Pulmonary mite disease
Introduction
Introduction to pulmonary disease Pulmonaryacariasis was found in Ceylon (now Sri Lanka) as early as 1944, but it has not yet been fully familiar to medical workers. It has not received enough attention for respiratory diseases. It is caused by pneumoconiosis. Pulmonary parasitic diseases caused by air, water and food invading the body, passing through the respiratory tract and parasitic on the lungs. basic knowledge The proportion of illness: 0.004%-0.008% Susceptible population: respiratory infection Mode of infection: contagious Complications: tuberculosis
Cause
Cause of pulmonary rickets
Route of transmission (25%):
It is a pulmonary parasitic disease caused by pneumonitis with air, water and food invading the body, through the respiratory tract and parasitic in the lungs. The disease is obviously occupational. It is engaged in the storage, processing, sales and textile workers of food and Chinese herbal medicine. The prevalence rate is significantly higher than that of the general population, and is generally reported to be 5.3% to 17.9%.
Parasitic parts (30%):
The pneumoconiosis enters through the respiratory tract and first parasitizes into the end of the bronchus and the alveolar sac, and migrates to other parts of the lung by its corpus callosum and foot. The pathogenesis is caused by acute mechanical inflammation caused by local mechanical stimulation of the alveoli during the process of pulmonary raft migration. In addition, worms, metabolites, and eggs are strong allergens that can cause type I, type III, and even type IV allergies, leading to allergic rhinitis, bronchitis, bronchiolitis, asthma, and lung parenchyma and interstitial The damage, the formation of pulmonary nodular lesions, pulmonary fibrosis and so on.
Pathological changes (5%):
The two lungs can be scattered or merged into a slightly conical nodule, 1~2mm in size, up to 5mm in size, close to the visceral pleura, slightly uplifted, slightly yellow, golden yellow material can be seen on the cut surface, and aphids can be found in the nodule compression tablets. These changes are due to the growth of aphids in the bronchioles of the lungs to form lesions, causing inflammation leading to consolidation of adjacent lung tissue. The main pathological changes are degeneration of bronchiole mucosal epithelial cells, necrosis, enlargement of goblet cells, thickening of basement membrane, bronchi Mucinous gland hyperplasia, hypertrophy, smooth muscle thickening, stenosis of the lumen, eosinophil infiltration around the bronchioles and bronchi, granulation tissue formation and connective tissue hyperplasia, increased inflammatory exudate, and similar pulmonary interstitial inflammation, even A wide range of lung consolidation and local pleural adhesions can also be seen.
Prevention
Pulmonary plague prevention
Do a good job of the work unit's dust-proof measures, pay attention to personal hygiene, strengthen indoor ventilation and lighting, keep indoor dry, or use formaldehyde solution indoor steaming, or 1% Lindane, 0.2% peroxyacetic acid soaking clothes, pillowcase, sheet Wait, the latter soak for 10 to 15 minutes, rinse off with water.
Complication
Pulmonary dysentery complications Complications, tuberculosis
Often combined with bacterial infections.
Symptom
Symptoms of pulmonary rickets Common symptoms: night sweats, acute chest pain, diarrhea, abdominal pain, fatigue, dry cough, hilar widening, low heat, weight loss
Slow onset, clinical manifestations are different, or similar to a cold, bronchitis, or similar tuberculosis, or an asthma-like attack, most patients have cough, cough, followed by anorexia, low fever, chest tightness, chest pain, night sweats, shortness of breath Or asthma, sputum is mostly white foamy, occasionally with blood in the sputum, there are purulent sputum in the case of bacterial infection, some patients have long-term dry cough, or severe asthma, physical examination, lungs can hear dry snoring, a few have Wet squeaks or wheezing sounds, such as mites that invade the skin or digestive tract, can cause itchy skin, rash or abdominal pain, diarrhea, weight loss, etc.
Engaged in the storage, processing, adjustment, sale and close contact of food, Chinese herbal medicine or textiles, such as respiratory symptoms or signs, long-term anti-infective treatment without improvement or light weight, prolonged unhealed, blood eosinophils, X-rays have widened hilars, rough texture, scattered small nodules or small shadows; immunological examination of serum sputum-specific antibodies positive, should be suspected, such as cockroaches found cockroaches, larvae or eggs can be diagnosed.
Examine
Examination of pulmonary rickets
1. General examination: peripheral blood leukocytes are normal or slightly increased, eosinophils often increase, accounting for about 10% to 50%, serum IgE is significantly increased, up to 5 to 6 times that of normal people, IgG and IgA are also increased, IgM increased in different degrees in the early stage of the disease, but there was no significant difference compared with the control group. There were more eosinophils in the sputum. Occasionally, the crystallization of the sylvestris was observed. After 24 hours, the 5% to 7.5% sodium hydroxide was digested. ~ 3h, centrifugation smear microscopic examination to find adult worms, larvae or eggs can be diagnosed.
2. Immunological examination: commonly used are:
(1) Skin test: At present, the sputum allergen prick test (SPT) is used, and the total positive rate is 80%.
(2) Indirect fluorescent antibody test (IFA): The method is simple, sensitive and specific, and the positive rate is above 90%.
(3) Indirect hemagglutination test (IHA): The positive rate is slightly lower than that of IFA, about 85%, and its specificity is also good. The titer should be 1:16 when diagnosing pulmonary rickets.
(4) Biotin-avidin enzyme-linked immunosorbent assay (ABC-ELISA) test: The method is simple, rapid and easy to promote, and its positive rate is about 80%.
(5) Enzyme-linked immunosorbent assay (EIISA): a method for detecting serum antibodies in patients with scrub typhus in recent years. If the absorbance value OD 3 is positive, the positive coincidence rate of pulmonary rickets is 83%. The negative coincidence rate of patients with non-pulmonary respiratory diseases is 90%, and the negative compliance rate of healthy people is 95%. Because of its high sensitivity and strong specificity, it can be used for the diagnosis and key population of pulmonary rickets. Epidemiological investigations, but these tests must be combined with the clinical to be correctly diagnosed.
The main signs of X-ray manifestations are widening of the hilar shadow, thickening of the texture, cloud-like shadows in the lower lungs, and nodules or spots of different sizes (2 to 5 mm) in the hilar and lungs. Shaped shadow, this is the characteristic X-ray manifestation of pulmonary rickets. It has been reported that X-ray chest X-ray has such signs as 70%-80%.
Diagnosis
Diagnosis and diagnosis of pulmonary rickets
The disease is easily confused with chronic bronchitis, bronchial asthma, tuberculosis, Leofflers syndrome, intrathoracic sarcoidosis, pulmonary schistosomiasis, pulmonary infection, pleurisy, etc., especially long-term dry cough, X-ray chest radiograph has interstitial The changer is easily misdiagnosed as diffuse lung disease, which should be carefully distinguished. The specific population of people engaged in food and Chinese herbal medicine work frequently, the breathing difficulties are not progressively aggravated, the chest auscultation has no popping sound, no clubbing, and metronidazole treatment is effective.
