Yellow-white sticky phlegm with fruity smell
Introduction
Introduction Flavobacterium aureus was first detected in the feces of intestinal patients in 1920 and subsequently found on the surface of urine, blood, sputum, wounds and ulcers. A patient with acute intracerebral hematoma was reported. On the 4th day after surgery, the body temperature increased, the breathing was difficult, and the amount of sputum increased. It was yellow-white sticky and fruity. Check the lungs have a fine voice, a small amount of wheezing. White blood cells were 23.7×10 9 /L, and the chest radiograph was infected with both lungs. Three times of sputum culture during hospitalization showed non-fermenting bacterium Lactobacillus, which belongs to the pure growth of Flavobacterium fuliginea. The strain produced insoluble yellow pigment, which had special aroma and positive oxidase test. Signs of Flavobacterium pneumonia: The clinical manifestations of this bacterium after infection are diverse and vary depending on the site of infection. Common clinical manifestations are fever, with mild or moderate irregular fever, and some are relaxation heat. In severe cases, such as meningitis, lung, septicemia, etc., the body temperature is higher, and the toxemia is heavier. After the baby is infected, there are signs of poisoning such as wilting, less movement, less crying, pushing food, and vomiting.
Cause
Cause
Flavobacterium-negative bacillus, including F. menigosepticum, group IIb yellow bacillus (F.IIb), F. odoratum and F. multivocum )Wait. Among them, the Haemophilus meningitidis and the IIb subgroup are the main pathogens, which can cause various infections and sepsis to humans. The genus Gram stain is negative, the bacteria are slender, the ends are slightly rounded, no power, no spores, oxidase positive, can decompose mannitol, and the ability to ferment sugar is slow and weak. A striking feature is the production of yellow pigment during growth. Meningococcus bacillus can be divided into A, B, C, D, E, F6 serotypes, causing human infection mainly C type, followed by B, D, F type. The biochemical characteristics of the yellow bacillus. The pathogenicity of the disease is not strong, it is a conditional pathogen, and generally does not cause infection, but may cause infection when the body's immunity declines. The bacteria are easy to cause infection in infants, especially in premature infants. Adult cases are common in elderly and frail hospitalized patients, or those suffering from acute and chronic diseases. There are also high-dose broad-spectrum antibiotics, anti-tumor drugs, corticosteroids, surgery, tracheotomy, etc., which can often cause infection. The hands of contaminated equipment and workers are the main medium for the transmission of germs.
Examine
an examination
Related inspection
Sputum bacteria culture blood sputum smell
Because the clinical manifestation of Flavobacterium infection is not specific, it is difficult to judge the infection from the clinical manifestation. It is necessary to quickly obtain the specimen and isolate the bacteria. Using blood agar or MacConkey agar plate, cultured at 30 °C for 18-24 hours, suspicious colonies were inoculated with TSI, cultured at 30 °C for 24 h, high-level and slanted surface did not produce acid, oxidase-positive, yellow moss, slightly sticky, suspected flavobacterium , to be further identified. The next step is the genus, the OF test is oxidized, yellow pigment is produced (a few are not produced), does not diffuse into the medium; no motility, no spores; has oxidase and catalase; Gram-negative bacillus or coccus . The next step is to determine the species and determine the strain by biochemical tests. Importantly, the identification of the above-mentioned yellow bacillus of the meninges and the yellow group of Flavobacterium has been described above.
Laboratory examination: the number of white blood cells is generally significantly increased, which can be greater than 5.0×10 9 /L, neutrophils can reach more than 90%, and there is a nuclear left shift phenomenon. ESR is often increased. Patients with multiple organ failure and septic infection had elevated ALT in the blood and abnormal renal function. The disease can be complicated by low plasma permeability syndrome, blood sodium, potassium decreased and plasma osmotic pressure decreased in urine osmotic pressure. Arterial blood gas analysis can have hypoxemia, hypercapnia and acidosis.
Other ancillary examinations: Some patients with ECG may have abnormal changes in hypokalemogram and arrhythmia.
Diagnosis
Differential diagnosis
1. Cough chocolate color: The sputum is mucus secreted by the mucous membranes of the respiratory tract (bronchial, tracheal, larynx, and nose). Under normal circumstances, the mucous membrane of the respiratory tract secretes a small amount of mucus to maintain the moisturization of the respiratory tract. The dipping solution can also act as a barrier. It can stick to germs and dust, foreign matter, etc. that invade the respiratory tract. Because there is a large amount of "lysozyme" in the mucus, it can kill the bacteria. Normal people generally do not cough, only a few people get up early in the morning can have a small amount of sputum cough, its color is clear and transparent, is a normal phenomenon. When the respiratory tract changes abnormally, or at different times of the same disease, the amount, quality, taste, etc. of the sputum changes. Therefore, if you carefully observe these changes in your daily life, you can distinguish the disease. Reddish-brown or chocolate-colored sputum, seen in the amebic disease of the lung caused by the amoebic abscess that penetrates into the lungs.
2, lemon color : lemon color is common in simple pulmonary eosinophilia, simple pulmonary eosinophilia (simple pulmonary eosinophilia) was first reported by Loffler in 1932, it is also known as Lufler synthesis Lofflers syndrome. It is characterized by mild systemic symptoms, a transient lung shadow on the X-ray, and blood eosinophilia. The course of disease is 2 to 4 weeks, also known as acute pulmonary eosinophilia. Patients may have a history of personal or family allergies.
3, sticky or purulent sputum with scent: sputum is often sticky or purulent, may have odor is the clinical diagnosis of Escherichia coli pneumonia. Escherichia co1i (also known as Escherichia coli) pneumonia has increased significantly in recent years, is the second most common pathogen of Klebsiella pneumoniae, which is the second most common pathogen of Klebsiella pneumoniae, which causes community-acquired Gram-negative bacilli pneumonia. 12% to 45% of pneumonia, accounting for 2.0% to 3.3% of all pneumonia pathogens. It is one of the main pathogens of acquired pneumonia in hospitals, with an incidence of 4.2 to 9.0/10,000, accounting for 9.0% to 15.0% of Gram-negative bacilli pneumonia. In the 1960s, the mortality rate of the disease was as high as 60%, and it dropped significantly after the 1980s, with a report of 29%. It mainly occurs in elderly debilitated patients, all kinds of chronic basic diseases, critically ill patients, tracheal intubation, long-term treatment with corticosteroids and other immunosuppressive agents, long-term use of antibiotics and dysbacteriosis, and various immune balls. Patients with protein defects, etc., are susceptible to this disease.
4, cough up yellow sputum: cough symptoms caused by bronchitis: early mild dry cough, later turned into a wet cough, can cough up yellow purulent. Early symptoms of cold, such as fever, sneezing.
