Pneumococcal pneumonia

Introduction to pneumococcal pneumonia Pneumococcal pneumonia is caused by pneumococci or Streptococcus pneumoniae, accounting for more than half of all outpatient infections. The lung segment or the lung lobe is acutely inflammatory, and the patient has symptoms such as chills, high fever, chest pain, cough and blood stasis. In recent years, due to the wide application of antibacterial drugs, clinical symptoms are mild or atypical diseases are more common. Pneumococci usually pass through the upper respiratory tract to the lungs. They stay in the bronchioles to proliferate and cause inflammatory processes, and begin to produce a large amount of protein in the alveolar cavity. This liquid acts as a medium for the culture of the pathogen and can help the bacteria spread to the adjacent alveoli. The typical result is that the large leaves are caused. Pneumonia. basic knowledge The proportion of illness: the incidence rate is about 3-5% Susceptible people: no special people Mode of infection: respiratory transmission Complications: Myocarditis, premature beats, septic shock, sepsis

The cause of pneumococcal pneumonia

Excessive fatigue (25%):

Chinese medicine believes that pneumococcal pneumonia is often caused by excessive fatigue, drunkenness, wind and other human body deficiencies, feeling the evil of wind and heat or the evil of coldness into the heat. The patient has a history of cold rain, fatigue, and drunkenness.

Low immunity (45%):

When the respiratory defense function is weakened, the respiratory tract is infected by the virus, destroying the integrity of the bronchial mucosa, and easily inducing bacterial infection. Common in cold, fatigue, hunger, drunkenness, anesthesia, coma, immunodeficiency disease, congestive heart failure and so on.

Pathogenesis

Pneumococci usually pass through the upper respiratory tract to the lungs. They stay in the bronchioles to proliferate and cause inflammatory processes, and begin to produce a large amount of protein in the alveolar cavity. This liquid acts as a medium for the culture of the pathogen and can help the bacteria spread to the adjacent alveoli. The typical result is that the large leaves are caused. Pneumonia.

The initial stage of lobar pneumonia is hyperemia, characterized by a large amount of serous exudate, vasodilation and rapid proliferation of bacteria. The next stage is called "red liver-like change", that is, the solid lung has a liver-like appearance: the air cavity is filled with polymorphonuclear cells, blood vessel congestion and extravasation of red blood cells, so the naked eye is reddish. This is followed by a "grey liver-like change" phase in which fibrin accumulation is associated with white blood cells and red blood cells at different stages of decomposition, which are filled with inflammatory exudates. The final stage is the dissipation period characterized by exudate absorption.

Pneumococcal pneumonia prevention

1. Pneumococcal pneumonia is the most common bacterial pneumonia. In recent years, due to the widespread use of antibiotics, it is common to be mild or atypical in clinical practice. Most of the prognosis is good. After reasonable treatment for about 2 weeks, it can be recovered, but it is frail and old. The original chronic disease, serious illness and shock patients have a poor prognosis, so we must pay attention to prevent upper respiratory tract infections, strengthen cold-resistant exercise; avoid rain and cold, drunk, excessive fatigue and other incentives; actively treat primary diseases, such as chronic heart and lung disease, Chronic liver disease, diabetes and oropharyngeal diseases can prevent the occurrence of pneumonia.

2. Vaccination.

Pneumococcal pneumonia complications Complications Myocarditis Premature Beat Infectious Shock Septicemia

1, the pneumococcal pneumonia complications have been less common in recent years, severe sepsis or toxemia patients can be complicated by septic shock, there is high fever, but also have body temperature does not rise, blood pressure drops, limbs cold, sweating, cyanosis.

2, complicated with myocarditis, tachycardia, heart rhythm disorder, such as premature beats, paroxysmal tachycardia or atrial fibrillation, and pleurisy, pleural fluid is serous fibrinous exudation.

3, in the era of penicillin application, there are reports of concurrent empyema.

Pneumococcal pneumonia symptoms Common symptoms Cough with chest pain High heat chest pain with bloodshot fever with cough, slightly...

Patients often suffer from cold rain, fatigue, drunkenness, mental stimulation, and history of viral infection. Half of the cases have prodromal symptoms of upper respiratory tract infection for several days. The onset is more rapid, with high fever, half with chills, and body temperature can rise to within a few hours. 39-40 ° C, peak in the afternoon or evening, can also be traced heat, parallel with the pulse rate, the patient feels full body muscle pain, chest pain on the affected side, can be radiated to the shoulder, abdomen, cough or deep breathing, exacerbated, less It can be bloodshot or rust-colored, with a sharp reduction in appetite, occasional nausea, vomiting, abdominal pain or diarrhea, sometimes misdiagnosed as acute abdomen.

