Butterfly shade

Introduction The butterfly-like shadow refers to the chest X-ray showing the thickening and blurring of the lungs and the butterfly-like shadow centered on the hilum. It is the clinical manifestation of lung malaria. Pulmonary malaria refers to the damage of the malaria parasite to the lungs. The body may be infected with Plasmodium with or without typical malaria systemic symptoms and obvious respiratory symptoms such as cough, cough, shortness of breath, wheezing or chest pain. Its clinical manifestations include malaria asthma, bronchitis, pneumonia, pulmonary edema, and acute respiratory distress syndrome (ARDS). Pulmonary malaria is a manifestation of pulmonary systemic damage of malaria parasites, and its incubation period is comparable to that of malaria infection. The number of malaria and ovarian malaria is 10 to 20 days, the malaria is 70 to 80 days, and the falciparum malaria is 10 to 14 days.

Cause

Current malaria patients and carriers are the source of infection. Domestically, it is mainly transmitted by four species of Anopheles sinensis, Anopheles sinensis, Anopheles sinensis and Anopheles sinensis, among which Anopheles sinensis. In addition, transfusion transmission and maternal-infant transmission have been reported occasionally.

an examination

Related inspection

Chest smear smear urine sputum bacterial smear check chest flat film

Laboratory inspection:

1. Peripheral blood, bone marrow or sputum smear

The diagnosis of Plasmodium was found by Giemsa or Wright staining. In patients with multiple episodes, blood red blood cells and hemoglobin decreased. Reticulocytes increase. The total number of white blood cells is normal or low, mononuclear cells increase, and the eosinophils are in a normal range. Some scholars have suggested that the total number of white blood cells in peripheral blood is reduced, and mononuclear cells are greater than 15%. In combination with medical history, malaria may be considered.

2. Serological examination

There are indirect immunofluorescent antibody test, indirect red blood cell agglutination test, radioimmunoassay and enzyme-linked immunosorbent assay. The density of malaria parasites in blood is very low, and it is difficult to find patients with Plasmodium by general methods, which has auxiliary diagnostic significance.

3. Molecular biological method examination

DNA probe technology is a fast and specific method for diagnosing malaria. 10 pg of purified Plasmodium DNA or very low levels of Plasmodium can be detected using an isotope-labeled DNA probe.

Other auxiliary inspections:

Asthma type

X-ray chest radiographs have a degree of hyperinflation of the lungs of varying degrees.

2. Bronchitis type

X-ray chest radiographs often have enhanced lung texture, and it has been reported that 60% of the signs appear in this case, and some may have small shadows along the lung line.

3. Pneumonia

X-ray films show the shadow of plaque-like or small-like bronchial pneumonia along the lung line, or the shadow of segmental or large-leaf edge. It can be multiple or single, and is more common in the lower field. This type is easily misdiagnosed as bacterial pneumonia, but anti-inflammatory treatment is ineffective. After 2 to 3 days of antimalarial treatment, clinical symptoms and chest X-ray findings are significantly improved.

4. Pulmonary edema

The chest X-ray shows that the texture of the two lungs is thick and fuzzy, the butterfly-like shadow centered on the hilum, and the large asymmetrical shape of the lower lungs can change with the change of body position.

Differential diagnosis

However, it needs to be differentiated from influenza, sepsis, tuberculosis, bacterial pneumonia, encephalitis, etc., especially bronchitis type lung malaria disease needs to be differentiated from diffuse lung disease, both have cough, shortness of breath, auscultation with dry or wet Echo, X-ray chest radiographs increased or small-like shadows, but the former auscultation without popping sound, pulmonary function restrictive ventilation dysfunction is not significant, arterial oxygen partial pressure and blood oxygen saturation is higher, blood urea nitrogen The values and the average concentration of blood lactic acid are higher, the hemoglobin is low, and often the metabolic acidosis and the clinical symptoms can be alleviated after antimalarial treatment.

Diagnosis: according to: 1 has epidemiological data; 2 typical or atypical periodic chills, fever, sweating and retreat symptoms; 3 obvious cough, cough, shortness of breath, asthma and other respiratory symptoms; 4X chest X-ray Show lung pattern enhanced or flaky shadow; 5 blood, bone marrow or sputum smear to find Plasmodium; 6 anti-malarial treatment, clinical symptoms disappeared can be diagnosed.

Laboratory inspection:

1. Peripheral blood, bone marrow or sputum smear

The diagnosis of Plasmodium was found by Giemsa or Wright staining. In patients with multiple episodes, blood red blood cells and hemoglobin decreased. Reticulocytes increase. The total number of white blood cells is normal or low, mononuclear cells increase, and the eosinophils are in a normal range. Some scholars have suggested that the total number of white blood cells in peripheral blood is reduced, and mononuclear cells are greater than 15%. In combination with medical history, malaria may be considered.

2. Serological examination

There are indirect immunofluorescent antibody test, indirect red blood cell agglutination test, radioimmunoassay and enzyme-linked immunosorbent assay. The density of malaria parasites in blood is very low, and it is difficult to find patients with Plasmodium by general methods, which has auxiliary diagnostic significance.

3. Molecular biological method examination

DNA probe technology is a fast and specific method for diagnosing malaria. 10 pg of purified Plasmodium DNA or very low levels of Plasmodium can be detected using an isotope-labeled DNA probe.

Other auxiliary inspections:

Asthma type

X-ray chest radiographs have varying degrees of lung hyperinflation.

2. Bronchitis type

X-ray chest radiographs often have enhanced lung texture, and it has been reported that 60% of the signs appear in this case, and some may have small shadows along the lung pattern.

3. Pneumonia

X-ray films show the shadow of plaque-like or small-like bronchial pneumonia along the lung line, or the shadow of segmental or large-leaf margins, which can be multiple or single, more common in the lower field. This type is easily misdiagnosed as bacterial pneumonia, but anti-inflammatory treatment is ineffective. After 2 to 3 days of antimalarial treatment, clinical symptoms and X-ray chest radiographs have improved significantly.

4. Pulmonary edema

X-ray chest radiograph shows that the texture of the two lungs is thick and fuzzy, the butterfly-like shadow centered on the hilum and the large asymmetrical shape of the lower lungs can change with the change of body position.

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