Legionellosis: zviratidzo, nechirwere, kurapwa

Legionella - a genus mabhakitiriya anogona kukonzera kwazvo nemabayo uye alveolitis nedzevakuru. First yakanyorwa chifo misi shure 1976 gore, apo muPhiladelphia nokuda kwazvo nemabayo pakati 4.400 Vatori pakati reCongress, "American Legion" akafa 35 yerusununguko. Total 221 vanhu vakarwara, uye mwero wokufa kwevanhu chirwere chakanga 15.4%. Ndizvo - legionellosis. Zvose pamusoro zvinokonzera, zviratidzo uye kurapwa chirwere ichi vaiedza kufunga rikketsiologi Makdeyt uye Shepard. Uye pashure pemwedzi 6 kubva musi yatanga nayo utachiona kuzivikanwa uye tinoona matanho kurwisa nayo.

Microbiological characterization of causative mumiririri

Somugumisiro akazotevera nyanzvi, yakakonzerwa utachiona Legionella pneumophila. Nderake muchikwata che anaerobes anogona kuvapo mumhuri pasina oxygen. Hazvina kuumba spores uye capsules, yakasimba microbe haana muchitokisi madziro uye rinoreva giremu asina marudzi. Panguva kushayikwa kwayo muviri akamanikidza kutsvaka nzira yokupukunyuka chokuita nemabasa evanhu.

Chekutanga, Legionella chinhu intracellular chisvetasimba, umo kudzivirirwa kubva zvirwere. Chechipiri, "kumirira" legionella dzevanhu dzaisatarisirwa nzvimbo iye, apo vanonzwa vakasununguka - vari kugeza, ari pool pamusoro panzvimbo uye motokari vakagadzirira pamwe mhepo-kutonhodza chikwata. Mvura inodziya uye simbi pombi kuti tikwanise muwande mabhakitiriya. vari zvakare kushingaira pamwe cyanobacteria ari inodziya mumvura uye pombi nemvura inodziya. Nokuda kwechikonzero ichi, vanenge 16% nemabayo zvose hunovapo chikamu rimwe kana kupfuura marudzi Legionella.

In zvachose pane anenge 50 okuva mabhakitiriya ari genus chokuita nokuwanda tasonomicheskomu pneumotropic zvipenyu genus Legionella. Ivo vanotsamwisa legionellosis (Masoja eRoma 'chirwere, kana) hunokonzera, zviratidzo uye vabatwe kuverenga zvirongwa zviri kare anozivikanwa. Zvino pamusoro kupararira chirwere, utachiona hwakakura kudyidzana inoratidza pamwe nhengo, uyewo kukura chirwere vane ruzivo rwakakwana. Zvinoita here kuti kuedza kuderedza kufa kubva Legionella nemabayo uye alveolitis.

Hwevanhu vanorwara uye kupararira unhu

Zvakadaro chirwere sezvo legionellosis, zviratidzo nekuomarara mamiriro kunoenderana zvinoitwa nhengo. With zvakakwana zvirwere kudzivirira kunyatsoshanda vanhu, kunyange kuramba richikurukurirana haagoni kurwara. Zvisinei, aine kuderera mitambo yayo mukana chirwere inowedzera kakawanda. Uyezve, varwere immunocompromised, kusanganisira-HIV chokuita hweHIV, zviratidzo Masoja eRoma 'chirwere zvakawanda zvakakomba uye hwakareba munguva yokurwara.

Utachiona anopinda muviri kuburikidza kufema maitiro uye kuburikidza maronda. Chokutanga mhando chinhu kufema mumate. Mukana pakugoverana Legionella mvura mumate zvinopa yaro epidemiological maitiro. Zvikurukuru, vose vanorwara vanhu vari chikwata kushanda muimba imwe, kana kutapata yavo ashaye. Contact nzira zvikuru zvisingawanzoitiki, asi dziripowo. Panyaya iyi, zviratidzo Masoja eRoma 'chirwere munharaunda, kureva munzvimbo yacho ronda kana kukuvadza ganda, uye gadziriro - zviratidzo kudhaka.

