Pulmonary penicillosis
Introduction
Introduction to lung penicillosis Penicillium is widely found in nature. Some can produce antibiotics such as penicillin and various enzymes and organic acids. Most of them are usually contaminated bacteria. A few species can cause penicillosis and penicillin under certain conditions. Non-specific, similar to tuberculosis or pulmonary aspergillosis, can occur cough, cough, hemoptysis, difficulty breathing, fever, loss of appetite, weight loss, systemic failure and other symptoms. Allergic bronchopulmonary penicillosis caused by inhalation of a large amount of Penicillium spores in a short period of time, can show temporary lung infiltration, increased eosinophils in peripheral blood and sputum, intermittent airway obstruction, chest tightness, throat Itching, asthma, urticaria and other manifestations. basic knowledge The proportion of illness: 0.002% - 0.003% Susceptible people: no special people Mode of infection: contagious Complications: abscess
Cause
Causes of pulmonary penicillium
Penicillium infection (45%):
Most of the genus Penicillium has only asexual stages, and a few have found sexual stages. The basic characteristics of this genus are that the vegetative mycelium is colorless, light or bright, with a sloping, ambush or partially ambush type, and some serotypes. The aerial hyphae are densely felt-like, loosely flocculated or partially aggregated into mycelial cords, and the conidiophores are produced by the aerial hyphae or aerial hyphae, with a slant, individually erect or some degree of collection. Even densely integrated with a certain hyphae or spore bundle, the top of the conidiophore has a broom-like branch structure called a sacral branch, which consists of a single or two to multiple branch system, and the last branch That is, sporulation cells, called bottle stems, the cells of the bottle stem are stalk bases, the cells of the support group are the accessory branches, and the conidia are produced from the bottle stems to form unbranched chains.
Colony characteristics
(1) Growth rate: Generally, when cultured at 25-28 °C, the growth is faster, and the diameter of the colony is usually 5-6 cm after 12 to 14 days of culture.
(2) Color: The surface color is mainly expressed in the conidia region, most of which are blue or gray-green, most of the aerial hyphae are colorless, a few are colored, the mycelium in the base is colorless or in various colors, and the pigment Infiltrating the matrix allows the matrix to behave in a corresponding color.
(3) Colony texture: typical can be divided into 4 types, 1 velvet: there are few aerial hyphae, and the conidiophore is almost entirely produced by ambush hyphae or a dense mycelium layer closely attached to the substrate. 2 flocculent: there are more loose and entangled aerial hyphae. The conidiophore is mainly branched by aerial hyphae, its living point is away from the matrix, 3 rope: most aerial hyphae integration A rope-like shape, easy to identify under low magnification, 4 bundles: Most of the conidiophores are produced from the matrix, non-uniformly distributed, more or less clustered, making the colonies into a granular or powdery appearance, even the majority The spore stalks can be assembled into a bundle of filaments. In actual observation, there may be transition types, and some strains can produce exudates or special odors.
Braid
(1) Penicillium group: The sickle branch consists of a single-wheeled bottle stem.
(2) Symmetrical two-wheeled Penicillium group: There are closely-rotated stalk bases, each of which has a slender sharp bottle stem. All the sacral branches are generally symmetrical to the main stem, and are closely like a funnel. Most of the spores are oval.
(3) Asymmetric Penicillium group: including all braided branches for two or more branches, asymmetry for the main stem, close to symmetry and no symmetrical two-wheel set as tight structure and slender sharpening Bottle stems.
(4) Multiple rounds of Penicillium group: The braided branch is extremely complex, multiple branches and often symmetrical, and this group of bacteria is rare.
Primary disease (25%):
It is generally believed that bronchial-lung penicillosis is caused by bronchopulmonary injury first, and then caused by inhalation of dust containing penicillium spores, and can be spread to the brain or other parts by blood, the patient's own serious primary disease The use of broad-spectrum antibiotics and corticosteroids is also an important cause of penicillin infection. AIDS and cancer patients have reports of penicillosis infection.
The surface of the lungs is gray and dark, spreading most of the small particles. The lungs are diffusely tidal red and foamy. Most of them are scattered from a few millimeters to 3 cm of pale granules and hemorrhage. The necrotic bronchioles filled with soft clots are often seen in the center. Pulmonary blood vessels.
