TB可能有助于明确诊断。
Objectives To investigate clinical features of polyserositis caused by co-infection,causes of misdiagnosis and propose preventive measures.Methods Retrospective analysis of clinical data from one case of polyserositis in our hospital caused by co-infection of tuberculosis and mycoplasmal pneumonia.Results The child was admitted to our hospital because of cough,abdominal distension for more than 1month.The early course of the disease was diagnosed as pneumonia in another hospital before our diagnosis of mycoplasmal infection.After giving the appropriate treatment,we found that cough disappeared,pericardial effusion and pyoperitoneum absorbed,but the right pleural effusion existed.We stopped the treatment and then a small amount of pyoperitoneurn and pleural effusion was increased.Serum T-Spot.TB antigen showed positive.Considering tuberculosis and using soniazid,rifampicin and pyrazinamide as anti-TB treatment for3 weeks,right pleural effusion was not significantly absorbed.After prednisone 2mg/(kg·d)orally was added for 10d,chest X ray showed that pleural effusion was absorbed,supporting the diagnosis of tuberculosis.Conclusion Atypical history and signs,single negative culture for tubercle bacillus in pleural effusion and normal ADA and T-Spot.TB concentration in pleural effusion are the main causes of misdiagnosis.Repeating examination of pleural fluid and blood ADA and T-Spot.TB concentration may help in confirming the diagnosis.
出处
《发育医学电子杂志》
2013年第2期101-103,共3页
Journal of Developmental Medicine (Electronic Version)
关键词
肺炎支原体
结核
多浆膜腔积液
Tuberculosis
Mycoplasma pneumoniae
Polyserositis
