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金黄色葡萄球菌败血症(金葡败)和风湿病虽然是两种性质不同的疾病,但其临床确有相似之处易造成混淆,增加诊断和治疗困难,本文就2例分析如下。 例1:男,7岁。因反复发热20天入院。患儿20天前突然高热40℃,伴头昏乏力,偶有神志模糊,在当地医院注射青霉素、退热药无效,腹泻稀便4次,拟诊“痢疾”,加用庆大霉素、输液等治疗2天,稍好转;第4天高热40℃,非喷射状频繁呕吐,CSF Pandy试验阳性,拟诊“病毒脑炎”,抗病毒治疗(用药不详),第8日热退呕吐止,精神好转出院。第10日再度高热40℃,头痛、神志模糊转县医院住院10天,以“风湿性心脏病”、“脑膜炎”转我院。病前健康。体查:体温37.6℃、血压10.7/5.3kPa,急性重病容,神清,皮肤无出血点,颈有抵抗,肺呼吸音粗,心尖搏动弥漫,律齐,心尖区Ⅲ～Ⅳ级收缩期吹风样杂音,向左腋下、肺动脉瓣
Staphylococcus aureus septicemia and rheumatoid arthritis are two different kinds of diseases, but their clinically similar causes can cause confusion and increase the difficulty of diagnosis and treatment. The two cases are analyzed as follows. Example 1: Male, 7 years old. Due to repeated fever admitted to hospital for 20 days. 20 days before the sudden onset of fever in children 40 ℃, with dizziness, occasional delirium, injection of penicillin in the local hospital, antipyretics invalid, diarrhea loose stool 4 times, to be diagnosed with “dysentery” plus gentamicin, Infusion and other treatment for 2 days, slightly improved; the first 4 days of high fever 40 ℃, non-jet frequent vomiting, CSF Pandy test was positive, the proposed diagnosis of “viral encephalitis”, antiviral therapy (medication unknown) The spirit of better discharge. On the 10th again high fever 40 ℃, headache, ambiguity go to the county hospital for 10 days, with “rheumatic heart disease”, “meningitis” to our hospital. Premorbid health. Physical examination: body temperature 37.6 ℃, blood pressure 10.7 / 5.3kPa, acute serious illness, Shen Qing, skin no bleeding point, the neck has resistance, lung breath sound coarse, apex pulsating diffuse, law Qi, apical Ⅲ ~ Ⅳ systolic hair Like noise, left armpit, pulmonary valve