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患儿男,19天,因“发热、气促1天”入院,系第3胎第3产,胎龄37周顺产。患儿居住于山脚下,老鼠活动猖獗。其母分娩当日发热,体温最高40.3℃,分娩后仍反复发热,分娩后第6天查恙虫病抗体(间接免疫荧光法)阳性,确诊恙虫病,予口服强力霉素治疗1天后体温降至正常,治疗7天痊愈。入院前1天患儿出现发热,体温39～39.7℃,气促,偶有咳嗽。入院查体:T38.4℃,HR170次/min,R62次/min,BP67/34mmHg;全身皮肤花斑状,穿刺抽血部位不易止血,易激惹,前囟张力稍高,颈部抵抗感,全身浅表淋巴结未及肿大,吸气性三凹征(+),双肺呼吸音粗,可闻及湿啰音穆士欤囊?钝,律齐,心前区闻及Ⅱ/6级杂音。腹稍隆,肝肋下
Children male, 19 days, due to “fever, shortness of breath 1 day ” admission, Department of the third birth of the third child, gestational age 37 weeks of birth. Children living in the foothills, rampant rat activity. The mother of childbirth on the day of fever, body temperature up to 40.3 ℃, repeated fever after childbirth, check the first 6 days after delivery check tsutsugamushi antibody (indirect immunofluorescence) positive diagnosis of tsutsugamushi disease, to oral doxycycline 1 day after treatment to normal body temperature , Cured 7 days treatment. 1 day before admission, children with fever, body temperature 39 ~ 39.7 ℃, shortness of breath, occasional cough. Admission examination: T38.4 ℃, HR170 times / min, R62 times / min, BP67 / 34mmHg; systemic skin piebald, puncture blood is not easy to stop the bleeding site, irritability, slightly higher anterior fontanelle, neck resistance, Systemic superficial lymph nodes less than enlargement, suction three recess sign (+), lung breath sounds crude, can be heard and wet rales Mu Shi 欤 capsule? Blunt, law Qi, heart area before and Ⅱ / 6 level noise. Abdomen slightly longer, liver ribs