Chickenpox pneumonia
Introduction
Introduction to Chicken Pox Pneum Varicella-zoster virus pneumonia is caused by the varicella virus and occurs mostly in adults. Winter and spring are good seasons, pneumonia symptoms occur more than 2 to 6 days after the rash, can also occur before the rash or 10 days after the rash. A small number of patients have mild symptoms and can recover after a few days. Most of them, except for typical skin manifestations, often have high fever, up to 40 ° C, cough, blood stasis or hemoptysis and chest pain. In severe cases, they have shortness of breath and progressive difficulty breathing. Cough and purulent sputum secondary to bacterial infection, about 40% of patients with cyanosis due to hypoxemia. In severe cases, the condition deteriorates rapidly, and the lesions in the lungs are diffused to cause severe arteriovenous shunt and cause respiratory failure. The chest X-ray signs are diffuse nodules or reticular shadows of the two lungs. The lesions can be fused with extensive infiltrates, often distributed in the lungs. The door or the bottom of the lungs. There may be signs of pleural effusion on both sides. The lesions are lighter than those in 1 to 2 weeks, and may be extended to several months. Those who may have residual calcifications at the end of the examination may have less chest signs during physical examination. Beep or wet voice, rarely found signs of lung consolidation, often not commensurate with lung lesions shown by chest X-ray signs. Varicella pneumonia can be diagnosed according to the history of exposure, typical varicella rash and clinical manifestations, as well as pulmonary X-ray pneumonia. basic knowledge The proportion of illness: 0.15% Susceptible people: no special people Mode of infection: respiratory transmission Complications: pulmonary edema shock
Cause
The cause of chickenpox pneumonia
Infection (30%):
Chickenpox is an acute infectious disease of the skin rash caused by varicella-herpes virus (varicella-herpes virus). The varicella virus is a herpes virus. It is a double-stranded DNA virus with a diameter of 150-200 nm and pneumonia caused by varicella virus. It is called varicella pneumonia.
Route of transmission (20%):
After invading the human body through the respiratory tract, the virus grows and multiplies in the nasopharynx mucosa, invading the bloodstream, and may replicate in mononuclear macrophages, which may cause viremia and systemic diseases. The virus mainly invades the skin, and the limbs and limbs are successively batched. A typical rash appears, with rash, papules, chickenpox and crusting in the same area. The rash develops very quickly. The short one can be converted into blisters in just a few hours. The severe infection affects the lungs or other organs such as the brain, liver, kidney, and digestive tract. Even if it can produce myocarditis or arthritis, the pathological manifestations of varicella pneumonia are similar to other viral pneumonia.
pathology:
Mainly caused by extensive interstitial pneumonia, lesions may involve the throat, trachea, bronchial mucosa and lung parenchyma, peri-bronchial and interstitial lungs with mononuclear cell-based inflammatory infiltration, pulmonary congestion, swelling, in the lungs In the interstitial cells, intranuclear inclusions are often seen. The alveoli are filled with fibrin, sometimes with a transparent membrane. The alveolar often has focal necrotic areas and vascular injury, and the pleural involvement produces nodules. Varicella rash and pleural effusion, bilaterally more common, lung and pleural nodule necrosis gradually calcified as the lesions healed.
Prevention
Chickenpox pneumonia prevention
Strict isolation measures are taken to isolate patients from herpes zoster, and children with varicella can be intramuscularly injected with gamma globulin or herpes zoster immunoglobulin, which can alleviate symptoms and prevent it. Foreign countries advocate immunity to susceptibility. Inferior contacts, pregnant women given intravenous acyclovir or attenuated varicella vaccine, have a preventive effect.
Complication
Chickenpox pneumonia complications Complications pulmonary edema shock
Fatal cases often have pulmonary edema and can also occur in shock.
Symptom
Symptoms of varicella pneumonia Common symptoms Dyspnea, respiratory failure, hypoxemia, cyanosis, cough, fever
The incubation period of chickenpox is 10 to 24 days. The varicella pneumonia is more common in adult varicella patients and immunocompromised patients. The symptoms of pneumonia occur more than 2 to 6 days after rash, and can also occur before rash or 10 days after rash. A small number of patients have mild symptoms and can recover after a few days. Most of them, except for typical skin manifestations, often have high fever, up to 40 ° C, cough, blood stasis or hemoptysis and chest pain. In severe cases, they have shortness of breath and progressive dyspnea. Fatal, secondary bacterial infection, cough and expectoration, about 40% of patients with cyanosis due to hypoxemia, severe disease rapidly worsening, the spread of lung lesions produce severe arterial shunt and cause respiratory failure, physical examination chest signs less, Smell the wheezing or wet voice, rarely found signs of lung consolidation, often not commensurate with the lung lesions shown by chest X-ray signs.
Examine
Examination of chickenpox pneumonia
The complement binding assay detects specific antibodies to aid diagnosis, and the Treponema pallidum antibody adsorption assay detects specific antibodies to aid diagnosis.
X-ray signs of the chest are diffuse nodules or reticular shadows of the two lungs. The lesions can be fused to form a wide infiltrating lesion, often distributed in the hilar or lung base, and there may be signs of pleural effusion on both sides. It is absorbed within 1 to 2 weeks, and it is also prolonged to the beginning of several months. In the end, there may be residual calcification.
Electron microscopy of the fresh herpes liquid for electron microscopy, see herpes virus particles, or take the herpes liquid inoculated human embryonic amniotic membrane for virus isolation can be diagnosed.
Diagnosis
Diagnosis and diagnosis of varicella
diagnosis
Varicella pneumonia can be diagnosed according to the history of exposure, the typical clinical manifestations of varicella and the pneumonia on the X-ray of the lungs. When the varicella is not diagnosed, the liquid in the fresh herpes can be taken for electron microscopy. See the herpes virus granules or take the liquid in the herpes to inoculate the human amniotic membrane. The tissue is isolated for virus, and complement fixation assay, indirect fluorescein-labeled antibody assay can be used to aid diagnosis.
Differential diagnosis
Diagnosis of viral pneumonia should be differentiated from secondary pneumonia caused by bacteria.
