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Abstract: The child presented with intermittent fever with cough for 6 days. Examination showed: shortness of breath, scattered vesicular sounds and a few sputum sounds could be heard in both lungs. Pulmonary CT: bilateral pneumonia and a small amount of fluid in the left pleural cavity. The child was given azithromycin for injection, prednisolone acetate injection to reduce the inflammatory reaction and exudation, and amiloride hydrochloride injection and acetylcysteine solution for inhalation to stop cough and resolve sputum. After 9 days of hospitalization, the child’s clinical symptoms disappeared and the treatment effect was good.
Basic information】Female, 6 years old
Disease Type】Mycoplasma pneumonia
Hospital】Chaoyang Second Hospital
Date of consultation】May 2022
Treatment plan】Intravenous infusion (azithromycin for injection, prednisolone acetate injection, amiloride hydrochloride injection) + nebulized inhalation (acetylcysteine solution for inhalation) + mechanical sputum evacuation
[Treatment period] 9 days of hospitalization
Treatment effect] Clinical symptoms disappeared and the treatment effect was good
I. Initial consultation
The child was admitted to the hospital with the complaint of intermittent fever with cough for 6 days. Parents’ description: 6 days ago, the child had intermittent fever with no obvious cause, about 2 times a day, with a fever peak of 38.6℃, and the body temperature could be reduced to normal after taking ibuprofen extended-release tablets orally, without chills and convulsions, accompanied by a cough, with sputum not easily coughing up, and occasional vomiting after coughing, and was treated at home with oral roxithromycin capsules and cough orange-red combination for 5 days after the disease, and was treated with cefadroxil injection, phlegm fever clear injection, and amiloride hydrochloride injection at the local clinic. After 5 days of treatment with cephalexin injection, phlegm fever solution and aminobromine hydrochloride injection (specific dosage is not known), no significant improvement was seen and he came to the hospital.
He was examined: body temperature: 36.0℃, heart rhythm: 104 beats/min, pulse rate: 32 beats/min, blood pressure: 106/67mmHg. He had a clear consciousness, mental status, shortness of breath, no hemorrhage or rash on the peripheral skin; both pupils were equal in size and round, light response was sensitive, no nasal fan or trismus sign; oral mucosa was smooth, pharynx was congested, tonsils were enlarged, neck was soft, no resistance; respiratory sounds were coarse in both lungs, scattered vesicular sounds were heard in both lungs. The heart sounds were strong and rhythmic, with a heart rate of 104 beats/min, and no murmurs were heard; the abdomen was soft, the liver and spleen were not palpable under the ribs, the bowel sounds were normal, and the muscle tone of the limbs was normal. Neurological examination: knee tendon reflex was normal, Achilles tendon reflex was normal, Kirsch’s sign was negative, Brønsted’s sign was negative, Babinski’s sign was negative, CRT: 2.0 seconds.
Auxiliary examination: leukocytes: 12.4×10^9/L (↑), percentage of neutrophils: 61.8%, percentage of lymphocytes: 21.1% (↓), percentage of monocytes: 13.2% (↑), absolute value of neutrophils: 7.7×10^9/L (↑), absolute value of lymphocytes: 2.6×10^9/L, absolute value of monocytes: 1.6×10^ 9/L (↑), erythrocytes: 4.76×10^12/L, hemoglobin: 123g/L, platelets: 403×10^9/L. Mycoplasma pneumoniae serological test (IgM): Mycoplasma pneumoniae IgM6.55COI. Pulmonary CT: patchy and large high-density foci were seen in the lower lobe of both lungs with fuzzy borders, mainly in the lower lobe of the left lung, some of the foci became solid and air was seen inside Bronchial sign. The left posterior thoracic cavity showed narrow strips of fluid density, with little hilar shadow, unobstructed trachea, symmetrical thorax, and no abnormal heart and large blood vessels.
II. Treatment history
The child had mycoplasma pneumonia, and the parents were fully informed and signed the informed consent form for intravenous injection of azithromycin, and the child’s blood and liver functions were monitored regularly. The child’s cough with sputum was treated with aminoglutethimide hydrochloride injection to stop the cough and resolve the sputum. Prednisolone acetate injection was applied to reduce the inflammatory reaction and exudation. On the 5th day of hospitalization, the child was discontinued from amiloride and was treated with nebulization with inhaled acetylcysteine solution and mechanical sputum excretion to promote sputum expulsion. On the 9th day of hospitalization, the patient’s condition stabilized and he was discharged.
III. Treatment effect
The child was hospitalized for 9 days, and the fever disappeared on the third day of hospitalization. On the fifth day of hospitalization, the number of coughs gradually decreased and the sputum gradually increased. After active treatment the pulmonary signs disappeared. On the eighth day of hospitalization, the lung CT was reexamined: both lung fields were well permeable, the lung texture was clear, the alignment was normal, the hilum was not large, the trachea and bronchi were clear, no enlarged lymph nodes were seen in the mediastinum, the thorax was symmetrical, the mediastinum was centered, and the heart and large blood vessels were not abnormal. The inflammatory lesions of both lungs were basically absorbed and the left pleural effusion was basically absorbed and disappeared, the child’s discomfort disappeared, and the treatment effect was good.
IV. Notes
We are glad that after treatment, the clinical symptoms of the child disappeared, and the lung affective changes disappeared, and the child was discharged with clinical cure. The child’s family is advised to come to the outpatient clinic to recheck the blood routine and liver function 1 week after discharge. After discharge, strengthen care, pay attention to protection, add clothes at the right time, avoid cold and flu, wear a mask when going out, prevent infectious diseases, keep indoor air fresh and circulating, maintain proper humidity and room temperature, prevent cross-infection, participate in outdoor sports appropriately, enhance the physical quality of the child, eat a light and reasonable diet, ensure adequate nutrition, and pay attention to dietary hygiene.
V. Personal insight
Through this treatment, I further realized that the smooth implementation of the disease treatment plan and the perfect manifestation of the treatment effect need the support of accurate examination and diagnosis. This treatment is more accurate and saves the time and cost of treatment for the child, and the treatment and results are recognized by the parents of the child and gain their trust. For children with mycoplasma pneumonia, parents should pay more attention to them, and if they have obvious symptoms of discomfort, they should not delay and should seek medical attention in time.