Acute illness

Introduction The complexion is flushed, the excitement is uneasy, the nose is fanned, the herpes is cold, and the expression is painful. More common in acute infectious diseases, such as pneumococcal pneumonia, malaria, epidemic cerebrospinal meningitis.

Cause

Pneumococcal bacteria are Gram-positive cocci, often paired (Pneumococcal) or in a chain arrangement (Streptococcus pneumoniae). These bacteria are normal flora of the upper respiratory tract and only cause disease when immunity is reduced. The incidence is mostly in winter and early spring. Smokers, dementia, congestive heart failure, chronic disease patients, chronic bronchitis, bronchiectasis, and immunodeficiency patients are all susceptible to pneumococcal invasion.

Malaria is caused by feeling malaria (malaria). It is a disease that often occurs in the summer and autumn when it is characterized by chills, heat, headache, and sweating. Contagious. This disease is the same as the name of the disease in Western medicine.

Etiology and pathogenesis:

(1) Feeling of malaria (malaria). Often, the wind, cold, heat, wet evil or eating and drinking are the predisposing factors.

(2) Malaria is succumbed to half a table and half, and it is between the camp and the guard. The evil is fighting with the cold and the heat is attacking; the evil is in the cold and the heat is stopped. Those who are afflicted with anger are one on the other, and those who are evil and deep are on the second or third day.

(3) Those with hot partiality are warm malaria; those with cold partiality are cold malaria; malaria is unhealed for a long time, and blood stasis condenses under the threat, then malaria is formed, or it is called long-lasting malaria.

an examination

Related inspection

Blood routine Mycobacterium tuberculosis gene detection (PCR) Epidemic cerebrospinal meningitis immunological test cultivating face expression

Patients with pneumococcal pneumonia often have a history of cold rain, fatigue, drunkenness, mental stimulation, and viral infection. Half of the cases have prodromal symptoms of upper respiratory tract infection for several days.

The onset is more rapid, there is high fever, half with chills, body temperature can rise to 39-40 °C in a few hours, peak in the afternoon or evening, can also be traced heat, parallel with the pulse rate. The patient feels a sore muscle in the body, pain in the affected chest, can be radiated to the shoulders, abdomen, and is exacerbated by coughing or deep breathing. Less, it can be bloodshot or rust-colored. The stomach is sharply reduced, occasionally nausea, vomiting, abdominal pain or diarrhea, sometimes misdiagnosed as acute abdomen.

The early signs of pneumonia are not obvious. Older and younger patients, as well as secondary to other diseases, often have atypical clinical manifestations.

an examination

Blood routine: The white blood cell count is mostly at 10-30×109/L, and the neutrophils are more than 80%.

Sputum smear examination: There are a large number of neutrophils and Gram-positive pairs or Streptococcus mutans.

culture: pathogens can be identified at 24-48h.

X-ray examination: Typical X-ray films have been rare in recent years.

Key points for clinical diagnosis of malaria:

1 Most cases have chills or chills of varying lengths before fever.

2 Body temperature rises rapidly in a short period of time, lasts for several hours, then falls quickly, and then there are varying degrees of sweating. When the body temperature is measured once every 2 to 4 hours, and the body temperature curve is analyzed, it can be found that the body temperature at night tends to fall to normal or below normal temperature.

3 seizures have timing, the fever period and the non-heat period overlap, and there is a certain regularity.

4 patients in the intermittent period of fatigue, weakness and slight discomfort, generally feel good.

5 The incidence was more common around noon and afternoon, and fewer authors started at night.

6 The clinical symptoms are more serious than once, and after repeated episodes, they gradually reduce, and there is a tendency of self-healing.

7 has clinical manifestations of hemolytic anemia, the degree of which is consistent with the number of episodes.

8 splenomegaly, the extent of which is related to the course of the disease, and some cases also see liver enlargement. The first and second episodes of infants, falciparum malaria and new infections are often atypical. In addition, some patients with high immunity have a large number of protozoa in the blood, but the clinical symptoms are not obvious or completely absent. In particular, the diagnosis can be confirmed by reference to physical examination and laboratory examination.

Differential diagnosis

Identification of pneumococcal pneumonia:

1. Tuberculosis: Patients often have symptoms such as fever, fatigue, night sweats and weight loss, hemoptysis. Combined with tuberculosis test and chest radiographs can be more clear.

2. Interstitial lung disease: The prominent manifestation is progressive shortness of breath and dry cough. The body can smell Velcro when inhaling, the lung function is restricted ventilatory dysfunction, and the diffuse function reduces the chest radiograph to diffuse symmetry. Distribution of reticular nodules, combined with HRCT can be clear.

3. Lung cancer: It can have a history of smoking for many years, and it is often characterized by irritating dry cough. There may be blood in the sputum. The chest radiograph shows block or nodular shadow in the lung. Antibiotic treatment can not completely dissipate. CT and sputum exfoliative cytology Fiberoptic bronchoscopy helps to be clear.

Clinical manifestations of typical malaria, diagnosis is not difficult, for more than 1/3 of the so-called atypical cases, must be differentiated from other diseases characterized by fever, splenomegaly and hepatomegaly, so as not to delay treatment, spread malaria, or neglect Other diseases in which malaria coexists.

1. Acute schistosomiasis has a history of exposure to schistosomiasis and a history of dermatitis, common digestive symptoms such as diarrhea and mucous membranes, and dry cough. Unlike malaria, more than 90% of the liver is large. More significant, increased white blood cell count, eosinophilia, cerebral palpebral reaction, ring egg precipitation test or stool incubation positive

2. Most of the filariasis has a history of previous episodes, white blood cells and eosinophils, no anemia and splenomegaly, and blood microbes are more positive than sputum.

3. Black fever has a history of living in the epidemic area of kala-azar. The fever is generally irregular, and the latter can develop into a complete blood cell reduction, nose bleeding or gum bleeding, liver and spleen, bone marrow puncture can be found Lidu body.

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