Pneumococcal pneumonia

Pneumococcal pneumoniaPneumococcal pneumonia (pneumococcal pneumonia) is the pneumococcal or Streptococcus pneumoniae (streptococcus pneuoncae) caused by, or hospital-acquired pneumonia in more than half. Lobe of a lung or acute inflammation is changed, with a shiver, high fever, chest pain, coughing and Xue Tan, and other symptoms. In recent years due to the extensive application of antibacterial drugs, mild or no clinical disease is more typical多见.

Pneumococcal for Gram-positive cocci, often in pairs (Streptococcus pneumoniae) or with a chain (Streptococcus pneumoniae), the cell outside the capsule, the polysaccharide capsule of a specific antigen, according to the serum tests are now known to have 86 subtypes. Pathogens and more adults are 1-9 and 12, section 3 of the most toxic, and children for 6,14,19, and 23 type. These bacteria for upper respiratory tract normal flora, only when the immunity when Fangshi reduce pathogens. A small part of bacteremia, or septic shock, if not timely appropriate treatment, can lead to death.

Pneumococcal sputum can survive in dry months, but direct sunlight 1 h, or heated to 52 ℃ 10 min, to sterilization, such as disinfectant on the phenols also very sensitive.

Incidence in winter and early spring for many, and this epidemic of respiratory tract infection have a certain relationship. Patients often as the original healthy young adults and elderly people and infants, men see more, the majority of patients to have mild upper respiratory tract infection, or Shouhan, drunkenness or the history of general anesthesia, respiratory function impairment defense, bacteria are inhaled Lower respiratory tract, in the alveolar breeding. Smokers, dementia, congestive heart failure, patients with chronic diseases, chronic bronchitis Yan, bronchiectasis, and immune deficiency patients are vulnerable to pneumococcal invasive. Pneumococcal not produce toxins, not primary cause necrosis or a hollow; its pathogenicity is due to contain polymer polysaccharide capsule of the invasion of the organization, the first cause pulmonary edema wall, rapidly emerging WBC and RBC seepage Out, the bacteria by Cohn's effusion hole to the central part of the lung proliferation, spread and even a few paragraphs or entire lung lobe, because of lung disease at the beginning of the week, it leaves a clear delineation between, and easy pleural involvement. Pathological changes have congestive period, the red variable period of the liver, liver variable period of ash and dispersed phase. Lung congestion and edema, pulmonary effusion in the pulp and red, leukocyte infiltration, swallowed up by bacteria, then fibrin exudation of dissolution, absorption, alveolar re-inflated. In fact four pathological stage there is no absolute boundaries, the use of antibiotics in the circumstances, this typical pathological stage has been rare. Lung lesions disappeared after the organizational structure have no damage, leaving scars fiber. A few patients with alveolar fibrin not fully absorbed, and even successful fiber cells, the formation of organizing pneumonia. The elderly and infants can be along the bronchial infection distribution (bronchial pneumonia). If no timely use of antibiotics, 5% -10% with empyema, 15% -20% of the lymphatic bacterial chest catheter into the blood circulation, the formation of lung infection (pleurisy, arthritis, pericarditis, endocarditis, peritonitis , Otitis media, and so on.

Patients often Shoulianglinyu, fatigue, drunkenness, mental stimulation, the virus infection, half of the cases of several upper respiratory tract infection symptoms of a pioneer. More Jizhou onset, high fever, with half shiver, the temperature can soar to within a few hours 39-40 ℃, the peak in the afternoon or evening, but also missed a hot, and the pulse rate parallel. Patients with flu general muscle soreness, chest pain side, radiation to shoulder, abdomen, deep breathing, coughing or aggravated. Sputum less, with Blood-streaked phlegm or a rust color. Weina a sharp drop, sometimes nausea, vomiting, abdominal pain or diarrhea, and sometimes misdiagnosed as acute abdomen.

Patients with a sudden illness capacity, cheek Crimson, dry skin. Zhou mouth and nose appeared herpes simplex. When extensive pneumonia, ventilation / reduce the proportion of blood, there hypoxemia, the performance for the short breath, cyanosis, septicemia, skin and mucous membranes may have bleeding; sclera with yellow; neck has prompted resistance may be involved meninges. By fast heart rate, sometimes arrhythmia. No obvious signs of early lung abnormalities, only thoracic respiration rate decreased slightly higher turbidity, respiratory pleural friction-reducing and sound. And when it changed the typical signs, such as call-Cloud, language and bronchial respiratory chatter enhance the sound. Disperse period can be heard and wet-La, can be associated with severe intestinal Flatulence, upper abdominal tenderness may be involved because of inflammation phrenic Extrapleural weeks. Serious infections can be associated with shock, disseminated intravascular coagulation, adult respiratory distress syndrome and neurological symptoms such as blurred consciousness, irritability, lethargy, delirium, coma, etc., should be closely observed, positive treatment.

