legionella pneumonia emedicine
1976 Philadelphia Veterans Association in the acute outbreak of febrile respiratory illness was, the study found that a bacterium named Legionella pneumophila. Subsequently, many of the bacteria temporarily included in this genus, and the retrospective study found that early Army officers in 1943, that is cases of the disease. has made more than 30 Legionella, at least 19 species of human pathogen of pneumonia. One of the most common pathogens as Legionella pneumophila (accounting for 85% of cases 90%), followed by is L.micdadei (5% ~ 10%), again is L.bozemanii and L.dumoffii. such bacterial form similar to a common biochemical characteristics, causing a similar disease.
Disease include: (1) changes in asymptomatic serum; (2) self-limiting influenza-like ill without pneumonia, sometimes called Pangti Ake heat (Pontiac fever); (3) Army personnel for the most serious disease and the most common to the type of pneumonia; (4) limitations, a rare soft tissue infection.
Legionnaires disease requiring hospitalization accounted for community-acquired pneumonia in 1% to 8%, accounting for lethal hospital-acquired pneumonia about 4%. Most cases are sporadic, late summer and early autumn occurred. And the people transmission has not yet been confirmed between. When water supply system contaminated by pathogens or the formation of aerosol evaporation condenser air conditioning system, or the spof contaminated shower head when the Legionella outbreak of legionnaire''s disease c
an occur at any age , but most people are middle-aged men. has identified risk factors include smoking, alcohol abuse and immunosuppression, in particular, caused by the corticosteroid immunosuppression.
Symptoms and signs
Incubation period is generally 2 to 10 days. Most patients have prodromal period, similar to the flu, there are whole body discomfort, fever, headache and myalgia. The patient cough, no sputum start, followed by mucoid sputum. Characteristic high fever , sometimes with a relatively slow pulse, diarrhea are more common. mind to change, there may be confusion, lethargy or delirium are rare.
Chest X-ray examination can be seen in early stage lung segments, patchy unilateral or lobar alveolar infiltrates. With the progress of the disease, many patients have bilateral disease, pleural effusions are more common. Occasionally, a few patients had pulmonary abscess and multiple round dense shadow, that there are septic emboli. There conscious change in the cerebrospinal fluid examination were normal, the patient''s stool in diarrhea without blood and white blood cells. the majority of patients with moderate leukocytosis, peripheral leukocyte count was 10000 ~ 15000/ l. Other common laboratory findings as hyponatremia, hypophosphatemia and abnormal liver function tests. Occasionally, patients have microscopic hematuria, sometimes with impaired renal function.
How to diagnose Legionella pneumonia?
There are four identified Legionella diagnostic test method: bacterial culture, direct fluorescent antibody staining of exudate, the use of indirect fluorescent antibody method for antigen serologic and urine analysis. The four respective fields specific, but not particularly sensitive.
Pathogens from sputum, tracheal aspirate, bronchial aspirate or brush biopsy material, lung biopsy, pleural fluid or blood was found. Legionella bacteria is not a normal flora, so the diagnostic value of a positive culture, but confirmed by other techniques cases, sputum culture positive rate was 30% to 70%. culture and direct immunofluorescence staining require high technology. urinary antigen analysis is relatively easy to do gymnastics and in the longer period of time after the start of treatment can have positive findings, but This method can only detect serotypes 1, Legionella pneumophila (accounting for 70% of all cases). to prove that 4 times higher titer (at least 1:128), serological diagnosis can be made. a convalescent serum can show titer 1:256, with corresponding clinical symptoms can be strong support for diagnosis. When the need to make treatment decisions with diagnostic significance of the titer generally does not appear, and usually 3 to 6 weeks after onset of emergence .
What is the treatment of Legionella pneumonia?
Erythromycin treatment of first choice, the daily 1-2g, a total of 4 oral, intravenous administration of severe, medication 2-3 weeks. Can be added with rifampin, an oral administration of 10mg/kg per day; daily doxycycline 200mg, once orally for 3 weeks or more, or easy to relapse. Aminoglycosides and penicillin, cephalosporin antibiotics on the fungus disease is invalid.
Legionella pneumonia patient care
Legionella strong endurance to heat, can survive in distilled water, 139 days, in the artificial water pipes can be settled by way of aerosol mist suction infected people. So, pay attention to regular window ventilation to keep indoor air fresh, the table clean with 0.5% of net decontamination, oxygen tubes, wet bottle, atomizer 1 week should be thoroughly disinfected. Warm air when the attention of patients to avoid the cold air blowing straight or convection. Acute phase, high fever during the absolute bed rest, recovery may be appropriate activities. Severe chest pain who take the affected side lying position in order to ease the pain. Shortness of breath half supine position were taken and given oxygen inhalation. Given high protein, high energy, high in vitamins, easily digestible diet, to encourage patients to drink more water daily at least 2000ml-4000ml.
Observation of symptoms and complications and nursing care
(1) heat: possible ice bag sponge bath with warm water, warm alcohol sponge bath, etc. physical cooling methods to reduce the suffering of patients and increase their comfort. When the heat reduced secretion of saliva, dry lips, prone stomatitis, can be liquid saline or mouthwash Doyle, chapped lips can be coated paraffin oil to prevent stomatitis.
(2) cough: Legionella pneumonia occur in the elderly and infirm, their activity less, and more accumulation of mucus in vivo, inability to cough. This time to guide patients to learn effective cough methods to encourage their own sputum. If it is not easy to cough up sputum or unable to cough up thick, the possible inhalation, turning, postural drainage, application expectorant agent, in order to maintain airway patency.
(3) of water, electrolyte disturbance and renal dysfunction: Legionella bacteria can cause low blood sodium and other toxins, so patients should be regularly checked serum electrolytes, urine and renal function. Actively assist the doctor to treat abnormal rescue.
Observation and care of drug treatment: erythromycin for the treatment of Legionella pneumonia Road, drug candidates, can be administered orally, but also intravenous infusion, the general course of treatment for 2-3 weeks. Infusion patients can lead to local pain, gastrointestinal discomfort (nausea, vomiting), etc., it should be a slow trickle and make life care, the timely removal of vomit, to encourage patients to Eat small meals often, moderate consumption.
Health Education: pneumonia, usually caused by lower body resistance, bacteria take advantage of, due to, occur in the winter and spring seasons. Therefore, we should strengthen the body''s own ability to exercise and cold, avoid cold, flu prevention, to develop a no smoking, no drinking habit. Should also pay attention to maintaining the surrounding environment clean and avoid water pollution.nikotinoff
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