Thickening of texture and infiltration around the lungs or bronchi

Introduction The clinical manifestations of Q fever, X-ray examination often found a segmental or large-leaf blurred shadow around the lower lobe of the lungs, and the texture of the lungs or bronchi can be thickened and infiltrated, similar to bronchial pneumonia.

Cause

Bernard Rickett infection.

an examination

Related inspection

Complement binding test

(1) Clinical diagnosis

For patients with fever, if there is a history of contact with livestock such as cattle and sheep, if there is a local disease, the possibility of Q fever should be considered. Those who are associated with severe headache, myalgia, pneumonia, hepatitis, and foreign Fibonacci test should be highly vigilant.

(2) Laboratory inspection

Blood picture

The blood cell count is normal, the neutrophils are slightly shifted to the left, the platelets can be reduced, and the erythrocyte sedimentation rate is moderately increased.

2. Serology

(1) Complement binding test

The acute Q-hot phase II antibody is elevated and the phase I antibody is at a low level. If the titer of a single serum phase II antibody has a diagnostic value of 1:64 or more, the serum titer of the double serum is increased by 4 times 2 to 4 weeks after the disease, and the diagnosis can be confirmed. Chronic Q fever, phase I antibodies are comparable or exceed II phase antibody levels.

(2) Microagglutination test

The phase I antigen was converted to phase II antigen by trichloroacetic acid treatment, and stained with hematoxylin and then agglutinated with the patient's serum on a plastic plate. This method is more sensitive than the complement fixation test, and the positive rate (50% in the first week and 90% in the second week) can also be measured by capillary agglutination. However, the specificity is not as good as the combination test.

(3) Immunofluorescence and EliSA detection of Q heat-specific IgM (anti-II phase antigen), which can be used for early diagnosis.

3. Pathogen separation

Blood, sputum, urine or cerebrospinal fluid materials were injected into the abdominal cavity of guinea pigs. The serum complement-binding antibody was measured within 2 to 5 weeks, and the titer was increased. At the same time, the animals had fever and splenomegaly. The spleen tissue and spleen surface infiltration were taken by necropsy. Liquid smear staining microscopic examination of pathogens; rickettsia can also be isolated by chicken embryo yolk sac or tissue culture method, but must be carried out in a conditional laboratory to avoid infection in the laboratory.

Differential diagnosis

1. Thickening of the lungs in two lower lungs: In patients with chronic bronchitis, the lungs are thickened in the X-ray examination. The symptoms are slow and the course is longer. Some patients have acute bronchitis, influenza or pneumonia before the onset. The history of respiratory infections has developed into a disease due to prolonged unhealed conditions. The main symptoms are chronic cough, cough and shortness of breath or wheezing. Symptoms are mild at first, and as the disease progresses, due to repeated respiratory infections, acute attacks become more frequent and the symptoms become more severe, especially in winter.

2, lung texture thickening: lung texture refers to the radiation strip shadow from the hilar to the periphery of the lung field seen during chest imaging examination. It is mainly composed of pulmonary artery, pulmonary vein, bronchus and lymphatic vessels. The lung texture on the chest X-ray is increased. Common causes of this symptom are chronic bronchitis, bronchiectasis, rheumatic heart disease, congenital heart disease, pneumoconiosis, and cancerous lymphangitis.

3, lung texture reduction: lung texture changes are affected by a variety of factors, any structure that constitutes the lung pattern lesions, all changes lead to lung changes, lung pattern is rare due to excessive lung volume expansion such as emphysema, congenital heart Lung lines are also rare when the lungs are less bloody. The reduction in lung texture in most cases means a reduction or thinning of the pulmonary blood vessels, the so-called "pulmonary ischemic sign".

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