Salmonella pneumonia
Introduction
Introduction to Salmonella pneumonia In 1885, Salmonella and other serotypes of Salmonella cholera were isolated during the cholera epidemic, hence the name Salmonella. Some of the Salmonella genus are pathogenic to humans, and some are only ill to animals, but also to humans and animals. Salmonella refers to a general term for different forms of infection caused by various types of Salmonella to humans, domestic animals, and wild animals. People infected with Salmonella or the faeces of carriers may contaminate food and cause food poisoning. According to statistics, among the various types of bacterial food poisoning in countries around the world, food poisoning caused by Salmonella is often ranked first. Salmonella is also the first in the inland areas of China. With the increase of the resistance rate of Salmonella, it has become a so-called "refractory" pneumonia, especially in children, the elderly and immunosuppressed patients, the mortality rate is extremely high, the pathogenic diagnosis level is improved, the antibiotics are rationally applied, and the emergence of drug-resistant bacteria is avoided. And improving supportive care is an urgent need to emphasize and solve the clinical treatment of pneumonia. basic knowledge The proportion of the disease: the probability of the population is 0.033% Susceptible people: no specific population Mode of infection: non-infectious Complications: septic shock arrhythmia
Cause
Causes of Salmonella pneumonia
The pathogen of salmonellosis. Is Enterobacteriaceae, Gram-negative enterobacter. Nearly a thousand (or strains) have been discovered. According to its antigenic composition, it can be divided into basic bacteria such as A, B, C, D, and E. Among them, there are mainly group A of parasiticidal bacillus, group B of parahatis bacillus and typhoid typhoid, group C of parahatis faecalis and cholera cholera, typhoid bacillus and enterobacteria. In addition to human diseases caused by Salmonella typhimurium, M. parahaemolyticus and B. paratyphimurium, most of them can only cause diseases of animals such as livestock, rodents and poultry, but sometimes they can also contaminate human food and cause food poisoning.
Salmonella is not easy to reproduce in water, but it can survive for 2-3 weeks, can survive for 3-4 months in the refrigerator, and can survive for 1-2 months in the feces of the natural environment. The optimal breeding temperature of Salmonella is 37 °C, and it can multiply at above 20 °C. Therefore, storage of food at low temperature is an important preventive measure.
Prevention
Salmonella pneumonia prevention
Old age, with severe underlying diseases, immune function inhibition host pneumonia has a poor prognosis. After the widespread use of antibacterial drugs, the mortality rate of pneumococcal pneumonia has dropped from 30% to 6%, but Gram-negative bacilli, Staphylococcus aureus It is a pneumonia caused by MRSA, the mortality rate is still high, enhance physical fitness, avoid upper respiratory tract infection, and the selective application of vaccine in high-risk patients has certain significance in preventing pneumonia.
Complication
Salmonella pneumonia complications Complications , septic shock, arrhythmia
Complications have been rare in recent years. Severe infections in toxic patients are prone to septic shock, especially in the elderly, which are characterized by decreased blood pressure, cold limbs, sweating, cyanosis, tachycardia, arrhythmia, and high fever and chest pain. Symptoms such as cough are not prominent. Other complications include pleurisy, empyema, pericarditis, meningitis and arthritis.
Symptom
Symptoms of Salmonella pneumonia Common symptoms Fever with chills, cough, cough, dyspnea, chest pain
Often suffering from cold, fatigue and other causes or chronic obstructive pulmonary disease, heart failure and other basic diseases, one third of patients have a history of upper respiratory tract infection before the disease, most of the onset is more urgent, more chills, fever, cough, cough Hemorrhoids, chest pain and other symptoms, fever is common, mostly for persistent high fever. After antibiotic treatment, the heat type can be atypical, coughing, coughing, early dry cough, gradually coughing, sputum volume is different, sputum is mostly purulent After the antibacterial treatment, the typical sputum development is rare. A few have hemoptysis and dyspnea. Some have chest pain. When the pleura is involved, there is acupuncture-like pain. The lower lobe pneumonia stimulates the pleura. The pain can be radiated to the shoulder. Department or abdomen, the latter is easily misdiagnosed as acute abdomen, systemic symptoms have headache, muscle aches, fatigue, a small number of gastrointestinal symptoms such as nausea, vomiting, abdominal distension, diarrhea, severe patients may have sleepiness, disturbance of consciousness, convulsions, etc. Systemic symptoms.
Examine
Examination of salmonellosis pneumonia
(1) Chest X-ray examination: The most common manifestation is bronchial pneumonia type change, which usually does not help to determine the pathogen of pneumonia, but some characteristics may be helpful for diagnosis, such as consolidation of the lung, cavity formation or a large amount of pleural effusion More common in bacterial pneumonia, staphylococcal pneumonia can cause obvious lung tissue necrosis, lung balloon, lung abscess and empyema, Gram-negative bacillus pneumonia often shows lower bronchial pneumonia type, easy to form multiple small abscess, diagnosis of pneumonia It has important value, the location of the inflammatory infiltrating shadow, the range, the presence or absence of cavities, and the pleural effusion are related to the pathogen.
X-ray findings of pneumonia from different pathogens
X-ray showed pathogenic bacteria leaves or segments of low-density flaky infiltration of Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Escherichia coli, Legionella uniform infiltration (spot or strip shadow) Mycoplasma pneumoniae, virus, anaxia Mixed infection of oxygen and non-anaerobic bacteria, diffuse uniform infiltration of the genus Legionella or nodular shadow Legionella, virus, Pneumocystis carinii, Mycobacterium, Aspergillus, Candida, blood dissemination Infected with invasive S. aureus, Gram-negative bacteria, anaerobic bacteria, Mycobacterium tuberculosis, Aspergillus
(B) bacteriological examination: sputum or pleural smear examination, cultivation of pathogenic bacteria and antibiotic susceptibility test. Continuous 2 or 3 times for the same bacteria growth, the possibility of pathogenic bacteria is large, only one positive or multiple times for different bacteria Growth, poor reliability, bacterial concentration 107cfa / ml for pathogenic bacteria, 105 ~ 107cfa / ml is suspicious, <105cfa / ml is mostly contaminated bacteria.
(3) Blood examination: white blood cell count and neutrophils generally increase, and there may be a left shift of the nucleus. The white blood cell count may not increase in the frail or severe cases.
(IV) Immunological examination: The detection of antigens or antibodies of serum pathogens by immunofluorescence, enzyme-linked immunosorbent assay, convective immunoelectrophoresis, etc., is helpful for diagnosis. The polymerase chain reaction has certain significance for the detection of pathogens.
(5) Other examinations: blood gas analysis, liver, kidney function, serum electrolytes, etc., if necessary.
Diagnosis
Diagnosis and identification of salmonellosis pneumonia
A few non-infectious conditions may have similar manifestations of pneumonia, such as acute respiratory distress syndrome (ARDS), congestive heart failure, pulmonary embolism, chemical gas inhalation, allergic alveolitis, drug pneumonia, radiation pneumonitis, connective tissue disease involving the lungs Department, tuberculosis, leukemia or other malignant tumors in the lung infiltration or metastasis, etc., should be identified, if necessary, diagnostic treatment can be used to confirm the diagnosis.
