*For medical professionals for reference
What is the disease?
Writing Wen | Gao Zou Kaige
Editors press
9 -year -old girl is a tonsillitis caused by bacterial infection due to fever, and antibiotics are prescribed.Unexpectedly, two days later, her mother came with her daughter again. She said that the child hurts as soon as she walks, and her posture becomes very weird.The doctor suddenly realized that he was misdiagnosed.The details of this case are as follows, hoping to provide a reference for doctors and colleagues.
A recent outpatient clinic encountered an interesting case, so I will share with you:
Little Girl, 9 years old, 9 years old, 9 years old, 9 years old, 9 years old, 9 years old, 9 years old, 9 years old,I went to the emergency treatment for half a day during the heat. At that time, there were no cough, no sore throat, no runny nose, no vomiting, diarrhea, abdominal pain and other symptoms.
At that time, the emergency doctor checked the blood conventional+CRP: ultravisive C reactive protein: 4.1 mg/L normal; white blood cell count: 9.3 × 109/l normal; medium -sex cell classification:76.2%↑; lymphocyte classification: 13.7%↓; single -core cell classification: 9.6%normal; hemoglobin quantity: 115g/l normal; platelet count: 318 × 109/l normal;
According to the routine of the blood, the emergency doctor opened a bottle of Houttuynia cordata oral liquid and the mixed suspension of the ibuprofen, and the little girl went back.
The next day, the little girl still repeatedly fever, up to 39.5 ℃ , parents are not assured and come to our hospital again.
Check it again and find tonsil infection, but ...
After watching the emergency department, I was repeatedly fever.
"Generally, fever takes two or three days." Director Wang quickly comforted his family and relieved her anxiety, and then asked: "In addition to fever, is there any symptoms?Such as cough, sore throat, vomiting, diarrhea, abdominal pain, urination pain, etc.No. "
" Okay, let me check it first, "Director Wang said quickly to scan the little girl and get a general impression: calm expression, painless face, autonomous face, autonomous face, autonomous faceThe position, the breathing is flat, no concave absorption, no flowers, pale, and hairpin with both hands.This preliminary impression prompts No obvious breathing, circulating disorders .
Then listen carefully to the cardiopulmonary with the hesitator: strong heart sound, no murmur, symmetrical breathing sound of bilateral lungs, not heard of it.
"Come, look at the mouth." The little girl opened her mouth very well.Accurately cooperate with the prompt that the little girl has no obvious conscious obstacles. Little girls tonsil II ° red swelling, showing white secretions, and red bleeding points .
"The childs tonsils are inflamed, it is recommended to review the blood."
The little girl mother cooperates very well, and the test results come out in half an hour.Blood conventional+super -sensitivity CRP: Ultra -sensitive C reactive protein: 44.3 mg/L ↑; white blood cell count: 9.8 × 109/l ↑; neutrality; neutralityClassification of granulocytes: 68.9%normal; lymphocyte classification: 13.8%↓; single -core cell classification: 16.7%↑; hemoglobin quantity: 124g/L normal; platelet count: 284 × 109/l normal.
Combined with the medical history, physical examination, and testing of the little girl. It mainly considers purulent tonsillitis , which may be Chain bacteria infection .
"Children are mainly tonsilization pus, and the inflammatory indicators are a bit high, it is recommended to infusion for 2 days," Director Wang said.
So the potassium acupuncture needle of amoxicillin Clarvate, who opened it for two days, and told the little girls mother: "Children may have red rashes in the past two days. If they appear, they will always appear.Come to the hospital to see "
I did not expect to see such a scene.Seeing what diseases this little girl has, it has come out of the water.
Director Wang checked the throat again. The original red bleeding point became herpes and ulcers. At the same timeDiscovering similar herpes, these symptoms further confirmed their diagnosis.
At this time, Director Wangs face was hot, and it seemed to be misdiagnosed.At that time, she did not see herpes, and there was indeed white secretions on the tonsils. I didnt see if the hands and feet had rashes. It seemed that I couldnt care about it in the future.
Hand -foot and mouth disease
HFMD (HFMD) is a clinical syndrome with oral mucosaSme and hands and feet (maybe other parts) rash, macroeache or shingles.Among children and adults, hand, foot and mouth disease is one of the most common viral rashes.Hand -foot and mouth disease was first reported for a summer outbreak in Toronto, Canada in 1957. At that time, the cause was the Corusci virus A16.Since then, at least 15 other intestinal virus serum types can cause hand, foot and mouth disease, and the most common type A virus A.
