tsutsugamushi pneumonia
Introduction
Introduction to tsutsugamushi pneumonia Ascariasis is a systemic infectious disease caused by rickettsia, often invading the lungs and causing pneumonia and other diseases. Outdoor activities are bitten and infected with rickettsia, and Rickettsia is a unique class of microorganisms between the smallest bacteria and viruses. Further, caused by systemic infectious diseases, the lung is one of the organs often invaded by tsutsugamushi, causing diseases such as pneumonia. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: bite spread. Complications: diffuse intravascular coagulation Myocarditis Pneumonia
Cause
The cause of tsutsugamushi pneumonia
Causes:
People who are outdoors are bitten and infected with rickettsia. The lungs are one of the organs that are often violated by tsutsugamushi.
Pathogenesis:
Rickettsia first reproduces in damaged skin, forming local skin lesions, with special ulcers and crusting, which in turn invade the blood and lymphatic system, forming rickettsial blood, in vascular endothelial cells and monocyte-macrophages The system grows and reproduces, produces toxins, causes extensive small vasculitis, perivascular inflammation and thrombosis. Toxemia can cause dysfunction and disease in various organs of the body, and even cause multiple organ failure, which can be manifested in the lungs. For interstitial pneumonia, there may also be alveolitis, bronchitis, pleural effusion and other manifestations.
Prevention
Ascariasis pneumonia prevention
1. Eliminate the source of infection: mainly to kill rats, should mobilize the masses, take comprehensive measures, can use a variety of mousetraps, combined with drug rodent control, commonly used drugs are zinc phosphide, safe and enemy mice.
2. Cut off the transmission route: eradicate weeds, and transform the environment is the most fundamental measure. It should be combined with the patriotic health movement, composting, and application of biogas to eliminate the breeding grounds. When working in the wild areas, eradicate or incinerate the surrounding areas. Weeds within a radius of 50 m, then spray 1% to 2% dichlorvos or 0.1% malathion, 20 to 25 ml/m2.
3. Personal protection: Avoid sitting, lying, drying clothes, preventing cockroach larvae biting in the disease season, working in the wild area, production labor, military training and other activities, you must tighten the cuffs, neckline and trousers Apply anti-insecticides such as dimethyl phthalate, diphenyl phthalate or benzyl benzoate to the cuffs and neckline.
At present, there is no tsutsugamushi vaccine available for use, and the inactivated vaccine is ineffective. The live attenuated vaccine has not reached the safety limit. Preliminary studies have shown that the mitochondrial rickettsia has a strong immunological immunity of 56000 membrane protein antigen. Originally, the gene encoding the protein has been successfully expressed in E. coli, and whether it can be used as a vaccine remains to be further studied.
Complication
Ascariasis pneumonia complications Complications, diffuse intravascular coagulation, myocarditis, pneumonia
Ascariasis combined with disseminated intravascular coagulation, toxic encephalopathy, toxic myocarditis and pneumonia, can be complicated by multiple organ failure.
Symptom
Symptoms of tsutsugamushi pneumonia Common symptoms Dyspnea, lung snoring, snoring, respiratory failure, pleural effusion, pericardial effusion
The lungs of tsutsugamushi have various manifestations. Among the 31 cases of sputum, there are 20 cases of cough, most of which are light cough, 16 cases of cough, mostly a small amount of phlegm, 7 cases of dyspnea, 4 cases of bun, and lung sputum. There were 15 cases of sound, including 14 cases of wet voice, 1 case of dry and wet sound, and 4 cases of hemoptysis in Zeng's report.
From the chest radiograph to the type and extent of the lesion, in the 30 cases of the sputum, 14 cases of double interstitial inflammation were changed (1 case with oblique fissure thickening, 1 case with double rib angle became blunt), unilateral pneumonia changes 7 cases (3 cases involving the pleura), 9 cases of bilateral pneumonia (3 cases involving the pleura), 1 case of chest CT examination of the double lower lung flocculent blur, 41 cases of Zeng's double lung texture roughened, and There were diffuse or localized infiltration of the two lungs, with two lower lungs, the lesions were cloud-like, the density was evenly shadowed, the rib angle of one side was blunt 3 cases, the middle pleural effusion was 1 case, and the pericardial effusion was 1 case.
It is necessary to point out that the degree of lung damage in tsutsugamushi disease is very different. Some patients only judge lung damage from the chest radiograph, and there is no corresponding symptom. For example, in 2 cases reported by Wu, there are reports like Lis report. In 2 cases, respiratory failure occurred after 1 week of hyperthermia, and the partial pressure of blood oxygen was 5.6 kPa (42 mmHg) and 4.7 kPa (35 mmHg), which was cured by artificial adjuvant therapy.
Examine
Examination of tsutsugamushi pneumonia
The peripheral blood leukocytes of patients were decreased. In 41 cases of Zeng's, white blood cells (4.3 ~ 9.6) × 109 / L, 27 cases, more than 4.0 × 109 / L of 6 cases, the lowest value was 1.65 × 109 / L, (12.4 ~ 24.2) × 109 / L, that is, only 8 cases of elevated white blood cells.
Pathogens are found as the basis for diagnosis. The methods are as follows:
1 mouse test: inoculated with the patient's blood in the mouse, from the liver, spleen and peritoneum of the dead animal, and then stained with Giemsa to find rickettsia in monocytes; also directly from the blood of patients with high fever Pathogens were found in the middle (by Markov staining).
2 Serological examination; the exogenous test titer increased from 1:160 to 1:1280.
From the chest X-ray, the type and extent of the lesion were seen. In the 30 cases of the sputum, 14 cases of double interstitial inflammation were changed (1 case with oblique fissure thickening and 1 case with double rib angle), one side Pneumonia changed in 7 cases (including 3 cases of pleura), and bilateral pneumonia changed in 9 cases (including 3 cases of pleura).
One of the chest CT scans was a double-lung lung flocculent shadow. The 41 cases of Zeng's lungs were thickened and blurred, and there were diffuse or localized infiltration of the two lungs. It is cloud-like and has a uniform density of shadows.
Diagnosis
Diagnosis and identification of scrub typhus pneumonia
Diagnostic criteria:
1 There is a history of contact with grass in the wild.
2 high fever with characteristic ulcers and eschar.
3 lymph nodes, rash.
4 Wai Fei test (Weil-Felix) 1:160 or more, with 3 items to diagnose.
Diagnose based on:
1 confirmed tsutsugamushi disease.
2 Excluding lung damage caused by other diseases.
3 have chest X-ray damage performance and / or pleural effusion.
4 with cough, cough, difficulty breathing, lung voice, cyanosis, respiratory failure and other performance, must have the first three items, may be accompanied by the fourth item.
From the experience of the above-mentioned cases of Wu, the chest radiograph should be used as a routine examination to find the lungs of patients with no respiratory symptoms.
Patients who are suspected of having this disease should pay close attention to finding eschar or ulcers, which are located near the swollen, tender lymph nodes.
Laboratory inspection:
Proteus OXk agglutination test is positive, agglutination titer equal to or greater than 1:160 can help diagnosis, but a small number of patients can always be negative, so this test can not rule out the disease, if necessary, can be used for intraperitoneal inoculation in mice, should be Other specific laboratory tests, such as complement fixation test, immunofluorescence test, dot immunoassay ELISA, PCR, etc., to confirm the diagnosis.
Treatment response:
If the patient is highly suspected clinically and cannot be diagnosed by experimental methods, chloramphenicol or tetracycline may be used for treatment. If the patient's body temperature returns to normal within 24 to 48 hours after starting treatment, the disease may be used as the disease. clinical diagnosis.
