以消化系统症状为首发表现的儿童肺炎支原体肺炎六例临床误诊分析

Clinical Misdiagnosis of Mycoplasma Pneumoniae Pneumonia in Six Chil⁃dren with Digestive System Symptoms as the Initial Manifestation

目的 探讨以消化系统症状为首发表现的儿童肺炎支原体肺炎误诊原因及防范措施。方法 对2022年11月至2024年4月收治的以消化系统症状为首发表现的儿童肺炎支原体肺炎6例的病例资料行回顾分析。结果 6例患儿因腹痛、腹泻、发热伴恶心2~4 d入院,早期均误诊为急性肠胃炎。经对症治疗后症状无明显好转,后经复查胸部X线、血清特异性抗体检查确诊为肺炎支原体肺炎,误诊时间为4~11 d。确诊后予阿奇霉素静脉滴注等治疗,症状均明显好转出院。出院后随访1~3个月,所有患儿预后良好。结论 儿童肺炎支原体肺炎临床症状及肺部体征缺乏特异性,当患儿以肺外症状为首发表现就诊时,有发生误诊的可能;临床医生应加强对儿童肺炎支原体肺炎的警惕性和认识,开拓诊断思维,认真鉴别诊断,对疑似病例及早行血清特异性抗体检查或多次复查X线胸片,以减少或避免本病误诊情况的发生。

Objective To investigate the causes and preventive measures of misdiagnosis of mycoplasma pneumoniae pneumonia(MPP)in children with digestive system symptoms as the initial manifestation.Methods The case data of 6 children with MPP with digestive system symptoms as the initial manifestation treated from November 2022 to April 2024 were retrospectively analyzed.Results Six patients were admitted to hospital with abdominal pain,diarrhea,fever,and nausea for 2-4 d,and were misdiagnosed as acute gastroenteritis in the early stage.After symptomatic treatment,the symptoms did not improve significantly.After reexamination,chest X-ray and serum specific antibody examination confirmed MPP.The misdiagnosis lasted 4-11 d.After the diagnosis and treatment with intravenous infusion of Azithromycin,symptoms were significantly improved and the patient was discharged.All patients were followed up for 1-3 months after discharge,and the prognosis was good.Conclusion The clinical symptoms and pulmonary signs of MPP in children are lack of specificity.When children present with extrapulmonary symptoms as the initial manifestations,there is a possibility of misdiagnosis.Clinicians should strengthen the vigilance and knowledge of MPP in children,develop diagnostic thinking,carefully perform differential diagnosis,and conduct serum specific antibody examination for suspected cases as early as possible or multiple reviews of chest X-ray,to reduce or avoid the occurrence of misdiagnosis of the disease.