Pulmonary fungal disease
Introduction
Introduction to pulmonary fungal disease Deep pulmonary fungal infections are often due to the inhalation of dust from various fungal spores, and their incidence is significantly increased due to the frequent use of broad-spectrum antibiotics, antimetabolite cytotoxic drugs, immunosuppressants, and hormones. Actinomycetes and Candida exist in the oral cavity and upper respiratory tract of normal people. If the oral hygiene is poor, the body's resistance is low, and it can invade the lungs and cause infection. basic knowledge The proportion of illness: 0.006% Susceptible people: no special people Mode of infection: respiratory infection Complications: lung abscess
Cause
Cause of pulmonary fungal disease
(1) Causes of the disease
There are three ways to infect pulmonary fungal diseases:
1 Endogenous: For example, actinomycetes and Candida exist in the oral cavity and upper respiratory tract of normal people. If the oral hygiene is poor, the body has low resistance and can invade the lungs to cause infection.
2 Exogenous: Inhalation of dust with fungal spores, such as cardiosis, aspergillosis and cryptococcosis.
3 secondary: fungal diseases in other parts of the body are spread to the lungs through the blood or lymphatic system, and the lesions under the armpits can also spread directly to the lungs, such as actinomycosis.
(two) pathogenesis
Fungi are widely found in nature. Spores fly with dust and are easy to inhale into the respiratory tract. Fungi are also present when the respiratory tract is normal. Therefore, sputum or secretions are taken for smear or culture. The fungi found may not be pathogenic bacteria, and patients may be at the same time or It is often mixed with bacterial viruses and other infections. The clinical manifestations are complicated and easily misdiagnosed or missed. The actual work is often based on the factors of opportunistic infection: long-term use of broad-spectrum antibiotics, immunosuppressants, anticancer drugs, etc., cannot be completely diagnosed in other diagnoses. The fungal infection is thought of when the patient's condition is explained. The fungal infection occurs after the fungus invades the lung. The basic pathological changes are coagulative necrosis, cell infiltration and suppuration, chronic infection, pulmonary fibrosis or granuloma formation.
Prevention
Pulmonary fungal disease prevention
(1) There is a history of pneumonia but the evolution is not typical. The correct use of antibiotics is not effective.
(2) Old and infirm, especially lung infections caused by the extensive use of antibiotics, glucocorticoids or cytotoxic drugs.
(3) X-ray showed flaky shadows of the two middle and lower lungs, and no absorption was improved after treatment.
(4) Typical thrush, sputum is milky white or grayish white, viscous and transparent like jelly, should pay attention to L. candida infection.
Complication
Pulmonary fungal disease complications Complications lung abscess
General pneumonia, lung abscess
Symptom
Symptoms of pulmonary fungal disease Common symptoms Cough, vomiting blood, chest pain, abscess, hemoptysis
Common types of pulmonary fungal diseases:
1. Lung actinomycosis actinomycosis is a chronic suppurative granuloma caused by actinomycetes of Israel. Actinomycetes are anaerobic filamentous bacteria, and mycelium is aggregated to a size of 1 to 2 mm. The so-called "sulphur" particles in white, which is a characteristic of the disease, the particles appear in the tissues of the pus, sputum or sacral wall, which is a reliable basis for the diagnosis of the disease, and the actinomycetes have long been classified into fungal diseases. Bacteria have bacterial characteristics, sensitive to penicillin treatment, can also be included in bacterial diseases, the disease is distributed throughout the world, more common among farmers, Israeli actinomycetes parasitize the oral mucosa of normal people, around the molars, tonsil crypt and colon Waiting for the disease, such as poor oral hygiene, or when the tooth is extracted from the trauma, oral bacterial infection, can be followed by the transmission of nematode infection, and spread to the face, neck, the formation of fistula, lung infection is caused by inhalation of oral pollutants Lung actinomycosis is rare, accounting for about 15%; facial and neck lesions account for more than 50%, and there is a lump in the neck of the jaw, which then forms an abscess and breaks into a sinus; abdominal actinomycosis accounts for about 25 %, often formed in the ileocecal area Block, actinomycetes can cause bronchial pneumonia, granuloma and connective tissue hyperplasia, formation of abscesses and softening lesions, or scar fibrotic mass, such as invasion of the pleura, pleural effusion or empyema, invasion of the chest wall can form chest wall abscess and fistula .
Lung actinomycosis is slow onset, early symptoms are not obvious, can present low fever, cough, chest pain, a small amount of mucous sputum, like general bronchial pneumonia, when the lung abscess is formed, there is high fever, cough and sputum, blood stasis or hemoptysis, When there is pleurisy or empyema, the chest wears liquid or pus, invading the chest wall, local lumps appear, there is tenderness, and the sinus is formed after the piercing, the surrounding tissue is hard, the pigment is deepened, and the chest X-ray performance is non-specific. Sexual, flaky nodular inflammatory infiltration or lung consolidation, granulation formation of block shadows, and even the formation of cavities, rib destruction can be seen when the chest wall is invaded, lung actinomycosis is rare, the diagnosis is mainly Depending on the sulphur particles found in the sputum or pus, the anaerobic culture and pathological examination of the lesions revealed a clear diagnosis of the actinomycetes.
