|
发表于 2015-11-5 11:05:55
|
显示全部楼层
IP:天津
本帖最后由 石桥wshh1975 于 2015-11-5 11:08 编辑
1. 病人可能的诊断是什么?
根据葛主任描述的患者临床症状,倾向于带状疱疹的诊断。
2.出现疱疹表现的疾病有哪些?如何进行鉴别诊断?
根据教科书,带状疱疹需与单纯疱疹鉴别,后者好发于皮肤与黏膜交接处,分布无一定规律,水疱较小易破,疼痛不著,多见于发热(尤其高热)病的过程中,常易复发。偶尔也有与接触性皮炎混淆的,但后者有接触史,皮疹与神经分布无关,自觉烧灼、剧痒,无神经痛。在带状疱疹的前驱期及无疹型带状疱疹中,神经痛显著者易误诊为肋间神经痛、胸膜炎及急性阑尾炎等急腹症,需加注意。
该病例描述的患者症状比较典型,鉴别诊断应该不难
3.该患者发病是否是医院感染?
根据现行的《医院感染诊断标准》,似乎不应诊断为医院感染。
但美国《CDC Definitions of Nosocomial Infections》将带状疱疹归于医院感染
CODE: SST-SKIN
DEFINITION: Skin infections must meet at least one of the following criteria:
Criterion 1: Patient has purulent drainage, pustules, vesicles, or boils.
Criterion 2: Patient has at least two of the following signs or symptoms with no other recognized cause: pain or tenderness, localized swelling, redness, or heat
and at least one of the following:
a. organisms cultured from aspirate or drainage from affected site; if organisms are normal skin flora (e.g.,coagulase negative staphylococci, micrococci, diphtheroids) they must be a pure culture
b. organisms cultured from blood
c. positive antigen test performed on infected tissue or blood (e.g., herpes simplex, varicella zoster, H. influenzae, N. meningitidis)
d. multinucleated giant cells seen on microscopic examination of affected tissue
e. diagnostic single antibody titer (IgM) or fourfold increase in paired sera (IgG) for pathogen.
4. 出现上述表现,作为感控人员,您有何考虑?
我认为首先应对该病区的患者进行调查,看是否存在其他相似病例。
其次应询问该患者既往史,调查是否既往有相似症状发生
如果确定为该患者自身携带,考虑到无免疫力的患者,应采取接触隔离与飞沫隔离措施。 |
评分
-
查看全部评分
|