Mitemo chirwere chokuita kwete chete peculiarities ose kutapata, asiwo makore cho boka revanhu. Kwakati kwatemwa kuti kakawanda uye zvakatoipisisa varume kurwara makore makore 40 kana kupfuura. Vakadzi nevana vanorwara nezvahwo. Nyaya iyi kunoita kuti kusiyanisa legionella mabayo kubudikidza Mycoplasma. Mycoplasmas kazhinji inobata vechidiki, zvisinei chechikadzi.

The kunotoda weboka utachiona Legionella

In zvirwere zvakadai legionellosis, zviratidzo regai kuitika kubva kwokutanga kuonana, uye mushure incubation nguva. Zvinofanira kutora anenge 2-10 mazuva: panguva iyi nguva pamuviri Anowanza legionella, asi pathological maitiro basa iri pasi, iyo kunokonzera kuduku (subclinical) zviratidzo. Chirwere kunoitika kana nyore nzira, anozivikanwa dzihwa-kufanana urwere, kana mhando nemabayo zvakaoma. kufema turakiti.

Chokutanga mhando Rinobatanidzwa aibuda legionellosis zvakanaka inodzivirira mano muviri. Somugumisiro neVadzidzi chakasimba kufema chirwere kuva legionellosis nokuda bronchitis mhando. Izvi mhando kunotoda kurapwa kosi inonzi Pontiac fivhiri. Rudzi wechipiri chirwere - Legionella nemabayo. Zviri zvikuru uye kunoitika dzakakwirira kufa.

Zvinokosha kucherechedza kuti Pontiac fivha - kanenge nechirwere chakakomba, ndiko chete legionellosis zvishoma ngozi. chirwere Masoja eRoma '(chirwere zviratidzo akafanana ne zvinhu nevamwe atypical nemabayo) chinoratidza Legionella nemabayo, zvakakomba, kazhinji dzinouraya kuti murwere.

The kupatsanura Zvinokoshawo govera legionellosis, ndoupiko unonyanya zvikuru zviratidzo. It alveolitis - kwazvo chimiro nemabayo kuti boosts muviri toxicity Akaroromesawo mukana wokuti nokupora. It hazvina kupa mhando mbiri legionellosis, zvichienderana nenzvimbo panowanikwa. It nosocomial legionellosis uye apo neapo, kuti ndiye munharaunda yakawanikwa. Hospital chirwere pamusoro legionellosis mvumo chete kana kurapwa zviratidzo akazviratidza pashure 2 kana mamwe mazuva kubva panguva iyo nzvimbo iri mira chikwata.

Mamirire zviratidzo Pontiac nefivhiri

Pontiac fivha muenzaniso aibuda zvemapapu zvirwere zvakadai Legionella pneumophila. Zviratidzo izvi hunhu legionellosis akafanana yokuSpain kana parainfluenza rinorema: Patient zvinokunetsa yakakwirira tembiricha (38-39 ° C), iro rinowanikwa pashure anenge 36 maawa pachapera chokupfeka. Yakatangawo zvikuru myalgia, nomusoro, yakaoma chikosoro kunotanga. Apo neapo, kunyanya nefivhiri pamusoro 38 madhigirii, anovandudza kurutsa.

hanya padivi zviratidzo pamwe yakawedzera tembiricha: nyota, muromo yakaoma, ungaderedza weti goho. Uyewo, marwadzo ari mubhokisi, kunyange chikamu ichi ndechokuti akarondedzera Legionella nemabayo kunokanganisa pleura, pane pamwe Pontiac fivhiri. Apo neapo pamusoro pakanyorwa kudhaka sokuti photophobia, havachanyatsogoni mafungiro uye mumisasa, asi pashure kupora, sezvinoita mutemo, chetsinga yematambudziko havana kuwanikwa.

Zvinokosha kuziva kuti sezvo legionellosis pachena: zviratidzo havasi pakarepo pachena, sezvo wokutanga kuonana utachiona. Uye kamwe muviri yave akaunganidza utachiona zvakakwana vanoonekwa. Murwere sokuti kuti vose zvekuchipatara zviratidzo akazviratidza pasina vamutangira, kureva tikafunga kunopindirana utano. Zvinoita pachake zvinhu zvayo uye zvinogona kukonzera zvisina kufanira chirwere "yomumuzongoza", nekuti chirwere ichi anotanga somunhu besa.

