Neisseria meningitidis pneumonia
Introduction
Introduction to Neisseria meningitidis pneumonia Neisseria meningitidis mainly causes epidemic cerebrospinal meningitis. As for Neisseria meningitidis pneumonia, many people think that it is a rare suppurative migration complication secondary to Neisseria meningitidis sepsis. . In fact, after the first report in 1907, there have been many reports that Neisseria meningitidis can be used as a pathogen of primary lower respiratory tract infection, causing primary meningococcal pneumonia. The immune response of Neisseria meningitidis is complex, and the bactericidal antibodies in newborns disappear after 6 months of birth; children and adolescents, whether they have severe Neisseria meningitidis infection, subclinical infection, or upper respiratory tract Non-pathogenic Neisseria meningitidis symbiotic, can stimulate the body to produce bactericidal antibodies, bactericidal antibodies can be immune to lytic pathogens promoted by complement C, lack of bactericidal or capsular antibodies against a specific serotype It is prone to the colonization and infection of this type of serotype bacteria, and the ability to obtain protective antibodies with age can greatly reduce the possibility of onset. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: mainly spread by droplets Complications: sepsis
Cause
Neisseria meningitidis pneumonia
(1) Causes of the disease
Neisseria meningitidis, also known as diplococcus intracellularis, is an aerobic Gram-negative cocci, which is kidney-shaped or bean-shaped, often arranged in pairs, not growing on ordinary medium, usually using blood agar or chocolate. In agar culture, the bacteria grow well in 5% to 10% CO2, the temperature is 35-37 ° C, and the humidity is 50%. The selective medium is beneficial to the isolation and identification of Neisseria meningitidis in the sputum specimen, such as improvement. Tayer-Martin (MTM) agar contains a variety of antibiotics to inhibit the growth of other microorganisms that grow faster, which is beneficial to the growth of Neisseria meningitidis. The bacteria are extremely sensitive to cold, dry and disinfectant, and are easily autolyzed in vitro. Therefore, the specimen must be sent immediately after the specimen is collected.
Identification of Neisseria meningitidis mainly based on morphological manifestations, Gram staining, oxidation and utilization of glucose and maltose and immune response (serological tests, such as detection of specific capsular polysaccharides), Neisseria meningitidis is a typical leather Lan-negative cocci, the outer membrane layer of the cell membrane contains lipopolysaccharide endotoxin. According to the polysaccharide of the capsule capsule layer, it can be divided into at least 13 serotypes, among which A, B, C, X, Y, Z and W-135 The type is becoming more and more important in the clinic.
(two) pathogenesis
The immune response of Neisseria meningitidis is complex, and the bactericidal antibodies in newborns disappear after 6 months of birth; children and adolescents, whether they have severe Neisseria meningitidis infection, subclinical infection, or upper respiratory tract Non-pathogenic Neisseria meningitidis symbiotic, can stimulate the body to produce bactericidal antibodies, bactericidal antibodies can be immune to lytic pathogens promoted by complement C, lack of bactericidal or capsular antibodies against a specific serotype It is prone to the colonization and infection of this type of serotype bacteria, and the ability to obtain protective antibodies with age can greatly reduce the possibility of onset.
After Neisseria meningitidis invades the human body, if the human body has strong immunity, the pathogen can be quickly killed or become a carrier state; if the body lacks immunity to the serotype or the bacterial virulence is strong, the pathogen is in the nasal cavity. The pharynx settles and invades adjacent tissues through the upper respiratory tract, causing infection. The lower respiratory tract is invaded by inhalation of the granules of the bacterium, and most of the respiratory tract secretion caused by the prior viral infection is excessive, the mucosal damage, and the microbial clearance is reduced. On the occurrence, bronchial pneumonia, large leaf infiltration and even lung tissue necrosis, abscess formation and other pathological changes can be seen. Because there is no animal model of Neisseria meningitidis pneumonia, detailed modern pathology and histology-related data are still lacking.
Prevention
Neisseria meningitidis pneumonia prevention
1. Elimination of the source of infection Neisseria meningitidis is mainly transmitted by droplets. Therefore, it is necessary to treat the isolated patients and eliminate the source of infection. Usually, suspicious patients should be isolated at least for the first 24 hours of treatment.
2. Drug prevention and vaccine prevention drugs and vaccine prevention have a very important role in reducing the incidence of epidemic cerebrospinal meningitis and controlling the prevalence of epidemic cerebrospinal meningitis, such as for carriers or Susceptible population, can be prevented by penicillin, rifampicin, minocycline, or tetravalent vaccine containing A, C, Y, W-135 serotype for immune prevention, but drug and vaccine prevention can protect There is no such information on the prevention of primary infection of the respiratory system in susceptible individuals. It remains to be seen.
Complication
Neisseria meningitidis pneumonia Complications sepsis
Combined with Neisseria meningitidis sepsis.
Symptom
Neisseria meningitidis pneumonia symptoms common symptoms high heat lung consolidation chest pain pharyngitis sputum sputum wet sputum sputum sputum chills pleural effusion
The clinical course of this disease has no specificity, so it is easy to miss clinical diagnosis, such as cough, cough and sputum or foam sputum, chest pain, chills, high fever and accompanying lung mutations, wet snoring, etc., if concentrated in the crowd If there are many cases of bacterial pneumonia in military camps, schools, nurseries or hospitals, you should be alert to the possibility of this disease. If you find gram-negative kidney-shaped diplococcus in neutrophils on the sputum smear, you should be highly suspicious of this disease. The diagnosis depends on further bacteriological examination, common cough culture or nasopharynx. It is sometimes difficult to obtain a positive result in throat swab culture. It is often necessary to obtain a positive result by pipetting the specimen.
Examine
Examination of Neisseria meningitidis pneumonia
Sputum bacterial smear test If gram-negative respirococcus is found in neutrophils on the sputum smear, the disease should be highly suspected, and the diagnosis depends on further bacteriological examination.
Sputum bacteria culture common cough culture or nasopharynx, throat swab culture sometimes difficult to obtain a positive result, often need to be taken through the trachea to obtain a positive result.
X-ray findings were non-specific, including bronchial pneumonia and large leaf infiltration with patchy shadows, common in the lower or middle right lobe, and approximately 20% of cases with pleural effusion.
Diagnosis
Diagnosis and differentiation of Neisseria meningitidis pneumonia
The clinical manifestations of primary meningococcal pneumonia are similar to pneumococcal pneumonia, manifested as cough, sputum or sputum, chest pain, chills, high fever, and associated lung consolidation, wet snoring and other signs. Early onset of pharyngitis, X-ray findings are non-specific, including plaque-like bronchial pneumonia and large leaf infiltration, common in the lower or right middle lobe, about 20% of cases with pleural effusion.
Clinical attention should be paid to the identification of pneumococcal pneumonia.
