Pediatric Legionnaires' Disease Nephropathy
Introduction
Introduction to Pediatric Legionnaires' Disease Legionella infections are mainly characterized by pneumonia, which can also be combined with damage from other systems, thereby aggravating the condition. Kidney involvement is one of the most common comorbidities of Legionnary Diseases (LD). Half of the cases can have proteinuria, and microscopic hematuria accounts for about 1/4. In severe cases, acute renal failure (acute renal failure) can occur. It has been reported that if LD has 2 organs, the mortality rate is 66%; 3 organs are damaged to 95%, and 4 organs are 100%. basic knowledge Sickness ratio: 0.0001% Susceptible people: children Mode of infection: non-infectious Complications: lung abscess pleurisy pericarditis respiratory failure
Cause
Etiology of nephrotic disease in children
(1) Causes of the disease
Legionella is an aerobic Gram-negative bacillus, of which LD1, 4 and 6 are more important. This bacterium can produce -lactamase. Legionella can secrete zinc-containing metalloproteinase, causing tissue dissolution and destruction. The cavity is formed, and in addition, the bacteria can release toxins and have a pathogenic effect.
(two) pathogenesis
At present, the pathogenesis of renal damage is not well understood, and may be directly related to endotoxin or bacterial invasion or related to immune response damage. Coagulation factors, complement system, vasoactive amines are associated with the pathogenesis of glomerulonephritis, and some reports suggest kidney damage. Related to DIC, most authors believe that acute tubular necrosis, acute interstitial nephritis is the main cause of acute renal failure in this disease, there are also reports of individual cases confirmed by histopathology as rapid glomerulonephritis, renal pelvis with abscess formation An autopsy report of nephritis.
Prevention
Pediatric Legionnaires' Disease Prevention
There are currently no effective preventive measures.
1. Drinking water can be sterilized by chlorination or boiling to kill the bacteria.
2. For the air conditioning system should be shut down, disinfection and cleaning; for the water supply system, wet equipment, sprayers, etc. for sanitary management to control the outbreak.
3. The immune vaccine is under development.
Complication
Pediatric Legionnaires' Kidney Disease Complications Complications lung abscess pleurisy pericarditis respiratory failure
Some cases of Legionnaires' disease may have lung abscess, pleurisy, pericarditis, respiratory failure, cardiac insufficiency, shock, DIC and other clinical symptoms. Legionnaires' disease patients with severe oliguria or anuria may develop acute renal failure.
Symptom
Pediatric Legion's disease nephropathy symptoms Common symptoms Nephrotic syndrome oliguria chest pain no urinary abdominal pain drowsiness diarrhea protein urine hematuria coma
1. The typical clinical manifestation of Legionnaires' disease is an acute pulmonary infection with fever, cough, chest pain and other respiratory symptoms.
2. Other systemic symptoms may include abdominal pain, diarrhea, gastrointestinal bleeding and other digestive symptoms. Some cases have headaches, irritability, lethargy, coma and other neurological symptoms.
3. Half of the kidney damage has proteinuria, some are nephrotic syndrome-like manifestations, some have microscopic hematuria, severe oliguria or no urine, can develop acute renal failure and corresponding clinical manifestations.
Examine
Pediatric Legionnaire's disease check
1. General examination of peripheral white blood cell count can be in the normal range or slightly increased, erythrocyte sedimentation rate is increased, hyponatremia is more common.
2. Urine routine examination The urine routine examination of this disease is abnormal, proteinuria and microscopic hematuria can be seen.
3. Patients with renal failure may have azotemia and other indicators of renal dysfunction, including a reduction in creatinine clearance, and a higher percentage of filtered sodium excretion.
4. Respiratory secretions (sputum or intratracheal aspirate) Gram staining can not find a large number of dominant bacteria, only a small number of neutrophils.
5. Legionella pathogen culture has little significance for early diagnosis. Sputum, intratracheal aspirate, bronchoscopy lotion, pleural effusion or lung tissue homogenate are inoculated into Mueller-Hinton medium, plus 0.025% iron pyrophosphate and 0.04% L-cysteine, or inoculated on charcoal yeast infusion agar medium, is currently considered to have a positive rate of 60% to 70%.
6. Serological examination using indirect immunofluorescence has higher sensitivity and specificity, double serum titer increased more than 4 times, or a single serum titer 1: 256 can be diagnosed.
(1) Indirect fluorescent antibody method: double serum antibody titer increased more than 4 times, and reached 1:128, or recovery period single serum titer 1: 956 can diagnose the disease, more than 3 weekends (minority 6 weeks) serum antibody titer can reach the diagnostic criteria, the positive rate of this method is about 80%.
(2) Direct fluorescent antibody method: The pathogenic bacteria of the respiratory secretions of patients are detected by known antibodies, and the positive rate can reach 50%, which can be used for early diagnosis.
(3) Enzyme-linked immunosorbent assay: detection of Legionella pneumophila antigen in patients with sputum or urine, can also be used for early diagnosis, routine B-ultrasound, electrocardiogram, X-ray film, etc., to understand the lungs, heart, etc. No damage.
Diagnosis
Diagnostic and differential diagnosis of pediatric legion disease
Diagnostic criteria:
1. Symptoms of respiratory infection and abnormal urine test.
2. The chest radiograph has an infiltrative inflammatory shadow in the lungs.
3. , respiratory secretions, blood culture has Legionella.
4. Serological test titers increased, except for one or two items, plus one or three or four items can be diagnosed.
Legionnaires' disease nephropathy must be differentiated from hematuria and proteinuria caused by other causes. Legionnaires' disease has two different manifestations of influenza type (Pontiac fever) and pneumonia type, so it must be clinically associated with influenza, viral pneumonia, and parrot. Heat, Q heat, mycoplasmal pneumonia, bacterial pneumonia and other identification.
