Pneumonia in immunocompromised patients
Introduction
Introduction to immunodeficiency pneumonia Immunodeficiency pneumonia refers to pneumonia caused by defects in the patient's own immune system. Its onset is often associated with pathogen infection. Potential pathogens in patients with impaired dysfunction may be many, but depending on the nature of the host's immune deficiency, X-ray changes, and the type of clinical symptoms, the most likely pathogens are often identified. According to the type of patient's immune deficiency, it should be noted that respiratory symptoms and chest X-ray abnormalities may be caused by various causes other than infection, such as pulmonary hemorrhage, pulmonary edema, radiation damage, lung damage caused by cytotoxic drugs, and tumor infiltration. . basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: bacterial pneumonia, viral pneumonia, radiation pneumonitis, mycoplasma pneumonia
Cause
Immunodeficiency pneumonia
Immune deficiencies may be congenital or acquire acquired, and immune diseases that are present at birth are usually hereditary.
Immunodeficiency pneumonia is a pneumonia caused by a defect in the patient's own immune system. Its pathogenesis is often associated with pathogen infection. The potential pathogens of patients with impaired defense function may be many, but according to the nature of host immunodeficiency, X-ray changes and clinical symptoms Types often identify the most likely pathogens.
Prevention
Immunodeficiency pneumonia prevention
Adequate nutrition, good personal hygiene, and avoiding uncooked foods and people exposed to infectious diseases. Some people must drink bottled water, quit smoking, avoid passive smoking and use illegal drugs, pay special attention to oral health care, prevent oral cavity. People infected with antibodies can vaccinate, but people who are deficient in B lymphocytes or T lymphocytes can only use inactivated viruses, bacterial vaccines, but not live vaccines (such as oral polio vaccine, measles, epidemics). Mumps, rubella and BCG).
Complication
Immunodeficiency pneumonia complications Complications, bacterial pneumonia, pneumonia, radiation pneumonitis, pneumonia
The main complications of immunodeficiency pneumonia are lung infections, including bacteria, viruses, chlamydia, mycoplasma, and fungal infections.
1. Bacterial pneumonia: such as Streptococcus pneumoniae (ie pneumococci), Staphylococcus aureus, Streptococcus hemolyticus, Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli, Pseudomonas aeruginosa.
2. Pneumonia caused by atypical pathogens: Legionella, Mycoplasma and Chlamydia.
3. Viral pneumonia: such as coronavirus, adenovirus, influenza virus, cytomegalovirus, herpes simplex virus, etc.
4. Fungal pneumonia: such as Candida albicans, Aspergillus, and radiobacteria.
5. Pneumonia caused by other pathogens: such as rickettsia, toxoplasma, protozoa, parasites such as lung hydatid, paragonimiasis, pulmonary schistosomiasis. People with low immunity (such as AIDS patients) are easily associated with infections such as Pneumocystis carinii, Legionella, Mycobacterium avium, Mycobacterium tuberculosis, and Toxoplasma.
6. Pneumonia caused by physical and chemical factors: such as radiation pneumonia, gastric acid inhalation, chemical pneumonia caused by drugs, etc.
7. Mycoplasmal pneumonia: caused by pneumonitis gas.
Symptom
Immunodeficiency pneumonia symptoms common symptoms pulmonary embolism edema immunodeficiency nodules
The speed of disease progression helps to understand the cause of the disease. Patients with acute symptoms may be diagnosed with bacterial infection, hemorrhage, pulmonary edema, leukocyte lectin response or pulmonary embolism, and the symptoms are subacute or chronic. Fungal or mycobacterial infections, opportunistic viral infections, Pneumocystis carinii pneumonia, tumors, cytotoxic drug reactions or radiation damage are more likely.
The type of chest X-ray abnormality is also helpful in judging. X-ray shows localized lesions with consolidation, which generally indicates that the infection involves bacteria, mycobacteria, fungi or Nocardia. Interstitial lesions mostly represent viral infections. Pneumocystis pneumonia, drug or radiation damage or pulmonary edema, diffuse small nodular lesions suggest mycobacteria, Nocardia, fungi or tumors, cavitary lesions suggest mycobacteria, Nocardia, fungi or bacterial.
Examine
Examination of immunodeficiency pneumonia
In immunodeficient patients, due to the risk of improper treatment, invasive means (such as bronchoscopy, transthoracic lung puncture or open lung biopsy) are needed to facilitate the diagnosis, by bronchoscopy (transbronchial biopsy) or open Surgical surgery to obtain tissue for histological examination or culture, although the latter method generally requires general anesthesia and the placement of a thoracic catheter after surgery, but can take sufficient specimens in the lesion under direct vision, this method is still The most diagnostically reliable measures, however, many patients are too ill to undergo invasive biopsy, in which case fiberoptic bronchoscopy and bronchoalveolar lavage often provide diagnostically valuable specimens.
Diagnosis
Diagnosis and identification of immunodeficiency pneumonia
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
Patients with acute symptoms should be identified for bacterial infection, bleeding, pulmonary edema, leukocyte lectin response or pulmonary embolism.
Symptoms are subacute or chronic, and are distinguished from fungal or mycobacterial infections, opportunistic viral infections, Pneumocystis carinii pneumonia, tumors, cytotoxic drug reactions or the possibility of radiation damage.
1. pulmonary edema (pulmonary edema): refers to the formation of imbalance and imbalance of reflux in the lungs for some reason, so that a large amount of tissue fluid can not be absorbed by the pulmonary lymph and pulmonary vein system in a short time, from the extravasation of the pulmonary capillaries, Accumulation in the alveoli, pulmonary interstitial and small bronchi, resulting in severe ventilation and ventilation function, clinical manifestations of extreme dyspnea, sitting breathing, cyanosis, sweating, paroxysmal cough with a lot of white or The pink foam is sputum, the lungs are full of symmetrical wet squeaks, and the X-ray chest radiograph shows the butterfly-like smear-like blurred shadows of the two lungs. In the late stage, shock or even death may occur. The arterial blood gas analysis may have low O2 and low CO2 partial pressure in the early stage. Severe deficiency of O2, CO2 retention and mixed acidosis is one of the clinical critical illnesses.
2. Pulmonary embolism refers to the pathological and clinical state caused by the insertion of the embedding material into the pulmonary artery and its branches, blocking the blood supply of the tissue. The common embolus is a thrombus, and the rest are rare new biological cells, fat droplets, and air bubbles. Intravenous drug particles or even pulmonary vascular occlusion caused by the tip of the catheter. Since lung tissue is subjected to dual blood supply to the bronchial artery and pulmonary artery, and gas exchange can also be performed directly between the lung tissue and the alveoli, most pulmonary embolism does not necessarily cause pulmonary infarction.
3. Pneumocystis carinii pneumonia, also known as Pneumocystis carinii pneumonia, is an interstitial plasma cell pneumonia caused by Pneumocystis carinii, a conditional pulmonary infection.
