Three Peaks Thermal Type

Introduction The body temperature of the fever patient is measured conventionally and marked on the body temperature sheet to form a body temperature curve of different shapes, that is, a heat type. The heat type is one of the manifestations of the interaction between pathogenic factors and the body. Many febrile diseases have relatively specific heat types, so the typical heat type is valuable for disease diagnosis. The pre-existing health status is poor, and most of them are accompanied by the primary disease affecting the body's defense function, and there are more people infected in the hospital. Cold war, high fever, sweating, and double-peak heat type are more common, and occasionally three-peak heat type, this phenomenon is rare in other diseases caused by sepsis, it is worthy of attention.

Cause

1. Human factors: The body's defense against immune function defects is the most important cause of sepsis. After the invasion of the pathogen, the healthy person usually only shows transient bacteremia. The bacteria can be quickly eliminated by the body's immune defense system and does not cause obvious symptoms; but various immune defense function defects (including local and systemic barrier function) Loss), are easy to induce sepsis.

2, bacterial factors: Staphylococcus aureus can produce a variety of each and exotoxin, of which the main pathogenic role of plasma coagulase, alpha - hemolytic toxin, leukocidin, enterotoxin (A - E, more common in type A ), botanic toxins, rash toxins, etc. can cause severe sepsis; the enterotoxin F isolated in recent years is associated with the occurrence of toxic shock syndrome (TSS). Endotoxin produced by Gram-negative bacilli can damage the myocardium and vascular endothelium, activate the complement system, kinin system, condensate and fibrinolysis system, and sympathetic adrenal stenosis system, ACTH/endorphin system, etc., and activate each Blood cells and endothelial cells. Produces a variety of cytokines (such as TNF-, IL-1, IL-6, IL-8 and other cytokines, of which TNF- plays a key role in pathological changes), inflammatory mediators, cardiovascular regulatory peptides Etc., leading to microcirculatory disorders, septic shock, and the like.

an examination

Related inspection

Blood routine bone marrow bacterial culture

(1) Blood image

The total number of blood cells increases, generally at (10-30)×109/L, the percentage of neutrophils increases, and there may be obvious left nucleus shift and intracellular toxic particles, and eosinophils decrease or disappear. The total number of white blood cells in patients with poorer body reactivity and a small number of patients with Gram-negative bacilli may be normal or low, but the number of neutrophils is still increasing.

(2) Pathogen examination

Blood culture is the most important. It should be carried out before the application of antibacterial drugs and during chills and high fever. It should be repeated several times. The amount of blood for each newborn and baby is 5ml, and for older children and adults is 10ml. Those with conditions should be anaerobic and fungal cultures at the same time. In cases where antibacterial drugs have been used, it is advisable to add magnesium sulfate, -lactamase, p-aminobenzoic acid, etc. to certain antibacterial drugs, or to use clot culture methods to increase the positive rate. The positive rate of bone marrow culture was higher than that of blood culture. It is also used for examination and culture of smears such as pus, cerebrospinal fluid, pleural effusion, and squeezing, and there is also a chance of detecting pathogenic bacteria.

(3) Other inspections

The sputum lysate test (LLT) can detect the endotoxin of Gram-negative bacilli in serum and other specimens, but it cannot identify which pathogen, which is helpful for the diagnosis of Gram-negative sepsis. If there is damage to the organs such as heart, liver or kidney during the course of the disease, or shock, DIC, etc., it should be checked accordingly. Septic arthritis was found only after X-ray examination 2 weeks after onset.

Differential diagnosis

Differential diagnosis of Sanfeng fever type:

1, respiratory viral infection

This group of diseases accounted for 70%-80% of acute respiratory diseases. By rhinovirus, influenza virus, influenza virus adenovirus, respiratory syncytial virus. Caused by ECHO virus Coxsackie virus, its clinical features are multiple manifestations. Most of the symptoms of upper respiratory tract infection are mild, and the symptoms of bronchiolitis and pneumonia are heavier. The diagnosis is mainly based on clinical manifestations, white blood cell count and X-ray examination and treatment response to antibiotics. In recent years, due to the progress of diagnostic techniques, pathogens can be determined by immunofluorescence and enzyme-linked immunosorbent assay (ELISA) rapid diagnostic methods. Commonly include influenza, common cold, glandular pharyngeal conjunctival fever, herpetic angina, bronchiolitis, pneumonia, etc. Must be identified with bacterial infections in the respiratory tract.

2, severe acute respiratory syndrome (severe acute respire-atory, syndrome, SARS)

The disease was first developed in Guangdong Province in November 2002. It is a contagious pneumonia caused by coronavirus caused by fever and respiratory symptoms. Severe patients easily progress to acute respiratory distress syndrome (ARDS). And die. For the epidemiological basis of SARS, there are fever, respiratory symptoms and pulmonary signs, and abnormal imaging changes such as lung X-ray CT, which can exclude other diseases, can make SARS clinical diagnosis based on clinical diagnosis. The diagnosis of SARS coronavirus RNA (SARS COV RNA) is positive, or serum SARS COV antibody positive or antibody titer is increased by 4 times or more.

3, sepsis

In the case of a primary infection, symptoms of systemic sepsis, and multiple migratory abscesses, it is helpful to diagnose that the primary infection may be mild or healed. Therefore, when suffering from acute high fever of unknown cause, accompanied by aversion to cold or chills, severe symptoms of systemic poisoning, increased white blood cells and no parasitic findings in the left migrating blood, no special symptoms and signs, should consider the disease in time to do blood Culture, find infections and migratory lesions (lung, skin, etc.) The pathogens are more common with Staphylococcus aureus, followed by Escherichia coli and other intestinal Gram-negative bacilli.

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