Herpesha pharyilitis is a benign clinical syndrome, characterized by fever and pain pimple-blisters-ulcerative oral mucosa.It can distinguish the disease, hand, foot and mouth disease and primary herpes gingivitis according to clinical manifestations.
In the 1920s, it was reported to herpeshamia, but it was not determined until 1951 that its virus was determined.There are 22 types of intestinal virus serum types that can cause herpeshamihalitis, which is the most common in type A virus A.
A variety of intestinal virus serum types can cause hand, foot and mouth disease and herpeshamia, most of which belong to Enterovirus.The Coscope Virus A16 and the intestinal virus A71 are the most commonly related serum types related to hand, foot and mouth disease, and are the culprits of most of the large -scale outbreak of hand, foot and mouth disease.Intestinal virus A71 has caused the outbreak involving thousands of patients involved in the Asia -Pacific region.Since 2008, more and more places around the world have reported that the Coxlecty Virus A6 is the cause of the outbreak of hand, foot, and mouth disease.
The main intestinal virus -related serum type related to herpeshallus is the Kedic Virus A1, 2, 3, 4, 5, 6, 8, 10, and 22.A large -scale outbreak of intestinal virus A71 and the Coxatchvi virus A16 occurred in the Asia -Pacific region. In these areas, these serum types are common causes of herpeshamia.
Hand -foot and mouth disease -patients usually complain about oral or pharyngeal soreness (children can be expressed in language), or they are manifested as refusal (children who cannot be expressed in language).If there is heating, it is generally lower than 38.3 ° C.
Usually there are no prefix symptoms.If the report has symptoms of front -drive, it includes fever, irritability, abdominal pain, vomiting and diarrhea.
Physical examination found that patients with hand, foot and mouth disease mainly discovered oral mucosa.However, oral mucosa rash may occur without rash, and vice versa.
Oral mucosa -oral disease damage of hand, foot and mouth disease is located in front of the arow, the most common inThe tongue and cheek mucosa are rare in the gingival gingival sulcus, soft palate and hard palate, and occasionally see it in the hanging of Yongchong, lip and tonsils.The oral mucosal rash began to be red spots, and then it made blisters, and there was a circle of thin erythema rings around.The diameter of the blisters is usually 1-5mm, but it may also be larger.The blisters quickly ruptured, forming shallow ulcers with gray -yellow bases and red edges.The diameter of the ulcer is usually 1-10mm, but there are also reports of 20mm diameter.
Smoil -The disease -related rashes may be rash, mobilization or blisters.These three diseases may occur in the same patient.Bles can evolve from rash or macroextwills.The diameter of the blisters is 1-10mm.The wall of the blisters is thin, containing clear or turbid liquids, and there is a thin (1mm) erythema rings around it.The skin disease of the hand, foot and mouth disease is no itching, and it is usually painless, but the cases caused by some serum type (such as the Coxle Virus A6) may have pain.Diseases generally fade within 3-4 days.Rasal usually involves both hands (refers to back, between fingers and palms), feet (toe back, feet side edge, foot and heels), hips, legs (upper thighs) and arms.Rarely, blisters can be found in trunk and facial.In the hips, macular pimples are more common than blisters.Infants and young children are also more common in children and adults.
Intestinal virus A71 hand, foot and mouth disease -intestinal virus A71 hand foot and mouth disease can be severe,Cultivation of central nervous system diseases (cerebral stem and encephalitis, acute relaxation paralysis, sterile meningitis), pulmonary edema and bleeding, and heart failure.
Coruscis virus A6 type, foot and mouth disease -since 2008, a new type of Cozic virus A6 genotype has caused "typical" hand and foot in children and adultsThe more serious condition of oral disease, the specific manifestations are as follows:
higher thermal body temperature
April and hip, hip, groin area and perineal; disease damage concentrated in the eczema area ("Corina")
Skin disease is more serious -blisters big blister skin lesions, big blisters, erosion, ulcers and coke formation formation formation
Average 12th)
1-3 weeks after oral diseases appear with palm and sole skin dedivilation
January-February of Hand-foot and mouth disease occurs, such as Na Nori, such as the deck Hengli (Bobe Line) or A skeleton (Anti-Actia)
Responsible editor: Moon
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