儿童肺炎支原体肺炎临床误诊分析
Clinical Misdiagnosis of Mycoplasma Pneumoniae Pneumonia in Children
施林燕 1马科星1
作者信息
- 1. 215600 江苏 张家港,张家港市第三人民医院儿科
- 折叠
摘要
目的 探讨儿童肺炎支原体肺炎(MPP)的临床误诊原因.方法 回顾分析2019 年3 月至2022 年9 月收治的初期曾误诊的儿童MPP 2 例病例资料.结果 1 例患儿因发热伴咳嗽4d,听诊双肺呼吸音粗,胸部CT平扫示右肺胸膜下多发不规则斑片影,因在新型冠状病毒感染流行期间就诊,初步诊断为新型冠状病毒性肺炎,予针对性治疗未见好转,待咽拭子、痰、新型冠状病毒核酸检测均阴性,查肺炎支原体抗体阳性,遂确诊MPP.1 例患儿因咳嗽、咳痰7d,急性加重3d,胸部正侧位X线片示右肺中下野内带见斑片状高密度影,以支气管肺炎收入院,予针对性治疗无好转,后经支气管肺泡灌洗液DNA-病原微生物检测肺炎支原体阳性,遂确诊MPP.误诊时间5～6d.确诊后予阿奇霉素抗感染、退热、止咳祛痰等治疗痊愈出院.结论 儿童MPP常缺乏特异性的临床症状,早期易被临床误诊;对持续发热、剧烈咳嗽但肺部体征不明显的患儿,接诊医生应考虑到MPP的可能,加强对本病的重视程度,认真鉴别诊断,避免误诊误治.
Abstract
Objective To investigate the causes of clinical misdiagnosis of mycoplasma pneumoniae pneumonia(MPP)in children.Methods The data of 2 children with MPP who were initially misdiagnosed in our hospital from March 2019 to September 2022 were retrospectively analyzed.Results A child with fever accompanied by cough had a thick respira-tory sound in both lungs,and chest CT scan showed multiple irregular spots in the subpleura of the right lung.He was initially diagnosed as novel coronavirus pneumonia(NCP)due to his treatment during the epidemic period of novel coronavirus infec-tion,but no improvement was observed after targeted treatment.The results of throat swab,sputum and novel coronavirus nu-cleic acid test were negative,and MPP was confirmed after testing positive for mycoplasma pneumoniae antibodies.A child was admitted to the hospital with bronchopneumonia due to cough and sputum for 7 d and acute aggravation for 3 d,and the anterolateral chest X-ray showed patchy high-density shadows in the middle and lower field of the right lung,and the patient was admitted to the hospital with bronchopneumonia.No improvement was achieved after targeted treatment.After bronchoal-veolar lavage fluid DNA-pathogenic microorganisms were tested positive for mycoplasma pneumoniae,MPP was confirmed.The misdiagnosis lasted 5-6 d.After diagnosis,Azithromycin was given anti-infection and antipyretic treatment,as well as cough and phlegm relief.Conclusion MPP in children often lacks specific clinical symptoms and is prone to misdiagnosis in clinical treatment.For children with persistent fever and severe cough but not obvious pulmonary signs,receiving doctors should consider the possibility of MPP,pay special attention to this disease,and perform differential diagnosis carefully,to avoid misdiagnosis and mistreatment.
关键词
肺炎支原体肺炎/儿童/误诊/病毒性肺炎/支气管肺炎/鉴别诊断Key words
Mycoplasma pneumoniae pneumonia/Children/Misdiagnosis/Viral pneumonia/Bronchopneumonia/Differential diagnosis引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据