Pulmonary malaria
Introduction
Introduction to lung malaria Pulmonary malaria refers to the damage of the malaria parasite to the lungs. The body may be infected with the malaria parasite with or without typical malaria systemic symptoms and obvious respiratory symptoms such as cough, cough, shortness of breath, wheezing or chest pain. Clinical manifestations include malaria asthma, bronchitis, pneumonia, pulmonary edema, and acute respiratory distress syndrome (ARDS), and there is no definitive statistics on the incidence. basic knowledge Sickness ratio: 0.0002%-0.0005% Susceptible people: no special people Mode of infection: insect vector infection Complications: pulmonary edema, respiratory failure
Cause
Causes of lung malaria
(1) Causes of the disease
Current malaria patients and carriers are the source of infection. Domestically, it is mainly transmitted by four species of Anopheles sinensis, Anopheles sinensis, Anopheles sinensis and Anopheles sinensis, among which Anopheles sinensis. In addition, transfusion transmission and maternal-infant transmission have been reported occasionally.
(two) pathogenesis
The pathogenesis of lung malaria disease has not been fully understood so far, but there are several possibilities.
1. Microvascular obstruction: pathology found that capillaries that die from the visceral (lung, brain, kidney, etc.) of patients with falciparum malaria are often blocked by red blood cells containing a large number of malaria parasites and macrophages containing malaria pigments, causing pulmonary congestion and edema. Focal hemorrhage, high expansion of alveolar wall capillaries, pulmonary microcirculation disturbance, lung tissue hypoxia, accumulation of metabolites, local cell degeneration, necrosis, impaired lung function, so there are a series of symptoms such as cough, shortness of breath and difficulty in breathing.
2. Disseminated intravascular coagulation: Parasitic reproduction of Plasmodium causes massive destruction of red blood cells, release of red blood cell thrombin and adenosine diphosphate, induce platelet aggregation, increase FDP, and promote intravascular coagulation.
3. Inflammation: Plasmodium can produce some soluble cytotoxic substances, which release into the blood and cause an increase in the concentration of various kininogens, kinins and histamines in the blood, plus the respiration and phosphorylation of mitochondria in the patient's cells. The function is impeded, resulting in increased permeability of small blood vessels in the lungs and pulmonary edema. The blood in the pulmonary blood vessels is concentrated, the blood flow is slowed down, the lungs are completely decomposed, and even necrosis, resulting in impaired lung function. In addition, the Plasmodium antigen binds to related antibodies in vivo to form an immune complex, which is deposited on the alveolar and bronchial walls, causing a non-specific inflammatory response. At present, most scholars believe that the pathogenesis of lung malaria disease is caused by a combination of inflammation.
Prevention
Lung malaria prevention
Radical malaria patients and malaria parasites, mosquitoes, especially early spring mosquitoes and wintering mosquitoes, try not to sleep or use mosquito nets and other mosquito bites, preventive use of pyrimethamine, primaquine, etc., in recent years, some people try Immunization vaccines (such as Spf66, etc.) have achieved certain effects, but are still in the trial.
Complication
Pulmonary malaria complications Complications pulmonary edema respiratory failure
Pulmonary edema, respiratory failure or acute renal failure can occur in severe cases.
Symptom
Pulmonary malaria symptoms Common symptoms Periodic chills and fever... Wheezing lung texture thickening diarrhea, abdominal distension, abdominal pain, hairpin, "butterfly" shadow
1. Incubation period: Pulmonary malaria is a lung manifestation of systemic damage of Plasmodium, and its incubation period is equivalent to the time of infection of malaria. The malaria and ovarian malaria are 10 to 20 days, and the malaria is 70 to 80 days. Malaria is 10 to 14 days.
2. Classification: According to the main manifestations of the disease, lung malaria disease can be divided into 4 types:
(1) Asthma type: There are symptoms such as cough, shortness of breath, dyspnea and asthma that are consistent with the clinical manifestations of malaria, fever, sweating, and heat withdrawal cycle. Asthma before the onset of malaria, the entire disease, even malaria has been clinically Can be seen after the cure, physical examination of the two lungs diffuse or scattered reversible wheezing, X-ray chest radiographs have varying degrees of lung hyperinflation.
(2) bronchitis type: malaria episodes at the same time there are obvious cough, cough, shortness of breath or wheezing during activities, generally do not relieve the ups and downs with the symptoms of malaria, but can be reduced with the cure of malaria, but cough and anger can exist for a long time, Physical examination of the two lungs may have scattered dry or wet voice, X-ray chest radiographs often have lung texture enhancement, it has been reported that the sign of this sign up to 60%, some may also have a small shadow along the lung line.
