The fever in children did not improve at the beginning of taking medicine, and it may be Mycoplasma pneumoniae infection

Fever in children is mostly related to infection, and if fever persists in children, it is recommended to do M. pneumoniae antibody testing, because Mycoplasma pneumoniae infection is very common. The child in this case came to the clinic with cough and fever, and was clinically diagnosed with upper respiratory tract infection, but the symptoms did not improve after treatment. Later, the diagnosis of Mycoplasma pneumoniae infection was confirmed by relevant examinations, and the treatment regimen was quickly adjusted, that is, intravenous azithromycin was used, combined with nebulized inhalation, etc., the child's body temperature returned to normal, and the cough was significantly relieved.

【Basic Information】Male, 5 years old

【Disease type】Mycoplasma pneumoniae infection (cough + fever)

【Hospital】Children's Hospital of Fudan University

Date of consultation: May 2021

【Treatment plan】Nebulized inhalation + drug therapy (intravenous azithromycin, oral erythromycin, oral azithromycin)

【Treatment period】Outpatient follow-up after 3 days and 2 days of inpatient treatment

【Treatment effect】After 5 days of medication, the child's body temperature was normal, the rales in the lungs disappeared, and the cough was also significantly relieved

1. Initial consultation

The child had a fever for 5 days and a cough that worsened for 2 days.The child began to have a cough 5 days ago and came to our hospital for outpatient treatment, with a body temperature of 38.5°C, no abnormality on abdominal auscultation, peripheral blood leukocytes of 1310^9/L, and was clinically diagnosed as upper respiratory tract infection, and was given comprehensive treatment such as cefdinir anti-infection, antipyretic and cough suppressant for 3 days. However, the child's symptoms did not improve after the medication, the fever continued, the fever reached up to 40 °C yesterday, and the cough worsened in the past 2 days, manifested as irritating dry cough and mild shortness of breath. I came to our hospital again today, and the peripheral blood leukocytes were 1510^9/L in the outpatient clinic, Mycoplasma pneumoniae was weak and positive, and there were small vesicles on the left back auscultation, and the X-ray immediately confirmed the bronchial pneumonia, according to the child's clinical manifestations, auscultation, and combined with the results of laboratory and X-ray, it was considered that the diagnosis of pneumonia was clear, and the pathogen was considered to be Mycoplasma pneumoniae infection.

Second, the treatment process

After the diagnosis of pneumonia was clear, and Mycoplasma pneumoniae infection was considered, the treatment plan was clinically adjusted, cefdinir was discontinued, and azithromycin was used intravenously, and comprehensive treatment such as cough and phlegm reduction and aerosol inhalation was combined. In view of the fact that the child's clinical hyperthermia did not go away and there was a slight manifestation of shortness of breath, the clinical symptoms of the child improved on the second day of medication, the high fever dropped to 38.8 °C, and the cough symptoms were also relieved, the child's body temperature had returned to normal after 3 days of azithromycin administration, the cough was also significantly reduced, and the fine crackles on lung auscultation basically disappeared, and it was recommended that the clinician should take azithromycin for another 2 days after outpatient follow-up.Considering that the current lung inflammation may not have been completely eliminated, it is recommended to continue taking erythromycin at home for 3 days, and then come to the hospital for follow-up after drug treatment with cough and phlegm, and it is recommended to re-examine the X-ray and then evaluate and decide the follow-up treatment plan.

3. Therapeutic effect

The reason why the initial respiratory tract infection treatment effect of cefdinir is not satisfactory is that the causative bacteria of the respiratory tract infection is Mycoplasma pneumoniae, so the infection is not effectively controlled, but the infection spreads to the lungs. After the mycoplasma infection was confirmed by laboratory examination and X-ray confirmation, once the treatment medication was adjusted and azithromycin was given intravenously, the symptoms of pneumonia in the child were significantly improved, and after 5 days of medication, the child's body temperature was normal, the rales in the lungs disappeared, and the cough was also significantly relieved.

4. Precautions

I am glad that the child's condition is under control and the discomfort has improved. It is recommended that during the period of home medication and follow-up, you should follow the doctor's guidance and take regular medication. Keep the room well ventilated, try to eat a nutritious and light diet, ensure adequate sleep every day, and exercise appropriately, but do not go to crowded places to avoid cross-infection.

5. Personal perception

Mycoplasma pneumoniae infection in children can often cause symptoms of fever and dry cough, and the cough at night is significantly aggravated, and some infants and young children can also have shortness of breath and dyspnea. At present, clinical Mycoplasma pneumoniae infection is relatively common, and mycoplasma antibodies may not be able to manifest themselves in the early stage of the disease, which requires doctors to make the right choice according to the clinical situation of the child and the comprehensive analysis of laboratory tests to achieve the goal of cure.