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男,40岁,农民,突起高热39℃以上,全身酸痛,乏力,食欲不振。当地医院给予青霉素G,氨苄青霉素、链霉素治疗8天无好转,入院前2天出现胸紧、胸痛。既往体健,无咳嗽、吐痰、咯血史。因农事活动常在草丛、森林坐卧休息。 体查:体温39℃,脉搏90次,呼吸25次,血压14.9/9.6kPa。神清,表情淡漠,急性病容,全身皮肤未见皮疹、溃疡及焦痂,双腹股沟淋巴结肿大,如花生米样大小,压痛、活动。颈软,气管左移。右胸肋间隙饱满,增宽,触觉震颤减弱,呼吸音消失。心率90次,律齐,无杂音.腹平软,肝未触及。实验室检查:血、尿、粪常规正常,血小板计数200×10~9/L。肝功能,转氨酶正常,检测HBV5项血清标志物仅HBsAg阳性。外斐反应OX_k1∶320(+),
Male, 40 years old, farmer, fever above 39 ℃, body aches, fatigue, loss of appetite. Local hospital penicillin G, ampicillin, streptomycin 8 days without improvement, 2 days before admission, chest tightness, chest pain. Past physical health, no cough, spit, history of hemoptysis. Due to agricultural activities often in the grass, the forest sit rest. Physical examination: body temperature 39 ℃, pulse 90 times, breathing 25 times, blood pressure 14.9 / 9.6kPa. Shen Qing, apathy, acute illness, no skin rashes, ulcers and eschar, double-breasted lymph nodes, such as peanut-like size, tenderness, activity. Neck soft, tracheal left. Right chest rib space full, widened, twitching tremor weakened, breath sounds disappear. Heart rate 90 times, law Qi, no noise. Abdomen soft, liver not touched. Laboratory tests: blood, urine, normal feces, platelet count 200 × 10 ~ 9 / L. Liver function, transaminase normal, detection of HBV 5 serum markers only HBsAg positive. Outside Fiji reaction OX_k1: 320 (+),