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Abstract: The patient, Xiao Zhang, had fever and cough for 3 days and then worsened with dyspnea and coughing up blood-colored sputum for 1 day. Based on the patient’s symptoms, blood tests, imaging and the season of occurrence, it was initially determined that viral pneumonia was likely. Early treatment with antiviral drugs and active improvement of pathogenesis were required. The result was a clear diagnosis of viral pneumonia, and the patient’s discomfort improved after giving medication and high-flow oxygen.
[Basic information] Male, 38 years old
Disease Type】Viral pneumonia
Hospital】The Second Hospital of Harbin Medical University
Time of consultation】November 2018
Treatment plan】Oral medication (Oseltamivir phosphate capsules + liver protection tablets) + intravenous medication (cefazolin sodium for injection) + high-flow oxygenation
[Treatment Period] 14 days of hospitalization, 1 month of outpatient follow-up
Treatment effect】The disease has been controlled, and all indicators are improving
I. Initial consultation
Patient Xiao Zhang was admitted to our department as an emergency patient. At the time of admission, the patient’s family reported that the patient had fever of 39.3℃ with no obvious cause and dry cough for 3 days. In the last day, he had dyspnea and coughing up blood-colored sputum with generalized muscle aches, but no headache, abdominal pain, or diarrhea. On examination, body temperature: 39.5℃, pulse: 86 beats/min, respiration: 32 breaths/min, blood pressure: 120/80mmHg, and acute face, clear and poor mental health, shortness of breath, coarse breath sounds in both lungs, dry and wet rales can be heard in both lungs, but the heart rhythm is uniform, no heart murmur, no abdominal pressure pain and rebound pain, no swelling in both lower limbs. On admission, CT of the lungs showed multiple patchy + lobular lattices and thickened lobular septa in both lungs. Laboratory tests showed normal white blood cells, 4.1% lymphocytes, increased monocytes, C-reactive protein 170.91 mg/L, glutamic oxalacetic transaminase 66 U/L, and glutamic alanine transaminase 80 U/L. The patient was considered to have viral pneumonia based on the season of onset, symptoms, imaging features, and blood tests.
II. Treatment history
The patient was considered to have been ill for 3 days with increasingly severe symptoms. After admission, the following diagnostic and treatment measures were taken: Oseltamivir phosphate capsules were given orally, and liver protection tablets were given at the same time because of liver function damage. Pathogenesis was returned 2 days later: pharyngeal swab, influenza virus nucleic acid test (+), influenza A virus, and the preliminary diagnosis was correct. Blood gas analysis and routine tests were improved, and active antiviral treatment was continued. The patient’s partial pressure of blood oxygen was reduced, and high-flow oxygen was given to maintain oxygen saturation within the normal range. Patients with viral pneumonia are prone to co-infection with bacterial infection, so it is necessary to monitor the changes of infection indexes such as blood routine of the patient. Since the infection indexes of bacteria are elevated, consider possible co-infection with bacterial infection and give cefazolin sodium for injection intravenously.
III. Treatment effect
The pathogenic result of the patient 2 days after admission was the same as expected, viral pneumonia, and anti-influenza virus treatment was given. Viral pneumonia progresses rapidly and is prone to respiratory failure, so blood gas analysis was monitored while on oxygen. Due to timely treatment, the patient’s disease did not continue to aggravate. After 7 days of treatment, the symptoms of fever and dyspnea were significantly reduced, and after 10 days the patient’s cough symptoms were reduced. 14 days of hospitalization for review, the patient had no other uncomfortable symptoms and the symptoms of fever, dyspnea and cough disappeared, and discharge was granted. The patient was instructed to review the outpatient clinic after 1 month.
IV. Notes
We are glad that the patient recovered and was discharged after active treatment. Patients are advised to prevent future recurrence of viral pneumonia and need good personal protection. The disease can occur throughout the year, but is mostly seen in the winter and spring. Influenza virus is the primary cause of viral pneumonia. Prevention of viral pneumonia is very important. It is important to take care of personal protection and avoid going to crowded public places; be sure to wash your hands regularly outside and do not spit anywhere, as spitting can easily increase the spread of the virus. If the patient’s physical condition has recently deteriorated, he or she must strengthen exercise to increase his or her physical condition.
V. Personal insights
The current pathogenic test results of community-acquired pneumonia in adults show 27.5% viruses, 23% bacteria, and 7.9% mixed infections. And the important viruses caused in order: influenza virus, rhinovirus, adenovirus, parapneumovirus, respiratory syncytial virus. Clinical features: acute onset, high fever, malaise, generalized muscle aches, and relatively mild respiratory symptoms. Early treatment with anti-influenza virus drugs can prevent complications. Early application of antiviral drugs for viral pneumonia is very important, followed by symptomatic treatment as well as bed rest.