2. Pulmonary aspergillosis Aspergillosis is widely distributed in nature, soil, plants, air, normal human respiratory tract, skin, external auditory canal, etc. can also find Aspergillus, generally not pathogenic, most of the pathogenic bacteria are smoked Aspergillus, a few black, white and small Aspergillus, this disease is secondary to bronchial cysts, bronchiectasis, pneumoconiosis, sarcoidosis and lung abscess, etc., the incidence is related to occupation, such as poultry breeding, winemaking, etc. There are three types of clinical Aspergillus infections:
1 allergic reaction type: such as Aspergillus bronchopneumonia, etc., allergic people inhaled a large number of spores, asthma within a few hours, low fever, cough and phlegm, chest X-ray examination showed migratory infiltration, after dissociation symptoms in 3 ~ After 10 days, it subsided by itself. The hormones were used to treat the lung lesions and disappeared rapidly. The re-exposure could occur again. After the recurrent episode, pulmonary fibrosis, bronchiectasis, emphysema, etc.
2 septic type: manifested as necrotizing bronchopneumonia, hemorrhagic infarction, abscess formation and hematogenous dissemination, etc., more common in long-term application of broad-spectrum antibiotics, hormones, immunosuppressive agents and organ transplant patients, such as advanced patients with tumors or leukemia, The prognosis is serious,
3 parasitic: that is, aspergilloma, a secondary lesion, existing in old tuberculous cavity, bronchodilated cyst, cyst after fluid discharge and blind end of bronchial stump after pneumonectomy, reported in recent years, It may be related to the extensive application of broad-spectrum antibiotics, and the examination of excised specimens is more detailed. The rounded mass formed by the mycelium of the mycelium is limited, and the development is slow. It may exist for several years. The symptoms are cough, hemoptysis, chest pain, low fever, etc. More often than the primary disease is not easy to distinguish, hemoptysis may be large, and a small amount of hemoptysis may persist for a long time, and even the patient has been in bed to dare not move, the cause of hemoptysis is unknown, some people think that there is a rich blood vessel in the sac of the fungal infection The fungus ball is active again, the friction is easy to cause bleeding, and the X-ray examination of the fungal ball is characteristic. The semilunar translucent area can be seen in the cystic cavity, which changes with the body position and remains at the highest position of the body position during the filming.
3. Nocardia infection of Nocardia is a chronic infection of the lung caused by Nocardia. Nocardia is positive for Gram staining, aerobic filamentous bacteria, and hyphae can be wound into a mass to form a similar The granules of nematodes, which are widely distributed in nature and livestock, are parasitic, and occasionally exist in healthy human bodies. If they are found by sputum or bronchoscopy, if they are found to be parasitic, If there is such a bacteria in the thoracic pericardial cavity or in the excised specimen, it should be diagnosed as Nocardia infection, Nocardia is primary in the lung, pathological changes are suppurative infection, abscess, granuloma, etc., malignant tumor, organ transplantation, Long-term application of adrenal cortical hormone, immunosuppressive agents, anti-cancer drugs cause immune dysfunction of the body, when the resistance is low, Nocardia can become a conditional pathogen, producing diffuse inflammatory infiltration of the lungs, consolidation of the lungs, tissue necrosis, emergence Many small abscesses, and can invade the pleura to produce empyema, the clinical manifestations of nocardiac disease are similar to tuberculosis, actinomycosis, easy to invade the chest wall, form abscess, sinus and fistula, pus and exudate Sulfur granules, cough, hemoptysis, fever, night sweats, weight loss, etc. X-ray examination of the chest with pneumonia infiltration, flaky or nodular shadows, can form a cavity, with pneumonia, abscess, tuberculosis and lung cancer Identification.
Examine
Examination of pulmonary fungal diseases
There are several types of lung X-ray changes in pulmonary fungal disease:
1 pneumonia type: the lesion develops rapidly, showing a large piece of dense shadow.
2 bronchial pneumonia type: the small shadow or lung texture of the bronchial distribution is significantly increased, and chronic cases have fibrosis and emphysema.
3 lung abscess type: evolved from pneumonia type or combined infection into an abscess, which may have a translucent area or a liquid level.
4 Inflammatory mass type: The inflamed mass is surrounded by a fibrous capsule with uniform density and slow disease duration.
5 mixed type: Aspergillus ball consists of a mixture of Aspergillus and fiber mucilage, parasitic in the cystic lesions in the lungs, such as tuberculosis, cystic branching, etc., there is gas between the bacteria ball and the cyst cavity, showing a curved gap Sometimes, it can rotate with the body position. The standing air, the supine and the lateral position film can all see the air shadow above. These patients often have hemoptysis, which is the only fungal disease with obvious X-ray changes.
6 pleurisy type: pleural hypertrophy or pleural effusion.
Diagnosis
Diagnosis and identification of pulmonary fungal diseases
The diagnosis of mycosis is quite difficult. Most of the fungal diseases are secondary infections. The clinical symptoms and signs are often the manifestations of the primary disease. The sputum or secretions are used for smear or culture. The fungi are not necessarily pathogenic bacteria. The patient is often infected with bacteria and viruses at the same time or in sequence. The clinical manifestations are complicated, misdiagnosed or missed. It is necessary to combine clinical related materials, mainly patients with "opportunistic infection" factors, such as long-term use of broad-spectrum antibiotics, immunosuppressive agents. , anticancer drugs, etc., sputum, pleural effusion, pus found fungal spores and / or hyphae, and antigen skin test, serological examination helps to confirm the diagnosis.
Because of the non-specific clinical and X-ray findings of pulmonary fungal disease, it is easily confused with common lung diseases such as tuberculosis, pneumonia fibrosis and chronic bronchitis.