When the body of the capsule antigen to generate sufficient specific antibody, a combination of both, in complement participation is conducive to swallow the bacteria cells to swallow. The first incidence 5-10 days, fever can be dropped or to gradually subside. The use of effective antibiotics in body temperature can return to normal within 1-3 days, the patient Dunjue symptoms disappear, gradually recover.

Blood white blood cell count in the majority of 10-30 × 109 / L, neutrophil and more in more than 80 percent, and the left or the toxicity of particles within the cytoplasm that, the frail elderly, alcoholism, the lower the immune white blood cell count often Not higher, but neutrophil percentage still high. In the use of antibiotics before the blood culture, 20 percent can be positive. Sputum smears a large number of neutrophils and gram-positive cocci in pairs or short chain, the cells are more meaningful. Sputum culture in the 24-48 h can be identified pathogen. Polymerase chain reaction (PCR) testing and fluorescent antibody test can improve the diagnosis rate of pathogen. Sputum samples in order to avoid pollution, in mouthwash after the acquisition of deep expectoration, the Anti-brush or bronchoscopy with BALF samples can be sensitive detection of bacteria, but not for conventional methods.

[X-check]

Early saw Fei Wenli thickening of the pulmonary or involvement, the lobe slightly fuzzy. In recent years the typical large-leaved see real change has been less, because of a pulmonary inflammatory exudation of the change is visible in the shadow of bronchial airway levy. Rib diaphragm Kok pleural effusion can be a small amount of the levy. In pneumonia dispersed period, X-ray showed that inflammatory infiltration gradually absorbed, the film can block absorption region earlier, showing "false empty" sign. Most cases in 3-4 weeks after the onset completely dissipated. Lesion slower to disperse the elderly, may also organizing pneumonia.

Are typical symptoms and signs of the case, then the chest X-ray examination, it is not difficult diagnosis. Early signs of pneumonia disease was not obvious, the elderly and child care patients, as well as secondary to other diseases, clinical manifestations often not typical, the disease can be confused with the following:

First, cheese pneumonia

Acute pneumonia and tuberculosis clinical manifestation and pneumococcal pneumonia similar, X-ray lung is also changed, but TB often low heat fatigue, tuberculosis can be found in sputum. X-ray showed that lesions in more than Feijian or collarbone from top to bottom, uneven density, lasting dispersed, and can form empty the lungs and disseminated. And pneumococcal pneumonia as penicillin treatment of 3-5 days, a return to more normal body temperature, lung inflammation faster absorption.

Second, other pathogens with the pneumonia

Staphylococcus aureus and Klebsiella pneumoniae pneumonia than those in serious clinical manifestations. Gram-negative bacteria more common in frail pneumonia, chronic heart and lung disease or immune deficiency patients, the hospital for more than secondary infection. Sputum and (or) the bacteria positive blood culture is an indispensable basis for the diagnosis. Mycoplasma pneumonia virus, and generally less severe diseases, interleukin often no significant increase in clinical process, the blood and sputum pathogens isolated immunological test in the diagnosis is important.

Third, acute lung abscess

Early clinical manifestation and pneumococcal pneumonia similar. But with the development of the course, a lot septic smell the characteristics of sputum for lung abscess, a pathogen Staphylococcus aureus, Klebsiella and other gram-negative bacteria, and anaerobes. X-ray showed that Vomica and fluid levels, make it easier identification.

4, lung cancer

A small number of peripheral lung cancer X-ray image Posi lung inflammation. But the general did not only low heat or fever, peripheral blood white blood cell count is not high, the sputum may find cancer diagnosis. Lung cancer can be associated with obstructive pneumonia, the inflammation dissipated after antibiotic treatment, tumor shadow of the increasing significantly, or associated with hilar lymph nodes, atelectasis. For the effective antibiotic treatment of inflammatory Jiubu dispersed, or dispersed after rehabilitation there, especially older patients, attention should be paid to observe, and sometimes take X-X-radiography, CT, MRI examination of sputum cells and fiber-shedding Examination so as to avoid delay diagnosis.

5, other diseases

With chest pain, pneumonia, pleurisy to be with exudative, pulmonary infarction differential. Pleural effusion signs and X-ray has its characteristics. Pulmonary infarction have formed the basis of venous thrombosis, hemoptysis see more, a little mouth herpes. Sometimes under the belly of pneumonia symptoms, should be X-ray and other inspection and subphrenic abscess, cholecystitis, pancreatitis and appendicitis, and so were identified.