Flavobacterium pneumonia
Introduction
Introduction to flavibacterium Flavobacterium can cause pneumonia, and can also cause infections such as meningitis and sepsis. It is a newly recognized strain. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: droplet spread Complications: pleural effusion
Cause
The cause of flavivirus
(1) Causes of the disease
Flavobacterium-negative bacillus, including F. menigosepticum, group IIb yellow bacillus (F.IIb), F. odoratum and F. multivocum ), among them, the strains of M. septicum and IIb are the main pathogens, which can cause various infections and sepsis to humans. The genus of this genus is negative for Gram staining, the cells are slender, the ends are slightly rounded, and there is no power. No spores, positive oxidase, can decompose mannitol, the ability to ferment sugar is slow and weak, and the remarkable feature is the production of yellow pigment during the growth process.
Meningococcus bacillus can be divided into A, B, C, D, E, F6 serotypes, causing human infection mainly C type, followed by B, D, F type, etc., biochemical characteristics of Flavobacterium are shown in the table 1.
(two) pathogenesis
The pathogenicity of this disease is not strong, it is a conditional pathogen, and generally does not cause infection, but it may cause infection when the body's immunity declines. This bacteria is easy to cause infection in infants, especially in premature infants. Adult cases are common in adults. Old and frail hospitalized patients, or those suffering from acute and chronic diseases, as well as high-dose broad-spectrum antibiotics, anti-tumor drugs, corticosteroids, surgery, tracheotomy, etc. can also cause infection, contaminated devices And the hands of the staff are the main medium for the transmission of germs.
Prevention
Flavobacterium pneumonia prevention
Flavobacterium pneumonia is an opportunistic pathogen that occurs in hospitalized and debilitated patients or critically ill patients in intensive care units. These high-risk groups are the focus of clinical prevention of flavivirus pneumonia, especially in ventilator therapy, nebulization and Intratracheal diagnosis and treatment operations should be strictly disinfected of various instruments, the tracheal tube should be boiled and disinfected 1 or 2 times a day, the suction tube should be used once, the ventilator tube should be cleaned and disinfected regularly, and the air in the hospital should be regular. Disinfection, medical personnel or accompanying members sometimes have a yellow bacillus in the respiratory tract, so it is strictly required to wear masks when inspecting and treating high-risk patients.
Once the infection or epidemic of Flavobacterium occurs, the infected patient should be closely isolated to prevent the spread of infection, and an epidemiological investigation is carried out to repeatedly culture the various instruments and instruments, patient secretions, air, etc., to identify the bacterial strains. Guide clinical protection and treatment.
When using a large number of long-term broad-spectrum antibiotics, it is necessary to pay attention to the imbalance of the flora in the body and prevent the opportunity pathogens to take advantage of the opportunity to breed. Therefore, when there is no clear indication, long-term use of broad-spectrum antibiotics for preventive treatment should be avoided, for the extensive use of adrenocortical hormones and Patients with immunosuppressive agents should pay special attention to prevent the occurrence of such fatal infections.
The hospital infection control institution should regularly check and predict the pathogens in the key intensive care unit and the flavobacterium susceptible area. All the utensils in the disease area of the yellow bacillus should be thoroughly disinfected to prevent infection.
Complication
Flavobacterium pneumonia complications Complications pleural effusion
Complicated with pleural effusion, combined with vasopressin syndrome.
Symptom
Symptoms of Flavobacterium pneumonia Common symptoms Dyspnea coma, asphyxia, sputum, relaxation, heat, hyponatremia, pleural effusion, ascites, yellow, white, sticky, fruity toxemia
The clinical manifestations after bacterial infection are various, depending on the infection site. Common clinical manifestations are fever, with mild or moderate irregular fever, some are relaxation heat, and severe cases such as meningitis and pneumonia. Septicemia and other body temperature is higher, and the toxemia is heavier. After the baby is infected, there are signs of wilting, less movement, less crying, pushing food, vomiting and other poisoning symptoms.
1. Meningobacter septicum is a recognized pathogen in the genus. The sputum counts 77 cases of purulent meningitis caused by the bacteria. The newborns account for 96.1%, the children account for 1.3%, and the adults account for 2.6%. Adult cases are more common in adults. Old and infirm.
Chen reported a case of pneumonia. The patient was admitted to the hospital as a Proteus, and the left lung tip was large-density. He had given erythromycin and cefoperazone, which was once better. The film showed a large number of blurred shadows, the left lower lung effusion and the outer effusion, and the sputum cultured 3 times (FM), except for the moderate sensitivity of carbenicillin and tetracycline, to other penicillins, cephalosporins, Aminoguanidines, chloramphenicol and sulfamethoxazole were all resistant. Patients were ventilated, given artificial mechanical ventilation, and tetracycline and penicillin improved. However, tracheal intubation occurred, gastrointestinal bleeding occurred, and suffocation died. He has also reported 1 case of nodular elastic fiber degeneration with blackhead syndrome, chest X-ray for double pneumonia, suspected bilateral pleural effusion, 620 ml of pleural effusion, exudate, then became bloody, admitted to hospital 1 The sputum was cultured for this bacterium, and it became pure culture after 5 days and died two days later.