Zviratidzo Masoja eRoma 'nemabayo

Zviratidzo Vakawanda Masoja eRoma 'chirwere, chirwere Legionnaire raMwari, anowanikwa chinotangira muenzaniso, nekuti tikafunga immunological zvirwere, kuti incubation nguva anogona kugara kusvika 3 mavhiki. Nguva iyi inonzi prodromal nguva uye inoratidza zvakajairika zvinhu: kuvapo fivha duku, tsandanyama simba, vangadikitira uye kupfupika kufema panguva chiedza mutoro, vangakosora. Zvisinei, vakawanda incubation nguva kunoitika chete kwemazuva 2-10. Ipapo zvose zviratidzo pasina prodromal nguva, kureva uyewo tikafunga kunopindirana utano, sezvinowanzoita pamwe Pontiac fivhiri.

Zvakadaro chirwere sezvo Legionella nemabayo (legionella), zviratidzo uye tsananguro dzavo haangaiti kuvimba immunological reactivity murwere uye mumuviri wake kutsungirira. The chirwere rinoitwa zvikuru uye kunogona kutungamirira kurufu. Pakutanga, hapana nefivhiri pamusoro + 39-40 madhigirii, izvo angasava, kana murwere anotambura ane immunodeficiency chokuita HIV kana cytostatic kurapa. Pamwe nefivha ane chikosoro kamwe uye Kutambudzika chipfuva. Pakutanga chete chikosoro yakaoma uye sputum havasi kuparadzaniswa.

Panguva iyoyo zvinenge pakarepo kutanga vavhiringe kurwadziwa muchipfuva, nokuti chirwere (Legionella) kunokonzera fibrinous pleural effusion uye Formação de. Uye zvose Legionellosis izvi ngozi: zviratidzo, chirwere, kurapwa uye fungidziro nokuti izvi zvakare mubvunzo. Pamwechete umboo zvaidiwa chirwere murwere ane dyspnea, chepfu kuvhunduka, kufema alkalosis, kuwedzera huru zviratidzo uye kuderedza rokuzvivandudza rakaita kuti irambe vachikwanisa muviri.

Common zviri nechirwere pakati legionellosis

Kana wakadaro chirwere sezvo legionellosis, chirwere uye kurapwa vane zvavo kunzwisisa. Chekutanga, pasina zvokushandisa chromatography kana Elisa yakavimbika kuona nayo utachiona kwakaoma zvisingaiti. Chechipiri, kunyange kana kusarudza Legionella sputum zvakaoma. Chechitatu, pasina mukana rakavimbika kutsunga kwemabhakitiriya chakaparira chirwere, chiremba ane kushandisa Beta-lactam mishonga senzira empirical inorwisa utachiona mishonga.

Nokuti vakawanda Beta-lactam nemishonga legionella nokuda kwayo intracellular nzvimbo mumuviri. It kunoderedza kubudirira kutapata kurwisa chirwere uye anowedzera chitsama muchetura kuti vane systemic nezvakwakaipira migumisiro. Nekuti chirwere ave kutsanya sezvinobvira. Kana zvichiita Murabhoritari nokusimbisa causative nomumiririri Masoja eRoma hazvisi kuwanikwa, chiremba anofanira taurira empiric kurapwa zvaiitwa nokushandiswa macrolide kana fluoroquinolone inorwisa mabhakitiriya.

chirwere zvokunyama Legionella nemabayo

Pakarepo vanoziva chirwere, nokuti ayo vanganzi yakaderera kakawanda, zvisingaiti. Uyezve, pane zvirwere anenge 10, kuerera ari kutanga munguva nowenyika legionellosis. Zviratidzo uye mabatiro Masoja eRoma 'saka anotanga empirical Zano - basa maviri kana kupfuura mishonga inorwisa mabhakitiriya ine kunonyanyisa nhau genera zvigare. It wo akaita uye mumuviri nechirwere, kwakavakirwa kunyatsoongorora mashoko anogona kuwanikwa aine nyore kuzviongorora murwere.

Chokuratidza chokutanga legionellosis - nefivhiri, kunyange hazvisi zvakananga. Pakutanga kuonana murwere chaioneka weighting kuva nokukurumidza mberi dyspnea uye kuwedzera, dzimwe nguva kune 40 kundosvikira paminiti. Kamwe ainetseka chikosoro pasina phlegm. Murwere anotora befu, asi gare gare anotanga kuregerera chipfuva nokuda kukura pleurisy. Kana legionella pleurisy hwapedyo dzichimhanya kupfuura pneumococcal nemabayo.

