Mycoplasma pneumoniae infection complicated by necrotizing pneumonitis with massive pleural effusion
Mycoplasma pneumoniae infection complicated by necrotizing pneumonitis with massive pleural effusion
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DOI：
10.1007/s00431-005-0058-z
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发表时间：
2006-04-01
影响因子：
3.6
通讯作者：
Chen, TP
中科院分区：
文献类型：
--
作者：
Chiu, CY;Chiang, LM;Chen, TP
肺炎支原体被认为是学龄儿童社区获得性呼吸道疾病的重要和常见原因[4]。支原体肺炎的临床过程通常是轻度和自限性的。胸腔积液不是M.肺炎，当它发生时，通常有少量的积液，不需要插入胸管[6]。我们在这里报告一个孩子与M。肺炎感染并发坏死性肺炎（NP），表现为继发于大量胸腔积液的呼吸窘迫。一个7岁的女孩，以前健康，提出了我们的医院与10天的历史发烧和咳嗽。入院前一天出现呼吸急促。以前没有口服抗生素，也没有已知的药物或食物过敏。到达我们的急诊室后，她似乎患有急性呼吸窘迫症。她的体温为39.5 ℃，脉率为163次/分，呼吸频率为50次/分，血压为107/55 mmHg。出现呼吸急促伴肋下收缩，胸部检查显示叩诊迟钝，左下肺野听诊呼吸音减弱。胸部X线片显示左下叶实变和左上叶部分肺不张伴大量胸腔积液。全血细胞计数和生化检查显示白色细胞计数为17，600/μl，中性粒细胞占89%，淋巴细胞占5%，C反应蛋白水平升高为337.8 mg/l（正常：< 5 mg/l）。进行胸部超声检查和诊断性胸腔穿刺术，吸出黄色而非浑浊液体。胸腔积液分析显示，白色血细胞为980/mm 3（中性粒细胞：54%;淋巴细胞：29%;单核细胞：11%），红细胞为70/mm 3，蛋白质为3.6 g/dl，葡萄糖为105 mg/dl，乳酸脱氢酶为2，002 U/l。革兰氏染色和酸性染色涂片均未发现微生物。胸水肺炎链球菌、流感嗜血杆菌B型和B组链球菌乳胶凝集试验为阴性。处方经验性头孢曲松（100 mg/kg体重/天），但高热和胸腔积液伴呼吸窘迫持续1周。细菌、结核分枝杆菌、真菌和病毒培养均为阴性。进行胸部计算机断层扫描（CT）以进行进一步评价，扫描显示左下叶实变伴多个低密度区域和大量胸腔积液伴左肺嵌压（图1a）。随后进行了胸腔镜手术（VATS）和胸膜剥脱术，并放置胸管，有效引流胸腔积液。最初，冷血凝素滴度为1：4，M的补体结合免疫球蛋白G（IgG）滴度为1：4。pneumoniae为1：160。一周后，重复检测;第二次冷血凝素滴度为1：16，补体结合IgG滴度增加至1：2，560。酶免疫法（EIA）检测支原体IgM阳性2例。继续使用早期处方的抗生素，并同时给予阿奇霉素（10 mg/kg体重/天）10天，直至发热消退以及体位性强引流。入院后14天的胸部X线片显示多发性肺囊肿（图1 B）。这名年轻患者从这次急性发作中完全康复，出院后住院22天。M.肺炎通常发生在...
Mycoplasma pneumoniae is recognized as an important and frequent cause of community-acquired respiratory illness in school-aged children [4]. The clinical course of mycoplasma pneumonia is typically mild and self-limited. Pleural effusion is not a common feature of M. pneumoniae, and when it occurs there is usually a small amount of effusion which does not require chest tube insertion [6]. We report here on a child with M. pneumoniae infection complicated by necrotizing pneumonitis (NP) who presents with respiratory distress secondary to massive pleural effusion. A 7-year-old–previously healthy–girl presented to our hospital with a 10-day history of fever and cough. Shortness of breath developed on the day before admission. Antibiotics had not been administered by mouth previously, and no known allergy to drug or food was elicited. Upon arrival to our Emergency Department, she appeared to be acutely ill with respiratory distress. Her body temperature was 39.5 C, pulse rate was 163 beats/min, respiratory rate was 50/min with a blood pressure of 107/55 mmHg. Tachypnea with subcostal retraction was present, and examination of the chest revealed dullness to percussion, with decreased breath sounds to auscultation over the left lower lung field. A chest roentgenogram showed consolidation of the left lower lobe and partial atelectasis of left upper lobe with massive pleural effusion. Complete blood cell counts and biochemical examination revealed a white blood cell count of17,600/μl with 89% neutrophils and 5% lymphocytes and an increased C-reactive protein level of 337.8 mg/l (normal:< 5 mg/l). A chest ultrasonography with diagnostic thoracocentesis was performed, and yellow, not turbid fluid was aspirated. Analysis of the pleural effusion showed white blood cells at 980/mm3 (neutrophils: 54%; lymphocytes: 29%; monocytes: 11%), red blood cells at 70/mm3, protein at 3.6 g/dl, glucose at 105 mg/dl and lactate dehydrogenase at 2,002 U/l. No organisms were found on Gram-and acid faststained smears. The latex agglutination test of the pleural fluid for Streptococcus pneumoniae, Haemophilus influenzae type b and group B Streptococcus was negative. Empiric ceftriaxone (100 mg/kg body weight per day) was prescribed, but spiking high fever and pleural effusion with respiratory distress persisted for 1 week. Cultures for bacteria, Mycobacterium tuberculosis, fungi and viruses were all negative. A computed tomography (CT) of the chest was performed for further evaluation, and the scan revealed consolidation of the left lower lobe with multiple low attenuation areas and a massive pleural effusion with left lung entrapment (Fig. 1 a). Subsequent video-assisted thoracic surgery (VATS) with pleural decortication was performed, and a chest tube was placed with effective drainage of the pleural effusion. Initially, the cold hemagglutinin titer was 1: 4 and the complement-fixation immunoglobulin G (IgG) titer for M. pneumoniae was 1: 160. One week later, the tests were repeated; the second time the cold hemagglutinin titer was 1: 16 and complement-fixation IgG titer had increased to 1: 2,560. Mycoplasma IgM by enzyme immunoassay (EIA) was positive on two occasions. The earlier prescribed antibiotics were continued, and azithromycin (10 mg/kg body weight per day) was administered concomitantly for 10 days until the fever had subsided as well as vigorous postural drainage. Multiple pneumatoceles were present on the chest roentgenogram taken 14 days after admission (Fig. 1 b). The young patient recovered completely from this acute episode and was discharged with a hospital stay of 22 days. M. pneumoniae pneumonia usually follows a …