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男患,27岁。因发热、微咳、头痛、精神饮食明显变差15天,听力下降2天入院。病前体健。体检:T40℃,P86次/分,R26次/分,Bp14/9kPa。急性重病容,表情淡漠。未见玫瑰疹。心肺正常。肝肋下1.5cm,脾肋下2cm,质软。化验:Hb80g/LWBC4.2×10~9/L,N0.65,L0.35。肝、肾功能正常,血培养(-)。肥达氏反应:H1:640,O1:160。入院诊断:伤寒。给氨苄青霉素抗感染及对症治疗。体温仍波动在39℃左右。入院后第10天,骨髓培养伤寒杆菌生长,氨苄青霉素耐药。入院后第10天腹部移浊(+)。B超发现腹胺3～4cm液平,胸腔2.5～3cm无回声暗区。心包1cm无回声暗
Male suffering, 27 years old. Due to fever, cough, cough, headache, mental diet significantly worse 15 days, hearing loss 2 days admission. Pre-sick body health. Physical examination: T40 ℃, P86 times / min, R26 times / min, Bp14 / 9kPa. Acute serious illness, expression indifferent. No rose rash. Cardiopulmonary normal. Liver ribs 1.5cm, Spleen ribs 2cm, soft. Laboratory: Hb80g / LWBC4.2 × 10 ~ 9 / L, N0.65, L0.35. Liver, kidney function is normal, blood culture (-). Widal response: H1: 640, O1: 160. Admission diagnosis: typhoid fever. To ampicillin anti-infective and symptomatic treatment. Body temperature is still fluctuating around 39 ℃. 10 days after admission, the growth of Salmonella typhi cultured marrow, ampicillin resistance. On the 10th day after admission, the abdomen moved to the left (+). B-found abdominal amine 3 ~ 4cm level, chest 2.5 ~ 3cm no echo dark area. Pericardial 1cm dark echoless