Missing fever
Introduction
Introduction The body temperature is constant at a level of 39 to 40 degrees Celsius, for several days or weeks, and the temperature fluctuation range of less than 1 degree Celsius within 24 small events is called the heat of detention! It is common in large leaf pneumonia and typhus.
Cause
Cause
The occurrence of large leaf pneumonia is caused by infection or allergies. The infection is mainly caused by infection with pneumococci, streptococci and staphylococcus. Some infectious diseases can be followed by lobar pneumonia. Allergic lobar pneumonia is an allergic disease with allergic inflammation. Cold, cold, long-distance transportation, excessive labor, poor sanitation, and irritating gases are all causes of this disease.
The above pathogens invade into the lung tissue through the gas source, blood source or lymphatic route, and rapidly multiply, spread along the lymphatic pathway to the connective tissue around the bronchi and the alveolar space, causing inflammation of the interstitial lung, gradually invading the alveoli and diffusing into the pleura. . Some of the dissolved bacteria release endotoxin, and the bacterial toxins and tissue decomposition products are absorbed, which causes high fever, cardiovascular system disorders, and specific immune antibodies.
The pathogen of typhus is Platts rickettsia, which is parasitic in the cytoplasm of human and animal vascular endothelial cells and in the epithelial cells of human intestinal wall, and also attaches to red blood cells and platelets in rickettsialosis. The basic form is a micro-ball shape and is arranged in a chain along the long axis. However, it has multiple forms in the developmental stage of the calf, and can be spherical, short rod-shaped, rod-shaped or long-lined. It is about 0.3 to 1 m × 0.3 to 0.4 m, and Gram stain is negative. The chemical composition and metabolites of pathogens include proteins, sugars, fats, phospholipids, DNA, RNA, various enzymes, vitamins and endotoxin-like substances. The lipopolysaccharide layer of its cell wall has an endotoxin-like effect. Platts rickettsia is sensitive to heat, ultraviolet rays, and general chemical disinfectants. It can be inactivated at 56 ° C for 30 min, and is highly resistant to low temperature and dryness. It can survive for several months in dry manure. The typhus typhus and the Proteus OX19 antigen components cross, so the patient's serum can agglutinate with Proteus OX19, that is, the external Fission reaction. Rickettsia przewalskii contains both group-specific antigens of soluble heat tolerance shared by this group. It also contains a type-specific thermolabile particulate antigen, which can be distinguished from Morax's rickettsia infection by serological examination.
Pathogens can grow in tissue culture and grow vigorously in the yolk sac of chicken embryos. Animals can only be used in guinea pigs, causing fever and vascular disease after inoculation. The swelling of the scrotum is not obvious, which is different from the infection of the rickettsii, which can be differentiated from endemic typhus. Toxin-like substances can dissolve red blood cells of warm-blooded animals such as humans, monkeys, and rabbits in test tubes, and can cause dyspnea, convulsions, and decreased blood volume after infusion into large and mouse veins. Animals die within 6 to 24 hours.
Examine
an examination
Related inspection
Fatda's reaction body temperature measurement Mycobacterium tuberculosis serological test (anti-TB) Urine routine urine -glutamyl transferase
Big leaf pneumonia:
1. The disease occurs in young men and winter and spring and spring.
2. There are many incentives before the onset of illness. About half of the cases have pre-existing manifestations such as upper respiratory virus infection.
3. Sudden onset of chills and high fever.
4. Cough, chest pain, shortness of breath, rust and rust. Severe patients can be accompanied by shock.
5. Physical signs of the lungs. In severe cases, blood pressure often drops below 10.5/6.5KPa (80/50mmHg).
6. The total number of white blood cells increased, neutrophils reached 0.80 or more, and the nucleus moved to the left, with poisonous particles.
7. A large number of Gram-positive cocci are visible in the smear.
8. , blood culture has pneumococcal growth.
9. Serological test positive (cooperative agglutination test, convective immunoelectrophoresis detection of pneumococcal capsular polysaccharide antigen).
10. Chest X-ray examination showed a large patchy density with uniform segment or leafiness.
11. Blood gas analysis showed a decrease in PaO2 and PaCO2, and PaCO2 in patients with chronic obstructive pulmonary disease increased.
typhus:
1. The prevalence of epidemiological data, the season of good development, the history of travel in the epidemic area and the history of contact with the deaf and the possibility of being bitten, have important reference value for diagnosis.
2. Clinical manifestations of fever and heat history, rash date, rash characteristics and obvious central nervous system symptoms can help diagnose.
3. Laboratory examination of the characteristics of blood, Faye reaction positive, especially in the recovery period serum titer is more than 4 times the early growth has diagnostic value, but can not be typed. Conditionally, it can be used for the identification of specific antibodies by the Platts rickettsia agglutination reaction, the complement binding assay and the immunofluorescence indirect staining method. Positive results of animal vaccination are particularly diagnostic.
Diagnosis
Differential diagnosis
Intermittent heat: After the sudden rise of body temperature reaches the peak for several hours, it quickly drops to the normal level. The no-heat period (intermittent period) can last from one day to several days, so that the high heat period alternates with no heat. Common in malaria, acute pyelonephritis and so on.
Dehydration heat: refers to the phenomenon that the body (especially children), after severe dehydration, is reduced by the evaporation of water from the skin, which is caused by the heat dissipation of the body, which leads to an increase in body temperature.
Relaxation heat is also called septicemia. It means that the body temperature continues to be above 39 degrees, and the fluctuation range is large. The body temperature fluctuation range exceeds 2 degrees within 24 hours, but both are above the normal level. Common in sepsis, rheumatic fever, severe tuberculosis and suppurative inflammation. Persistent relaxation heat can be seen in malignant granuloma.
Big leaf pneumonia:
1. The disease occurs in young men and winter and spring and spring.
2. There are many incentives before the onset of illness. About half of the cases have pre-existing manifestations such as upper respiratory virus infection.
3. Sudden onset of chills and high fever.
4. Cough, chest pain, shortness of breath, rust and rust. Severe patients can be accompanied by shock.
5. Physical signs of the lungs. In severe cases, blood pressure often drops below 10.5/6.5KPa (80/50mmHg).
6. The total number of white blood cells increased, neutrophils reached 0.80 or more, and the nucleus moved to the left, with poisonous particles.
7. A large number of Gram-positive cocci are visible in the smear.
8. , blood culture has pneumococcal growth.
9. Serological test positive (cooperative agglutination test, convective immunoelectrophoresis detection of pneumococcal capsular polysaccharide antigen).
10. Chest X-ray examination showed a large patchy density with uniform segment or leafiness.
11. Blood gas analysis showed a decrease in PaO2 and PaCO2, and PaCO2 in patients with chronic obstructive pulmonary disease increased.
typhus:
1. The prevalence of epidemiological data, the season of good development, the history of travel in the epidemic area and the history of contact with the deaf and the possibility of being bitten, have important reference value for diagnosis.
2. Clinical manifestations of fever and heat history, rash date, rash characteristics and obvious central nervous system symptoms can help diagnose.
3. Laboratory examination of the characteristics of blood, Faye reaction positive, especially in the recovery period serum titer is more than 4 times the early growth has diagnostic value, but can not be typed. Conditionally, it can be used for the identification of specific antibodies by the Platts rickettsia agglutination reaction, the complement binding assay and the immunofluorescence indirect staining method. Positive results of animal vaccination are particularly diagnostic.
