The 10-year-old girl was successively infected with mycoplasma pneumonia and influenza A, and the doctor reminded that the child had this condition, and it was best to rest for a week
Chao News client reporter Wu Chaoxiang correspondent Jiang Sheng, Shi Zongying, Zheng Lijie, Huang Linjuan
"My friend's children have been hospitalized and washed their lungs, and the recent wave of the virus is too bad. ”
"Doctor, the child has been having a fever, it can't be mycoplasma pneumonia or influenza A. ”
Recently, respiratory diseases in various places have entered a period of high incidence: common cold, influenza, mycoplasma pneumonia, syncytial virus, etc. are menacing, Chao News reporters visited a number of hospitals in Hangzhou, some hospitals in the fever clinic, one-third of the patients are influenza A; in the pediatric outpatient clinics of some hospitals, many children are treated in one morning are mycoplasma pneumonia superimposed with influenza A.
The 10-year-old girl had a high fever for several days, and the 10-year-old girl was superimposed
Just after 9 a.m. on November 27, in the Pediatric Diagnosis and Treatment Center of the Community Health Service Center of Wenxin Street, Xihu District, Hangzhou, the outpatient number was called to No. 45 on the comprehensive display screen.
The waiting hall was full of parents and children, because it was Monday, most of the children were brought by the elderly, coughing one after another, many children had fever tapes on their foreheads, and there were nebulized children sitting in front of the eight machines in the nebulization room, and there were seven or eight children in the infusion.
"We have been having a fever for the past few days, from 12 o'clock in the middle of the night last night to four or five o'clock in the morning today, we pulled three or four times, and we were taking antipyretics and anti-inflammatory drugs, but it didn't work. A mother with her seven or eight-year-old daughter was chatting with the parents next to her, "This wave is too bad this year, a friend's child of mine was hospitalized for 3 days a few days ago, and his lungs were washed. ”
Pediatric outpatient clinic of Wenxin Community Health Service Center
The little girl wilted, leaning against her mother.
"Recently, there has been a significant increase in the number of children infected with influenza A, bronchitis, mycoplasma pneumonia. Lin Yun, the attending physician of pediatrics, was in the outpatient clinic and did not stop for a moment, "From the outpatient clinic, it is more bronchitis or upper respiratory tract infection. ”
The Chao News reporter roughly counted that of the nine patients who came to the hospital in the morning, two-thirds of the patients had a common cold. Coughing, runny nose, and hoarseness are common characteristics of these children.
"If there is no fever, there is no abnormality in the auscultation of the lungs, or there is no abnormality in the blood picture, and there is no abnormality in the nucleic acid of Mycoplasma pneumoniae, some cough suppressants will be used. If the white blood cells are too high to indicate a bacterial infection, antibiotics are given. Lin Yun said.
The 10-year-old girl, Jingjing (pseudonym), is in a relatively complicated situation: she tested positive for influenza A and Mycoplasma pneumoniae, which means that she has a superposition of influenza A and Mycoplasma pneumoniae.
"I have a fever of 39 degrees, and for a few days, several students in their class have been recruited, and I met my classmates from the same school here just now. Jingjing's grandfather said.
While reporting the information of influenza A in the system, Lin Yun prescribed azithromycin, oseltamivir and Motrin to Jingjing, and instructed her parents, "Just take these three medicines, and don't take anything else for the time being." Azithromycin should be taken for 3 days in a row, and the fever cannot be stopped. ”
There was a slight decrease in patients with mycoplasma pneumonia and an increase in patients with influenza A
An 8-year-old boy, Xiao Tang (not his real name), wore a mask and followed his mother into the consultation room, and then leaned weakly on a chair.
"It didn't stop for three weeks, it was mycoplasma pneumonia before, just for a while, and now I have a high fever. Xiao Tang's mother was a little annoyed, "He had a fever of 39 degrees last Friday, coughed badly, and did nebulization and cephalosporin, but it had no effect." There is a classmate in their class who is a flu, and I think he is too, otherwise he would not have a high fever all the time, but the test result is negative. ”
"Sometimes influenza A may not always be detectable, but based on the epidemiological history and the child's symptoms and signs, oseltamivir should be used first. Lin Yun said.
A 7-year-old boy, Feifei (pseudonym), was infected with mycoplasma pneumonia, and after 3 days of oral azithromycin, he still had fever and cough, and the CT scan of his lungs just made showed inflammation. Lin Yun informed the patient that he would need to be infused for 4 days.
"If you want to hang water for 4 days, will you not be able to go to school again this week? Grandma Feifei said on the side.
"Not only this week, but probably next week. The body is important, and the disease is cured first. Lin Yun explained to Grandma Feifei.
