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Abstract: This case is a middle-aged and elderly female patient who presented with cough and yellow pus sputum with fever after exposure to cold, chest CT suggesting lung infection, and bronchoscopic alveolar lavage fluid sent for NGS suggesting Streptococcus pneumoniae infection, and was then diagnosed with bacterial pneumonia. During hospitalization, she was treated with symptomatic medication. After treatment, her symptoms were completely relieved and all indexes returned to normal, and the treatment effect was good.
Basic information】Female, 57 years old
Disease Type】Bacterial pneumonia
Hospital】Wuhan University People’s Hospital
Date of consultation】May 2022
Treatment plan】Medication (cefoperazone sulbactam sodium for injection, moxifloxacin hydrochloride tablets, amiloride hydrochloride tablets)
Treatment period】Inpatient treatment for 10 days, outpatient follow-up
Treatment effect】Symptoms completely relieved, all indicators back to normal, good treatment effect
I. Initial consultation
Patient’s complaint: 5 days ago, he started to cough and cough yellow pus sputum with fever, maximum temperature 38.3℃, accompanied by sore throat, chills, general weakness, no hemoptysis, chest pain, dyspnea, no headache, dizziness, tinnitus and other discomforts, and took oral cefixime tablets for 3 days, but the above symptoms were not relieved. After ruling out the new crown infection in our fever clinic, it was recommended to visit the respiratory medicine clinic, and a chest CT examination was performed to suggest lung infection. He had no special medical history, no history of smoking or drinking, and denied any history of drug allergy. On examination, the patient was clear, poor in spirit, with coarse breath sounds in the left lower lung and audible wet rales.
II. Treatment history
After admission, routine blood tests and calcitoninogen tests were performed, which indicated significantly elevated inflammatory indexes, and sputum culture and blood culture did not show significant bacterial growth. Bronchoscopy was performed to send alveolar lavage fluid NGS suggesting: Streptococcus pneumoniae infection. The patient was given cefoperazone sulbactam sodium + moxifloxacin hydrochloride tablets for injection as anti-infection and aminoglutethimide hydrochloride tablets for sputum treatment. During the hospital stay, the patient was advised to strengthen nutrition, pay attention to rest, avoid straining and staying up late, etc. The chest CT and blood routine were reviewed after the proposed anti-infection treatment.
III. Treatment effect
After 10 days of active anti-infection + sputum treatment, the patient’s blood routine was rechecked, indicating that the inflammatory indexes had completely returned to normal, and the chest CT was rechecked, indicating that the infectious lesions in the lungs had significantly improved. The patient was discharged with complete remission of symptoms. In conclusion, the patient’s symptoms were completely relieved, the indicators returned to normal, and the treatment effect was good. After discharge, the patient was advised to pay attention to rest outside the hospital, avoid strain and cold, strengthen nutrition, enhance physical fitness, and follow up with the respiratory medicine clinic.
(Comparison of chest CT before and after treatment)
IV. Notes
Bacterial pneumonia is mainly an infectious lung lesion caused by bacterial invasion in a state of decreased immunity, and can develop at any age, especially in young adults who are tired and stay up late, in elderly people with combined underlying diseases, and in patients with low immunity and weakness. In daily life, we should pay attention to rest, avoid exertion, cold, staying up late, strengthen nutrition, and enhance physical fitness. Pay attention to increase and decrease clothing during weather changes and seasonal changes, and receive preventive vaccination against pneumonia if necessary.
V. Personal insight
Bacterial pneumonia is the most common type of community-acquired pneumonia, with a high incidence of common causative organisms including Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, etc. Patients may have signs of solid lung changes, and after the diagnosis of bacterial pneumonia is confirmed by chest imaging and pathogenic examination, standard anti-infective treatment should be actively carried out, especially in patients with combined fever and respiratory failure, to avoid delayed treatment and progression to severe pneumonia In the present case, the patient was not feeling well. In this case, the patient took oral medication on his own when he had symptoms of discomfort, but the treatment effect was not good, so it was fortunate that he sought medical attention in time to avoid further aggravation of the disease.