误诊为咳嗽变异型哮喘的支原体肺炎临床分析

Clinical Analysis of Mycoplasmal Pneumonia Misdiagnosed as Cough Variant Asthma

目的 探讨支原体肺炎的临床特点及误诊为咳嗽变异型哮喘的原因及防范措施。方法 对148例支原体肺炎中曾误诊8例的临床资料进行回顾性分析。结果 本组误诊率5.41%。3例因发热伴阵发性咳嗽25~34d,偶感气促和喘息2~5d入院;2例因发热伴持续性干咳、喘息及胸闷、气促15和28d,加重1和3d入院;2例因发热伴阵发性咳嗽、咽痒且有少量白色黏痰1月余,加重3d入院;1例因发热伴咳嗽15d,喘息及胸闷、气促2d入院。8例就诊初期均误诊为咳嗽变异型哮喘。误诊时间7~12d。8例按误诊疾病给予相关治疗7~12d,症状皆未见明显好转,经进一步行肺部、实验室及影像学等检查均确诊为支原体肺炎。8例确诊后给予阿奇霉素治疗16~24d病情均明显好转出院;出院后随访3个月,皆预后良好,未见复发。结论 支原体肺炎缺乏特异性临床症状、体征及影像学表现,易误诊。临床医生应提高对该病重视程度和警惕性,加强对其相关知识学习,并拓展诊断思维,将患者病史、临床表现以及实验室、影像学等检查结果综合起来进行全面分析,以减少或避免支原体肺炎误诊误治。

Objective To analyze clinical characteristics of mycoplasmal pneumonia, causes of misdiagnosis and preventive measures of mycoplasmal pneumonia as cough variant asthma. Methods The clinical data of 8 misdiagnosed children out of 148 patients with mycoplasmal pneumonia were retrospectively analyzed. Results The misdiagnosis rate of this group was 5.41%. Three cases were admitted to our hospital due to fever with paroxysmal cough for 25-34 d, occasional wheezing, and shortness of breath for 2-5 d, respectively. Two cases were admitted to hospital for fever with persistent dry cough, wheezing, chest tightness, and shortness of breath for 15 d and 28 d, which were aggravated for 1 and 3 d, respectively. Two were admitted due to fever with paroxysmal cough, itchy throat and a small amount of white and sticky phlegm for more than 1 month, which was aggravated for 3 d before admission. One case was admitted due to fever with cough for 15 days, as well as wheezing, chest tightness and shortness of breath for 2 d before admission. Eight patients were misdiagnosed as cough variant asthma at initial visit. The duration of misdiagnosis was 7-12 d, Eight patients were treated based on misdiagnosed diseases for 7 to 12 days, and the symptoms were not significantly improved. Mycoplasma pneumonia was diagnosed by pulmonary examination, laboratory and imaging examinations. All children diagnosed with mycoplasmal pneumonia were treated with azithromycin for 16-24 d and discharged after the condition was significantly improved. All patients had a good prognosis at 3-month follow-up after discharge and there was no recurrence. Conclusion Mycoplasma pneumonia is likely to be misdiagnosed due to lack of specific clinical symptoms, signs and imaging manifestations. Conclusion Should increase their vigilance and attention, improve their study and understanding of the knowledge of mycoplasmal pneumonia, and comprehensively analyze the patient's medical history, clinical manifestations, laboratory and imaging results, thereby reducing or avoiding the misdiagnosis and mistreatment of mycoplasmal pneumonia.