Pulmonary pleural amebiasis
Introduction
Introduction to pulmonary pleural amebiasis Pleural pleural amebiasis refers to the intestinal infiltration of the amoeba into the lungs, bronchi, pleural pneumonia, lung abscess, pleurisy and empyema, etc., is the lung manifestations of systemic amoebic infection. In parenteral amebiasis, the incidence is second only to the liver. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: lung abscess
Cause
Causes of pulmonary pleural amebiasis
Causes:
There are more than 10 species of amoeba parasitic in the human body. The only tissue-producing amoeba is pathogenic to the human body. The trophozoite is a parasitic form of the protozoa. The body exists in the form of large and small trophozoites and cysts. The large trophozoites are Pathogenic type, small trophozoite is an intermediate transition type between trophozoites and cysts. Mature cysts are infectious and have strong resistance to external abilities. They survive in feces for more than 2 weeks and survive in water for more than 5 weeks. The only form of disease, the pathogenic amybat, which encodes a proteolytic enzyme gene, has an important influence on the ability to invade tissue.
Pathogenesis:
In the infection of amoeba, 90% are recessive infections, and 10% are invasive amebiasis, which depends mainly on the characteristics of the infected strain, and also on the immune status, nutritional status and resistance of the host. After swallowing the food or water contaminated by the capsule, the capsule has anti-gastric acid action, so it reaches the lower part of the small intestine. With the catalytic action of trypsin, the cystic worms are disintegrated and split into small trophozoites. In the intestinal cavity, when the colon function is normal, the small trophozoites stop moving, the cyst wall forms a cyst, and is discharged with the feces. When the host body's resistance is reduced or the bowel function is disordered, the small trophozoite invades the intestinal wall and multiplies. It turns into a large trophozoite. The pathogen directly contacts and adheres to the target cells, phagocytizes and dissolves the tissue cells. The trophozoite releases hydrolyzed protease to cause tissue lysis and necrosis, and at the same time resists complement and adheres to the neutrophils involved in the body's response. Release more enzymes, aggravate tissue inflammation and destruction, and form abscesses.
Lung, chest and abdomen amebiasis 90% of liver-derived, can be perforated by the liver abscess to the pleura and lung; through the liver, sputum, lung adhesion at the interstitial space, blood vessels invade the lung; through the hepatic vein into the inferior vena cava to the lung and Pleural, intestinal-derived trophozoites enter the lungs from the intestinal wall lesions through the intestinal lymphatic vessels, the thoracic duct into the superior vena cava or the lower rectal vein into the inferior vena cava.
Prevention
Pleural pleural amebiasis prevention
Do a good job in health promotion, pay attention to personal hygiene, strengthen manure management, prevent water pollution, thoroughly treat patients and insects, and eliminate infection sources. Drink water must be boiled, do not eat raw Lai, to prevent the diet from being contaminated. Prevent flies from breeding and killing flies.
Complication
Pulmonary pleural amebiasis complications Complications lung abscess
Complicated with bronchospasm, lung abscess and empyema.
Symptom
Pulmonary pleural amebiasis symptoms common symptoms fatigue, chills, chest pain, dyspnea, hepatomegaly, relaxation, hot appetite deficiency
1, acute onset, often chills, fever (mostly relaxation heat), with fatigue, loss of appetite and other systemic symptoms, cough, cough, early dry cough or mucus purulent, typical for chocolate-like sputum, liver Abscess penetrates into the lungs, can suddenly cough up a large number of tan , the amount of sticky up to 500ml per day, may have blood stasis or even large hemoptysis, liver abscess to the chest cavity, often accompanied by severe chest pain and breathing difficulties, serious Pleural shock can occur.
2, early patients may have no obvious signs, after the common right lower lung percussion dullness, respiratory sound reduction, dry and wet voice and pleural effusion sign, combined with liver abscess liver enlargement, tenderness.
Examine
Examination of pulmonary pleural amebiasis
Hematological examination
White blood cells, eosinophils increased, chronic patients with anemia, hypoproteinemia, increased erythrocyte sedimentation rate.
2. Pathogen examination
Hemorrhoids can be found in pleural effusions, but the positive rate is only 15% to 20%.
3. Serological examination
The indirect fluorescent antibody test, indirect hemagglutination test, enzyme-linked immunosorbent assay, etc. are used to determine the amoebic antibody, the positive rate is over 95%, and the specificity is high. However, due to the long duration of the antibody, the activity of the disease should be determined in combination with the disease. Sexual, convective immunoelectrophoresis for the detection of amoeba antigens in pus and biopsy tissue is more rapid than detection of antibodies, which is helpful for diagnosis and prognosis.
4, X-ray examination
Most of the lesions are located in the right lower lobe of the right lung. The basal segment is most common, the right iliac crest is elevated, the pleural reaction or pleural effusion, and the right lower lung has a large flaky density and infiltrated the shadow. The liquid level and the irregular abscess wall are visible. The blood source is It is characterized by multiple small abscesses in both lungs.
Diagnosis
Diagnosis and identification of pulmonary pleural amebiasis
According to the medical history, clinical manifestations and laboratory tests, it is generally not difficult to diagnose. The pathogen can be diagnosed by sputum or pleural effusion. When the ultrasound examination confirms that there is liver abscess, liver puncture should be done. If the pus is chocolate or found. Miba protozoa is of great significance for the diagnosis of this disease.
The disease should be differentiated from bacterial lung abscess, cancerous cavity, and bacterial empyema.