The patient presented with acute illness, red cheeks, dry skin, simple herpes on the mouth and nose, when the pneumonia was extensive, the ventilation/blood flow ratio was reduced, hypoxemia occurred, manifested as shortness of breath, purpura, sepsis, skin and There may be bleeding points in the mucosa; yellow staining of the sclera; resistance to the neck may affect the meninges, increased heart rate, sometimes arrhythmia, no obvious abnormalities in early lung signs, only a reduction in thoracic respiratory motion, mild turbidity, breathing Reduced sound and pleural friction sound, and there are typical signs in consolidation, such as turbidity, increased vocal fibrillation and bronchial breath sounds, dissipative period can be heard and wet voice, severe cases can be associated with flatulence, upper abdominal tenderness may be due to inflammation Peripheral pleural, severe infection may be associated with shock, disseminated intravascular coagulation, adult respiratory distress syndrome and neurological symptoms, such as confusion, irritability, lethargy, paralysis, coma, etc., must be closely observed, active treatment.

When the human body produces enough specific antibodies to the capsular antigen, the combination of the two, in the presence of complement, is beneficial to the phagocytosis of the bacteria by the phagocytic cells. On the 5th-10th day of onset, the fever can diminish or gradually decrease on its own, and the use is effective. The antibacterial drug can restore the body temperature to normal within 1-3 days, and the patient suddenly disappears and gradually recovers.

Examination of pneumococcal pneumonia

1, blood routine: white blood cell counts are mostly 10-30 × 109 / L, more than 80% of neutrophils.

2, sputum smear examination: there are a large number of neutrophils and Gram-positive pairs or short-chain cocci.

3, sputum culture: pathogens can be identified at 24-48h.

4, X-ray examination: In recent years, typical X-ray films have been rare.

5, pneumococcal pneumonia chest X-ray examination: the distribution of the lungs or lung segments of uniform and dense large-scale solid shadow.

Diagnosis and identification of pneumococcal pneumonia

diagnosis

1. Suddenly high fever, showing a heat retention pattern, accompanied by systemic poisoning symptoms such as chills.

2, chest pain, cough, rust-colored sputum or blood stasis, breathing difficulties and other respiratory symptoms and signs of lung consolidation.

3, bacteriological examination can make a pathogen diagnosis.

4, white blood cells and neutrophil counts, bacterial infections are generally elevated, viral infections are generally normal or low.

Differential diagnosis

1. Caseous pneumonia: The clinical manifestations of acute tuberculous pneumonia are similar to pneumococcal pneumonia. X-ray also has lung consolidation, but tuberculosis often has low heat and fatigue. It is easy to find tuberculosis in the sputum. X-ray shows lesions mostly in the lung tip or clavicle. Up and down, uneven density, long-term does not dissipate, and can form voids and intrapulmonary dissemination, and pneumococcal pneumonia treated with penicillin for 3-5 days, body temperature can return to normal, lung inflammation is also absorbed faster.

2. Pneumonia induced by other pathogens: The clinical manifestations of staphylococcal pneumonia and Klebsiella pneumoniae are serious. Gram-negative bacilli pneumonia is more common in frail, chronic heart disease or immunodeficiency patients, mostly secondary infections in the hospital. And or blood bacterial positive culture is an indispensable basis for diagnosis. Viral and mycoplasmal pneumonia are generally mild, white blood cells are often not significantly increased, clinical processes, sputum pathogen isolation and blood immunological tests are important for diagnosis.

Third, acute lung abscess: early clinical manifestations similar to pneumococcal pneumonia, but with the development of the disease, a large number of pus sputum is a characteristic of lung abscess, the pathogens are Staphylococcus aureus, Klebsiella and other Gram-negative bacilli And anaerobic bacteria, X-ray shows abscess and fluid level, easier to identify.

Fourth, lung cancer: a few peripheral lung cancer X-ray images are similar to lung inflammation, but generally no fever or only low fever, peripheral white blood cell count is not high, cancer cells can be diagnosed in the sputum, lung cancer can be associated with obstructive pneumonia, by After antibiotic treatment, the inflammation subsides, the tumor shadow becomes more and more obvious, or the hilar lymphadenopathy is accompanied by the atelectasis. For the effective antibiotic treatment, the inflammation does not dissipate for a long time, or after the dissipating, the older patients are especially reappeared. Should pay attention to observation, sometimes X-ray tomography, CT, MRI examination, sputum exfoliated cells and fiberoptic bronchoscopy, etc., so as not to delay diagnosis.

V. Other diseases: When pneumonia is accompanied by chest pain, it needs to be differentiated from exudative pleurisy, pulmonary infarction, pleural fluid and X-ray. Pulmonary infarction has the basis of venous thrombosis, hemoptysis is more common, rarely occurs. Oral herpes zoster, lower lobe pneumonia sometimes has abdominal symptoms, should be identified by X-ray and other examinations and underarm abscess, cholecystitis, pancreatitis and appendicitis.

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