Rotten peach-like bloody phlegm
Introduction
Introduction Rotten peach-like blood stasis is a common clinical manifestation of pulmonary paragonimiasis. Paragonimiasis, also known as paragonimiasis, is an acute or chronic endemic parasitic disease caused by Paragonimus. The worm is mainly parasitic in the lungs, with cough and rotten peach-like color as the main performance. Parasitic in a variety of tissues and organs, such as the brain, spinal cord, gastrointestinal tract, abdominal cavity and subcutaneous tissue, produce corresponding symptoms. Its clinical manifestations are also diverse. The incubation period is several days to 20 years, mostly within one year.
Cause
Cause
(1) Causes of the disease
There are nearly 40 species of paragonimus in the world, among which 8 species are pathogenic to human body, mainly Paragonimus sinensis and Paragonimus sichuan.
The first intermediate host of Paragonimus pygmaea is more than 20 species of freshwater snails, and the second intermediate host is crabs, which are crustaceans. The terminal host is a mammal or a mammal such as a cat or a pig. These animals, other than humans, are also called insect-preserving hosts, and are the main source of infection that constitutes a natural foci.
(two) pathogenesis
The cystic sputum enters the human body from the mouth, and is decapsulated into a child worm in the intestine. The worm enters the chest cavity through the intestinal wall, penetrates the diaphragm into the chest cavity, and develops into an adult in the lung. The worms migrate, and the spawning stimulates the tissue, causing tissue damage and immunological pathological reactions of the human body, leading to tissue necrosis and abscess formation. The granulation tissue around the lesion proliferates to form a cyst wall and becomes a cyst. The cyst fluid is brown-red jam-like, containing insects, Charcot-Ryden crystals and eosinophils. The worms die, the contents are discharged or absorbed, and the cysts are replaced by fibrous tissue to form scars. Since the eggs do not develop into hairy mites in the human body, they do not secrete soluble antigens, causing only mechanical or foreign body stimulating effects, and there are inflammatory cells infiltrating into miliary-sized pseudo-nodules. It belongs to the foreign body granuloma reaction and gradually becomes fibrotic. The worm body has a migratory nature and can cause lesions in a variety of tissues and multiple sites.
Examine
an examination
Related inspection
Cultivate sputum routine examination
1. Peripheral blood test
Blood peripheral leukocytosis. Eosinophilia is generally 5% to 20%, and the acute phase can be as high as 85% or more. The performance caused by Paragonimus in Sichuan is more significant. More than half of the ESR increases.
2. Pathogen examination
Eggs can be found in patients with paragonimiasis. Some patients can find eggs by swallowing them. Cerebrospinal fluid and pleural effusion can also find eggs and more eosinophils. Tissue biopsy subcutaneous masses, especially migratory masses or nodular tissue biopsies, can be found in children and eosinophilic granuloma. Paragonimus is more common in Sichuan.
3. Immunological examination
Intradermal test: simple and easy to use, often used for epidemiological investigation and screening. The positive rate is as high as 99%, but the specificity does not cross-react with other trematode diseases. Once the infection reaction lasts for a long time.
Complement binding test: Diagnostic significance for early paragonimiasis, sputum-negative. The serum complement fixation test can be positive 2 to 4 weeks after infection, and the positive rate is 98%, but it has cross-reaction to other trematode diseases.
Enzyme-linked adsorption test: sensitivity up to 100%, no cross-positive reaction. A positive person may be infected recently or is suffering from a disease.
4. X-ray inspection
Early manifestations of pleural reaction and pleural effusion, late pleural adhesion thickening. Pulmonary lesions are mainly in the middle and lower lung fields. Due to the different stages of development of the lesion, there are different X-ray signs:
(1) In the early stage of abscess, the infiltrated shadow of the blurred boundary of 1~2cm, the center has a small translucent area. Its pathological basis is the early hemorrhage or inflammatory infiltration caused by adult migration in the lungs.
(2) The cystic period is a nodular or agglomerate with vacuoles of different sizes. Single or multiple rooms, the capsule wall is thin and the edges are blurred. The old lesions have thicker walls and clear edges. This is the most characteristic sign. This is caused by the formation of a tunnel when Paragonimus paragonimiasis migrates in the lungs.
(3) The fiber scar period is a sharp circular nodular shadow with a small vacuole, or a dense speckled strip shadow and calcification. A fibrous proliferative lesion caused by a worm. As the insects move continuously, the above performance can occur simultaneously.
Diagnosis
Differential diagnosis
1, hemoptysis: respiratory diseases are mostly cough, cough symptoms. It can be a grayish white mucus or a yellow-green purulent. Sometimes the coughed sputum has bright red blood, which is called hemoptysis. Medically, hemorrhage is caused by hemorrhage of the trachea, bronchus or lung tissue below the larynx and excreted by cough.
2, lemon color : common in simple pulmonary eosinophilia, simple pulmonary eosinophilia (simple pulmonary eosinophilia) was first reported by Loffler in 1932, it is also known as Luffler syndrome (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, bloody phlegm: that is, blood in the sputum, blood clots. Sputum with bright red blood, more common in tuberculosis or bronchiectasis, sometimes this phenomenon can also occur in the throat.
4, the adhesion of coal dust or cholesterol crystal: it is a symptom of the clinical manifestations of coal workers' pneumoconiosis. Coal miner's pneumoconiosis refers to the general term for lung lesions caused by coal mine workers' long-term inhalation of dust in the production environment.
5, cough chocolate color: reddish brown or chocolate color enamel, found in the amoebic liver abscess swollen into the lung caused by lung amebiasis.
6, rust color sputum, seen in pneumococcal pneumonia.