Tissue section display (20%):
The lung damage is hemorrhagic infarction, the pulmonary artery is blocked by penicillium hyphae, the hyphae can also enter the necrotic lung parenchyma and bronchial wall, there is no obvious cell infiltration, but there may be hemorrhage and cellulose deposition, HE staining, penicillium in tissue It is basophilic and has a hyphae branching at an angle of 25° to 45°. The hyphae are 2 to 5 m wide. The hyphae in the tissue often grow radially, and the hyphae grow out from the blocked blood vessels.
Prevention
Pylorimycin prevention
Enhance immune function, treat primary diseases, and help prevent the occurrence of lung penicillosis. The first thing to do is to quit smoking, keep warm, avoid cold, prevent colds, improve environmental hygiene, do personal labor protection, and eliminate and avoid the effects of smoke, dust and irritating gases on the respiratory tract.
Complication
Pulmonary cordycosis complications Complications
Often complicated by multiple abscesses. Cough, cough, hemoptysis, difficulty breathing, loss of appetite, weight loss, systemic failure and other symptoms may occur. Allergic illness caused by inhalation of a large amount of Penicillium spores in a short period of time, can be characterized by temporary pulmonary infiltration, increased eosinophils in peripheral blood and sputum, intermittent airway obstruction, chest tightness, itchy throat, asthma , urticaria and other allergic reactions.
Symptom
Symptoms of pulmonary penicillosis Common symptoms convulsions dyspnea hemoptysis coma fever
Non-specific, similar to tuberculosis or pulmonary aspergillosis, can occur cough, cough, hemoptysis, difficulty breathing, fever, loss of appetite, weight loss, systemic failure and other symptoms.
Allergic bronchopulmonary penicillosis is caused by inhalation of a large amount of Penicillium spores in a short period of time, which can be characterized by temporary pulmonary infiltration, increased eosinophils in peripheral blood and sputum, intermittent airway obstruction, and chest tightness. Itching, asthma, urticaria and other allergic manifestations.
If the brain is involved, there may be central nervous system symptoms such as punctate or flaming hemorrhage, insanity, convulsions, coma, etc. In addition, penicillin invading other parts may cause non-specific endocarditis, otitis externa, otitis media, Urinary tract infection, skin granuloma, hyperthyroidism, foot swelling and so on.
Because various penicillium species are widely present in the surrounding environment, the diagnosis of penicillin must be cautious. Some patients with bronchial diseases often have live penicillium spores in their dilated bronchus or bronchioles without invading the tissues. When the patient spits spores from the sputum, the spores are still alive; in some patients with more serious diseases (such as tuberculosis), the penicillium occurs occasionally in the sputum, which is often unimportant, only in tissue sections and sputum separation. Penicillium is found in the culture to confirm the diagnosis. If the mold is directly examined and cultured in the patient's sputum, or the mold is cultivated by sputum, urine, blood, etc., or in the living tissue with fungal infection. Penicillium is cultivated in the body, and then combined with clinical manifestations, it can be diagnosed as penicillium, but the strain must be further identified and appropriately treated.
Examine
Examination of lung penicillosis
1. Take sputum, bronchoscope aspirate, pus and other specimens, microscopic examination with 10% potassium hydroxide, visible branch-separated hyphae and microspores.
2. Bacterial culture is rapidly grown on glucose peptone agar and CzC medium at 25-28 °C. The colonies are velvet, flocculent, rope-like or bundle-like. The surface is mostly blue or gray-green. The matrix may have various colors.
X-ray films showed focal pulmonary inflammation infiltration or cavity formation. X-ray signs were reported as "soap bubbles". The density was generally weak, the lower lungs were concentrated, and the wall thickness and size of soap bubbles were extremely inconsistent.
Diagnosis
Diagnosis and identification of pulmonary penicillium
Penicillium disease needs to be differentiated from aspergillosis. In the tissue, penicillium is a branch-separated hyphae, similar to Aspergillus. If an Aspergillus conidia head or a Penicillium spp. The separation and culture of living tissue is of great significance in differential diagnosis.
