(Disclaimer: This article is for scientific use only, and the relevant information in the following content has been processed to protect patient privacy)
Abstract: Uncle came to the hospital with cough, coughing yellow sputum with fever for 5 days. Sputum culture and blood culture both returned Klebsiella pneumoniae, and the diagnosis of lobar pneumonia was made by combined imaging. After aggressive antibiotic treatment the patient improved and was discharged. The patient had community-acquired pneumonia, and the causative organism was not the common Streptococcus pneumoniae, nor was it an atypical pathogen, but Klebsiella pneumoniae.
[Basic information] Male, 47 years old
Disease Type】Lobar Pneumonia
Hospital】The Second Hospital of Harbin Medical University
Time of consultation】June 2018
【Treatment plan】Injectable medication (piperacillin sodium tazobactam sodium for injection + ambroxol hydrochloride injection)
Treatment period】Inpatient treatment for 14 days, followed by outpatient visit 2 weeks after discharge
Treatment effect】The disease has been controlled, and all indicators are improving
I. Initial consultation
A 47-year-old uncle came to the hospital and said that he had a sore throat, cough, yellow mucous sputum and fever after catching a cold in the rain 5 days ago. He was treated at home with medication for upper respiratory tract infection, but the above symptoms were not relieved and tended to worsen. He had a worsening cough, increased sputum, difficulty in lowering the body temperature, and decreased physical strength during the attack. On examination, blood pressure: 70/125/mmHg, body temperature: 39.1°C, pulse: 98 beats/min, respiration: 20 breaths/min. The general status was poor, with an acutely ill face with flushing. There was no yellowing of the skin mucosa, no enlargement of superficial lymph nodes, congestion of the pharynx, and no enlargement of the tonsils. The thorax was normal in appearance, and dry rales could be heard in the middle lobe of the left lung. Heart rate: 98 beats/min, normal heart borders on percussion, no pathological murmurs were heard in the valves and auscultatory areas, abdomen was flat and soft, liver and spleen were not palpable. The spine and extremities were normal, there was no swelling in both lower extremities, and the nervous system was normal. The patient reported 8 years of diabetes mellitus with poor control and a history of smoking and alcohol consumption. Based on the patient’s medical history, physical examination and imaging, a preliminary diagnosis of lobar pneumonia was made.
II. Treatment history
After admission, the patient was given moxifloxacin hydrochloride sodium chloride injection intravenously, and sputum culture and blood culture were performed. After 3 days of treatment, the fever did not decrease significantly, and sputum and blood cultures returned Klebsiella pneumoniae, so the treatment was continued for 2 days without changing the protocol, but the fever did not decrease significantly, so bronchoscopy was continued and alveolar lavage was retained. In order to maintain the patient’s respiratory drainage, amiloride hydrochloride injection was given to treat the sputum and continue to monitor the infection index.
III. Treatment effect
After admission, moxifloxacin hydrochloride sodium chloride injection was given intravenously for 5 days, and the patient’s fever did not resolve significantly. Later, according to the results of alveolar lavage fluid culture and drug sensitivity test, piperacillin sodium tazobactam sodium for injection was selected for treatment for 5 days, and the fever was reduced, and the yellow sputum was significantly reduced under the treatment of amiloride hydrochloride injection. A consultation with an endocrinologist was given to adjust the blood glucose, which was controlled within the normal range. The patient’s symptoms improved significantly before discharge, and the routine blood leukocytes returned to normal, and the patient was discharged with great satisfaction after 14 days of hospitalization. The patient was instructed to review the lung CT after 2 weeks of discharge.
IV. Notes
We are glad that the patient obtained satisfactory results after active treatment, but in the follow-up recovery, we still need to advise the patient to follow the doctor’s prescriptions, such as taking medication on time and reviewing regularly, etc. In addition, we also need to pay attention to the following matters.
1, the patient has diabetes, need to actively control blood sugar, blood sugar control is not good easily secondary to a variety of infections.
2, need to quit smoking, quit drinking, strengthen exercise to enhance their own physical fitness, for the control of blood sugar and other diseases have a positive role.
3, at the same time in the diet to eat light, more vegetables, fruits, and minimize spicy, greasy, high-sugar, high-calorie food.
V. Personal insight
This case reminds us that the causative agent of pneumonia in diabetic patients is different from those without underlying diseases. The common causative organisms of community-acquired pneumonia in patients with underlying diseases, such as diabetes and tumors, are mostly Klebsiella pneumoniae and Staphylococcus aureus, and treatment is often with piperacillin sodium tazobactam sodium for injection, imipenem cistatin sodium for injection, and other drugs in combination in severe cases.