According to Olsen's examination of 27,600 physical examinations of male and female genitourinary organs, 114 cases of S. cerevisiae were detected, of which 100 were from females. Therefore, he believes that female genitalia may become the source of infection of the bacteria in hospitals and should be given enough attention. At the same time, he also collected 269 specimens from different parts of the hospital for training, 33 of which were positive. Among the inpatients and medical staff, there were also respiratory carriers, and even reported that 1 chlorhexidine dip in disinfection equipment. This bacteria was also found in the liquid.
The treatment of FM is more difficult. Because it is resistant to most antibiotics, it has been reported that FM is sensitive to a few antibiotics such as erythromycin, rifampicin and SMZco. Brown et al. detected 20 FM from the respiratory tract. The tested antibiotics (including the third-generation cephalosporins) were not sensitive, but ciprofloxacin was all sensitive. Five of them were treated with ciprofloxacin, 2 died, 3 improved significantly, and Scully also reported FM pairs. Ciprofloxacin is sensitive, suggesting that it may be an effective drug for the treatment of FM. It is worth noting that the FM outbreak is prevalent. Brown reported in 1989 that in order to prevent Pseudomonas aeruginosa infection, prophylactic administration of polymyxin B was inhaled. The result was an epidemic of FM respiratory infection. In two and a half months, FM was isolated from 20 sputum cultures of 9 patients, of which 5 were FM pneumonia. There are still no reports of pneumonia in China. The characteristics of this case of pneumonia were reported in the report.
2. Flavobacterium aureus was first detected from the feces of intestinal patients in 1920, and then found on the surface of urine, blood, sputum, wounds and ulcers. Jin et al. reported a case of acute intracerebral hematoma, the fourth day after surgery. Increased body temperature, difficulty breathing, increased amount of sputum, yellow-white sticky, fruity, check the lungs with fine voice, a small amount of wheezing, white blood cells 23.7 × 109 / L, chest X-ray infection, Three times of sputum culture during hospitalization showed non-fermenting bacterium Lactobacillus, which is a pure growth of Flavobacterium fuliginea. The strain produces insoluble yellow pigment, has a special aromatic taste, and is positive for oxidase test. It has been given ceftazidime, chloramphenicol, oxacillin, etc. Intravenous drip, gentamicin mist, ketoconazole nasal feeding and other treatments, invalid death.
3. More Flavobacterium, Lactobacillus fermentum, and Flavobacterium group IIb can be isolated from sputum, blood, ascites, cerebrospinal fluid, wounds, urine, etc., but less reported, short bacillus and Rhizopus oryzae The pathogenicity has not been determined. After accumulating the data, Wang et al reported that 1 case of Flavobacterium pneumonia complicated with vasopressin syndrome, hyponatremia, plasma osmotic pressure was lower than urinary osmotic pressure, and other reasons were excluded. The treatment was cured and discharged.
Examine
Examination of Flavobacterium pneumonia
The number of white blood cells is generally significantly higher, which can be greater than 5.0×109/L, neutrophils can reach more than 90%, there is a phenomenon of left nucleus shift, erythrocyte sedimentation rate is often increased, and multiple organ failure and septic infection are combined in the blood. Increased ALT, abnormal renal function, the disease can be complicated by low plasma permeability syndrome, blood sodium, potassium decreased and plasma osmotic pressure decreased in urine osmotic pressure, arterial blood gas analysis may have hypoxemia, hypercapnia and acidosis .
Some patients with electrocardiogram may have abnormal changes in hypokalemia and arrhythmia.
Diagnosis
Diagnosis and identification of flavivirus
Because the clinical manifestation of Flavobacterium infection is not strong, it is difficult to judge the infection from the clinical manifestation. It is necessary to quickly obtain the specimen, and isolate the strain, and incubate it with blood agar or MacConkey agar plate at 30 ° C for 18-24 hours. Pick suspicious colonies inoculated with TSI, culture at 30 ° C for 24 h, no acid on the upper layer and slope, oxidase-positive, yellow moss, slightly sticky, suspected flavobacterium, to be further identified, the next step is to belong to the genus, the OF test is oxidation Type, yellow pigment (not produced), does not diffuse into the medium; no power, no spores; with oxidase and catalase; Gram-negative or cocci, the next step is to refine, to biochemical The test identified the species, and it is important to identify the above-mentioned Flavobacterium septicum and the six groups of Flavobacterium, which have been described above.
If the bacterial culture results can not be diagnosed, the diagnosis of this disease is very difficult. It must be differentiated from various Gram-negative bacilli pneumonia in clinical practice. Pseudomonas aeruginosa pneumonia is green or yellow-green, and cockroaches are generally not as thick and yellow as bacillus. Very large, Pseudomonas aeruginosa can produce special odor during bacterial culture. The colonies are blue-green, yellow-green, and the pneumonia caused by Alcaligenes faecalis is sometimes similar to A. flavus pneumonia. The difference should be noted. The former is gray pus. In this case, the clinical condition is not as dangerous as the flavobacterium. In patients with chronic fibrovascular tuberculosis, it is easy to mistakenly believe that tuberculosis recurs when infected with flavobacterium. It should be noted that the sputum culture should be repeated, and the infected strain should be identified as soon as possible. More common, serous or bloody pleural effusion should also be routinely carried out in bacterial culture, the positive detection rate is very high, the disease is easy to be combined with sepsis and meningitis, conventional blood culture and cerebrospinal fluid bacterial culture are helpful to distinguish from other bacterial infections.