Wenxin Street Community Health Service Center, the child is receiving an infusion
During this time, Lin Yun and her colleagues were particularly busy, "We also sat in the clinic on weekends, and there were more people. Two-thirds of children have the common cold, and during this time, the number of children with mycoplasma pneumonia has actually decreased slightly, but the number of children with influenza A has increased. ”
Wang Jia, director of the Children's Health Center of the Qianjiang Evening News Health Station of Chao News and the Kangqiao Street Community Health Service Center in Gongshu District, Hangzhou, also said that in the past week or so, the number of children with influenza A has increased, and most of them are school-age children. ”
Community health centers can test for mycoplasma pneumonia, influenza, syncytial virus, adenovirus, etc., and generally test symptomatic children for symptomatic treatment.
"Although the number of patients has increased, our ability to receive patients is still okay, and two pediatricians sit in for consultation every day, and during peak periods, we can basically wait for half an hour, and we can see a doctor. "If you encounter a particularly serious disease, such as white lung, we will recommend referral to a higher-level hospital, and at present, there are not many such patients." ”
Chen Junsong, deputy chief physician of the Department of Respiratory Medicine at Hangzhou Children's Hospital, also said that during this period, mycoplasma pneumonia and influenza A had a trend of "one eliminating the other".
"This year's respiratory disease situation is indeed special, in previous years, the incidence of mycoplasma pneumonia began to increase gradually in May and June, but the number of patients will decline in the summer vacation, and this summer has not declined, and in the autumn and winter it collided with influenza A. ”
After discharge from the hospital with mycoplasma pneumonia
It's best to take a week off
Chen Junsong said that although both mycoplasma pneumonia and influenza A will have fever symptoms, there are still some differences between the two, and parents can make some judgments at the early stage.
Generally speaking, influenza A will cause high fever that does not go away, especially in the first two days of the disease, and the child will often have a fever of 39 degrees or even 40 degrees. After taking antipyretics, it will drop to 38 degrees, but after four or five hours, the fever will start again, and some people will take antipyretics three or four times a day.
"Older, expressive children will say muscle aches, fatigue, etc. Chen Junsong said that this is also one of the most obvious differences in symptoms between influenza A and mycoplasma pneumonia.
Children with mycoplasma pneumonia generally have symptoms such as fever and cough, and in severe cases, pleural effusion, lung consolidation, etc., which is called white lung.
"However, the white lung area caused by mycoplasma pneumonia is mostly localized, and it is a small part of the lung such as the upper left or lower right and upper right. Chen Junsong explained that children with white lung need to be hospitalized, which usually takes 5-7 days.
Some time ago, there was a hot search: how long after a child is infected with Mycoplasma pneumoniae can go to school.
In this regard, Chen Junsong suggested that children with mycoplasma pneumonia should rest for one to two weeks after being discharged, after all, there is damage to the lungs, and those with a mild degree can rest for three or four days before going to class, "but in either case, try not to do strenuous exercise within a week or two, such as playing ball, running, skipping rope, etc." It's okay to walk and walk. ”
After being hit by a flu
Don't use medication without permission
It is not only children who are affected by respiratory diseases, but also adults who are "swept in".
In recent days, the number of fever clinics at Sir Run Run Shaw Hospital's Qingchun Campus has increased fivefold.
"One-third of the fever patients are influenza A patients, and most of them are young and middle-aged. Chen Huiying, the head nurse of the fever clinic, said.
Recurrent high fever, cough, and runny nose are also common to adult patients.
"There are not too many adults who have mycoplasma pneumonia, and it is still mainly influenza A. Chen Huiying said.
"Mycoplasma pneumonia is also contagious, and we have also encountered the situation of the whole family in the outpatient clinic, but compared with children, adults may not be so serious after being infected with mycoplasma pneumonia, one is because the immunity of adults is better, and the other is that adults have more choices of medication. Ding Liren, chief physician of the Department of Respiratory Medicine of the Second Affiliated Hospital of Zhejiang University School of Medicine, said that every autumn and winter is a period of high incidence of respiratory diseases, but this year's wave is indeed more violent than in previous years: mycoplasma pneumonia, influenza, adenovirus... "There is a possibility of infection in all ages, but it is still necessary to be vigilant against the old and the young, as well as patients with underlying diseases such as diabetes, malignant tumors, suppressed immune function (such as long-term use of glucocorticoids, organ transplantation and anti-rejection therapy), and patients with lung diseases such as chronic obstructive pulmonary disease." ”
Ding Liren wants to remind everyone that mycoplasma pneumonia has a certain self-limit, if the child is suspected of being infected, the first thing to do is to make a timely and correct diagnosis, the diagnosis depends on the detection of the pathogen, and then the symptomatic medication, "The detection of pathogens includes nucleic acid, antigen and antibody detection, generally speaking, the accuracy of nucleic acid and antigen detection is higher, and the detection of serum antibodies often lags. The most important thing is that no matter what kind of anti-infective drugs are used, they should be used under the guidance of experienced specialists, and one of the biggest tips from this wave of the disease is that we should never abuse antibiotics, because the high resistance rate of mycoplasma to azithromycin has brought great trouble to the treatment of pediatric patients. ”
Chen Junsong also said that in the daily outpatient clinic, some parents will ask whether oseltamivir can prevent influenza A and whether they can give their children self-medication, "Oseltamivir is a prescription drug, or let the doctor judge after going to the hospital." We generally do not recommend giving it to children before they have symptoms. ”
Cough after infection
It usually lasts two or three weeks
In the interview, many doctors mentioned the problem of superimposed infection, does superimposed infection mean that the condition is more serious?