(3) Pneumonia type: There are many reports at home and abroad. Wang Huamin reported 3098 cases of pediatric malaria in the 3rd International Conference on Tropical Diseases and Parasitic Diseases, including 110 cases of pneumonia-type malaria, accounting for 3.6%. There is high fever, cough, hemoptysis (with hemoptysis as the first symptom), chest pain, shortness of breath, occasional bloating, abdominal pain, diarrhea or jaundice, and dry or wet snoring can be heard in the lungs. X-ray films show the shadow of plaque-like or small-like bronchial pneumonia along the lung line, or the shadow of segmental or large-leaf edge, which can be multiple or single, more common in the lower field. This type is easily misdiagnosed as bacterial pneumonia, but anti-inflammatory treatment is ineffective. After 2 to 3 days of antimalarial treatment, clinical symptoms and chest X-ray findings are significantly improved.
(4) Pulmonary edema type: only seen in falciparum malaria, it has been reported that cerebral malaria complicated with pulmonary edema is as high as 50% to 55%. The clinical manifestations vary depending on the virulence of the worm strain, the body's resistance and physiological functions, etc. Feeling chest tightness, slightly breathing, mild cough, low arterial oxygen partial pressure (interstitial pulmonary edema), to cough, difficulty breathing, foamy phlegm, pale and damp skin, cyanosis, arterial oxygen partial pressure and carbon dioxide partial pressure Significantly reduced, diffuse wet sputum (alveolar pulmonary edema) in both lungs, X-ray chest radiograph showed thickening and blurring of the two lungs, butterfly-like shadow centered on the hilum and large asymmetry of the lower lungs The shadows that change with the body position change.
Examine
Pulmonary malaria check
1. Peripheral blood, bone marrow or sputum smear
Giemsa or Wright staining found the diagnosis of Plasmodium. The blood red blood cells and hemoglobin decreased, the reticulocytes increased, the total number of white blood cells was normal or low, the number of monocytes increased, and the eosinophils were normal. Some scholars proposed peripheral blood leukocytes. The total number is reduced, and mononuclear cells are greater than 15%. In combination with medical history, malaria may be considered.
2. Serological examination
There are indirect immunofluorescent antibody test, indirect red blood cell agglutination test, radioimmunoassay and enzyme-linked immunosorbent assay, etc., and the density of malaria parasites in blood is very low, and patients who are not easy to find malaria parasites by general methods have auxiliary diagnostic significance.
3. Molecular biological method examination
DNA probe technology is a fast and specific method for diagnosing malaria. 10 pg of purified Plasmodium DNA or very low levels of malaria parasitemia can be detected with an isotope-labeled DNA probe.
4. X-ray chest
Asthma type: X-ray chest radiographs have a degree of hyperinflation of the lungs of varying degrees.
Bronchitis type: X-ray chest radiographs often have enhanced lung texture, and it has been reported that 60% of the signs appear, and some may have small shadows along the lung line.
Pneumonia type: X-ray films show the shadow of plaque-like or small-like bronchial pneumonia along the lung line, or the shadow of segmental or large-leaf edge, which can be multiple or single, lower field More common, this type is easily misdiagnosed as bacterial pneumonia, but anti-inflammatory treatment is ineffective, clinical symptoms and X-ray chest radiographs have improved significantly after 2 to 3 days of antimalarial treatment.
Pulmonary edema type: X-ray chest radiograph shows that the texture of the two lungs is thick and fuzzy, and the butterfly-like shadow centered on the hilum and the large asymmetrical shape of the lower lungs can change with the change of body position.
Diagnosis
Diagnosis and identification of lung malaria
Diagnostic criteria
1 has epidemiological data;
2 typical or atypical periodic chills, fever, sweating and fever symptoms;
3 obvious cough, cough, shortness of breath, asthma and other respiratory symptoms;
4X chest radiograph shows lung pattern enhancement or flaky shadow;
5 blood, bone marrow or sputum smear to find the malaria parasite;
6 After anti-malarial treatment, the clinical symptoms disappear and can be diagnosed.
Differential diagnosis
However, it needs to be differentiated from influenza, sepsis, tuberculosis, bacterial pneumonia, encephalitis, etc., especially bronchitis type lung malaria disease needs to be differentiated from diffuse lung disease, both have cough, shortness of breath, auscultation with dry or wet Arpeggio, X-ray chest film lung texture increased or small piece of shadow, but the former auscultation without popping sound, pulmonary function restrictive ventilation dysfunction is not significant, arterial oxygen partial pressure and blood oxygen saturation higher, blood urea nitrogen value And the geometric mean concentration of blood lactic acid is high, low hemoglobin, often metabolic acidosis and clinical symptoms can be alleviated after antimalarial treatment can be identified.
