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Case Report

Case Report. Ji n-fu Xu. 病史资料. Introduction of case. Female , 39 ys, staff of a supermarket Chief Complaint : F ever for 3 weeks , with cough for more than 1 week History of present illness ：

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Case Report

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  1. Case Report Jin-fu Xu

  2. 病史资料 Introduction of case • Female, 39 ys, staff of a supermarket • Chief Complaint: Fever for 3 weeks, with cough for more than 1 week • History of present illness： • the patient had high fever for 3 weeks before admitting to the hospital, body temperature reached 39 to 40 degree Celsius. • No cough, sputum, hemoptysis, chest pain, polypnea, night sweat, anorexia, asthenia and so on. • Received anti-infection therapy for one week, the patient's body temperature became normal, so she doesn't accept further treatments.

  3. One week later, the patient got fever again, the temperature is 38 to 40°C， mainlyhad fever in the afternoon, with night sweat, asthenia，productive cough with white sputum. • No yellow sputum, no hemoptysis and so on. • Chest X-ray shows “spot lesion in the left lung”，received anti-infection for a week with Levofloxacin+Cefuroxime, Azithromycin +Piperacillin Sodium and Sulbactam Sodium for Injection one by one，but the symdrone still exist. • Blood G test: 38.44pg/ml (cut-offvalue: 20) • Admitted to our department

  4. Medical history： Operation for ovarian cyst in 1995 Operation for ectopic pregnancy on Sep 2010

  5. 体检 PHYSICAL EXAMINATION • T: 38.5°C; P: 110 bpm; R: 25bpm; BP:120/62mmHg. • Acute sickly appearance, general status is good, Normal growth, nutrition and consciousness. • Lung auscultationshowed that breath is heavy, a little moist rale in the lower of both lungs. No abnormal finding on heart, abdomen and limbs

  6. LAB EXAMINATION

  7. Preliminary diagnosis？ • lung cancer • pneumonia • fungus infection • Pulmonary vascular inflammatorydiseases • tuberculosis • inflammatory pseudotumor • cryptogenic organizing pneumonia ……… Next step

  8. Day 0： • PIPERACILLIN SODIUM AND TAZOBACTAM SODIUM 3.375 bid • Isepamicin 0.4 qd • Day 3： • PIPERACILLIN SODIUM AND TAZOBACTAM SODIUM 3.375 q8h • Levofloxacin 0.5 qd Day 5 of admitting, the patient still had high fever, Tmax:40°C，a little cough and sputum. • blood culture • lung puncture • 18F-FDG lung scanning • bronchoscope

  9. Results of further examination • Lung puncture: inflammatory cell and epithelium • Blood Tumour landmark: CA50,double normal value • lung 18F-FDG scan：lower lobe of left lung had high unusual radioactivity concentration focus，possibly cancer; both hilus of the lung and mediastinumlymph nodeshow no concentration focus. • alergen detection：total IgE 109ku/L，ECP 21.8ug/L • Aspergillus fumigatus GM test: negative • latex agglutination test：negative • Blood parasiteantibody: negative • Rheumatoid immune antibodies：Negative

  10. ？

  11. Diagnosis ? • lung cancer • pneumonia • fungus infection • tuberculorsis • COP • others？

  12. Mar 15thBlood culture positive：Leuconostoc mesenteroids

  13. Diagnosis • Community acqired pneumonia CURB-65 score: 1 PSI score: 94,class IV • Sepsis

  14. Follow-up • From Mar 16th the patient’s temperature began to decrease • anti-infection therapy continued • Till Mar 20th temperature return to normal • Follow-up visit: blood culturenegative • Mass in the lung absorbed

  15. Mar 22th 2 weeks after admitting

  16. Apr 13th anti-infection for 4 weeks

  17. Discussion

  18. 1. CAP withPositive result of blood culture • CAPinclude • No pathogen detect • sputum culture (+) • blood culture:（+） • blood culture (+) and sputum culture (+), with the same bacteria strain • There are 20%～30% blood culture positive ofstreptococcus pneumonia in children Resti M, et al. Clin Infect Dis. 2010;51(9):1042-9.

  19. Retrospective analysis of CAP patient whose blood culture were positive in 2 years • 74/1805CAP patients' blood culture: Micrococcus pneumoniae (+) • Blood culture results can guide the chosen of antibiotics • The economy/efficiency rate of blood culture is high in CAP patients

  20. Editorial • Blood culture should be sent routinely for CAP patients • Sent 2 sets of blood culture before using antibiotics • Even though the age of cutting down the medical cost, sent it insistently

  21. Catch the chance of blood culture 王辉，肺部感染病原学诊断

  22. 2. About Leuconostoc mesenteroids

  23. Leuconostoc mesenteroids • Epiphytic bacteria that are wide spread in the natural environment • Play an important role in several industrial and food fermentations.  • A facultative anaerobe requiring complex growth factors and amino acids

  24. 61ys, female, sarcoidosis, coma suddenly • History of took prednisone for long-term • MRI showed: encephalon focus • Tissue culture showed positive after biopsy of surgery • Recovered by anti-infection

  25. Ectopia of the normal flora cause pathogenic changes

  26. 3. About treatment

  27. Why the role of primary anti-infection therapy is poor？ • Have fever for one month, although receiving several antibiotics therapy. • Pneumonia with Sepsis • Antibiotics’ PK/PD

  28. Adjust the using of antibiotic antibiotic antibiotic Temperature dropped admission

  29. Curve of Pharmacokinetics and pharmacodynamics

  30. jfxucn@gmail.com Thanks for your attention!

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