"In the outpatient clinic, mycoplasma pneumonia is superimposed with influenza A, and the course of such children is indeed longer. "Some time ago, Chen Junsong received a seven or eight-year-old child, because of fever to the doctor, after the test was diagnosed with mycoplasma pneumonia, after taking azithromycin for 3 days, the high fever subsided, but two or three days later, the fever began to rise again, the highest fever to 40 degrees, repeatedly, "I suspected that he was infected with influenza A, the test showed that it was, and then he was prescribed oseltamivir, which was quickly controlled, and he was not hospitalized." ”
In Chen Junsong's view, most children with superimposed infections can effectively control their conditions after symptomatic treatment, "Of course, there are also more serious conditions, such as lung consolidation and other situations that require hospitalization." These are in the minority, though. ”
In addition to fever, cough is also the most concerned in this wave of respiratory diseases. Several doctors said that during the consultation, the most anxious thing for parents was the child's repeated cough.
"There is a dry cough, there is also a cough with phlegm, and some children have a persistent cough after the fever has subsided, and the parents are more nervous. Chen Junsong said, "Cough is a symptom, and cough suppressants still need to find the cause of cough, such as whether it is an inflammatory reaction or allergies." ”
In Chen's view, coughing is not necessarily a bad thing, "Sometimes, it is a protective reflex behavior of the human body, excreting secretions from the respiratory tract." ”
In Lin Yun's outpatient clinic that day, there were many children with coughing that did not stop, and she usually prescribed some expectorant and cough medicines to relieve the symptoms.
A cough is also heard in adults.
Ms. Cheng (pseudonym), who is in her 30s, began to have a dry cough and runny nose two weeks ago. ”
"Some coughs are caused by damage to the mucosa of the intact airways after infection, which increases sensitivity to external stimuli. If mycoplasma or the virus is not completely eliminated in time, it can also cause the cough to persist, usually for two or three weeks, and sometimes even longer. Some coughs are related to the dry, cold weather of the season. But if the cough persists for two or three months, or even half a year, then it should be taken seriously. Ding Liren said.
A number of community health service centers in Hangzhou
The number of pediatric visits has increased
As the number of patients for respiratory diseases increases, will I be nervous about seeing a doctor?
A few days ago, a Chao News reporter recently visited the night clinic of Hangzhou Children's Hospital. At 7 o'clock in the evening, many children and parents sat in the waiting area of the fever clinic, calling more than 300 numbers, and the 8 consultation rooms were basically open. At around 7:22 p.m., the number was called to number 306, and one parent said, "There is still number 31 ahead." ”
The only place in the hospital where the queue appeared was the emergency department, where there were more than 10 people.
Fever clinic of Hangzhou Children's Hospital
"Generally, you can see a doctor within half an hour of queuing. Of course, the peak period will be slightly longer. Chen Junsong explained that from 9 a.m. to 10 a.m. every day, there will be more people in the outpatient and emergency department at night, "Parents will come to see a doctor when they get off work and their children are out of school." ”
Previously, in response to some parents' concerns about the lack of diagnosis and treatment capacity of community hospitals, the National Health Commission said that it has asked all localities to give full play to the role of medical alliances, strengthen technical guidance for primary medical and health institutions, and improve the diagnosis and treatment capacity of general infections and the efficiency of severe disease identification and referral.
During the visit, the Chao News reporter found that the number of pediatric outpatient visits in many community health service centers has increased, and many parents still choose to seek medical treatment nearby.
Taking Kangqiao Street Community Health Service Center and Wenxin Street Community Health Service Center as examples, they can perform related tests such as influenza A and mycoplasma pneumonia, as well as lung CT, and can undertake basic diagnosis and treatment services. The pediatric outpatient clinics of both community health centers have recently seen a significant increase in the number of patients, with more than 200 visits per day.
The number of patients in the two pediatric outpatient clinics at the Jiubao Street Community Health Service Center and Lanqiao Station in Shangcheng District of Hangzhou has also increased significantly, with more than 300 patients a day in the two hospitals, more than three times that of the past, and the waiting time for children is generally more than one hour.
"For children who are generally infected, our treatment plan is similar to that of higher-level hospitals, and parents will also feel that going to a big hospital will cause cross-infection if there are too many people. In addition, some parents will come back to the nearest infusion for azithromycin prescribed by a major hospital. Wang Jiajia said.
Depending on the weather conditions, Hangzhou may have a wave of cooling in the future, and Ding Liren said that every winter, when the temperature drops, the incidence of influenza A may be high. Chen Junsong also said that for children, in winter and early spring, syncytial virus may also increase, "Next, it is necessary to take precautions, ventilate frequently, wash hands frequently, and wear masks when entering public places and densely populated areas without ventilation, especially the elderly, children and people with underlying diseases, these hygiene habits must be maintained." ”
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