Auscultatory unhu legionellosis

Uyewo mumuviri zviratidzo pamberi auscultatory kuchinja. Wheezing dzakachinja nzvimbo yakakura zvemapapu, kazhinji rose mugove. Uyezve, kana evasingatombonamati zvemaziso kuongorora legionellosis, hunokonzera, zviratidzo, chirwere uye kurapwa huchava pachena. The ndezvokuti: kunyanya kunokanganisa rezasi lobes, uye kazhinji mumwe wavo. Kuruboshwe - nokuti kuti ayo nepaburi akafukidza principales uye matavi makuru bronchus pa necheparutivi, zvishoma kutambura. Right repasi akafukidza kunoratidzwa navanopinda uye pfupi akafukidza bronchus, kuti chiutsi kubva huru kushanda twasu. Izvi tsvina inoramba kuwa kakawanda kupfuura kuruboshwe yepazasi akafukidza, kunyange rinongova nhamba kuti haagoni kuva mutemo zvachose yakarurama.

On mumuviri chirwere kwakaratidza crepitus. Inonyanya bilateral, izvo hakusi kazhinji. Zvinofanira kusiyaniswa kubva congestive akanyorova dzakarukwa zvakanaka wheezing, izvo vakanzwa vaine chirwere chemwoyo pamwe zviratidzo mvura chengetedzo mumapapu. Kunyange zvakadaro, munhuwo zvakawanikwa chaiko nechirwere haagoni ivakwe. Rinofanira nechimwe richishanda uye mumarabhoritari nemiedzo.

Diagnostics nemabayo

Vaviri chinokosha chirwere chokushandisa nzira dzinosanganisira: bronchoscopy uye radiography. Kazhinji nzira iripo wechipiri kuwana mufananidzo munyama pechipfuva, kusanganisira zvomoto munzvimbo. On radiographs mu frontal fungidziro riri kuoneka zvakakwana guru lobular mumvuri, asingadi dzinoenderana kukura pachoto, nokukosha pashure auscultation.

Nomufananidzo dzine kuzvimba vakwanise, dzimwe nguva vakawanda vavo, kana ivo batanidza pamwe nemumwe. More kashoma kuona pleural fibrin kuifukidza mugove panowanikwa Legionella kuzvimba. Muchiitiko chino, pane imwe nguva apo radiography akagamuchira nokusimbisa kuti murwere ane kuzvimba zvemapapu rinenge chiremba anogona regai kureva kuvapo Legionella.

Bronchoscopy inzira zvishoma zvinokosha, pane imwe kukosha achine. Zvakakosha kuti differential zvawanikwa. Kushandisa zviri bvumidzwa kutora bronchoalveolar lavage, uye kuti vakwanise kuziva microbe kukonzera nemabayo. Chokwadi, kuti bronchoscopy, pane contraindications, rimwe riri kwokuomerwa murwere ezvinhu.

Laboratory chirwere Nzira

Gold mutemo chirwere kwezvirwere zvinotapuriranwa - bacterioscopy, kusarudzwa utachiona uye ayo kurimwa. Kuburikidza nzira ichiidzwa kuti pathogenic tupukanana vari muviri womunhu uye wayo mamiriro nokuda ichi. Asi nyaya legionellosis bacterioscopy zvisingaiti, nekuti pamwe Legionella mu zodzera kuwa sezvo dzimwe zvipenyu zvinogona kukonzera nemabayo, kana chete kana sembura ayo kosi. Nekuti kuwedzera kushandiswa chromatography uye enzayemu immunoassay.

Mabatirwo Legionella nemabayo uye Pontiac fivhiri

Bazi Health uye kurapwa kurumbidza kuti pulmonology huripo protocols nhasi ivatungamirire kuti bronchitis uye nemabayo vanofanira kubatwa nokushandiswa nezvemarudzi maviri inorwisa utachiona vaishandira yakafara chakarondedzera chiito. Mumwe wavo ari aminopenicillin kana cephalosporin. Chechipiri mhando chinhu macrolide mushonga. Kukodzera kutanga wakarurama mukana wokuita kuuyawo microflora, asi macrolides kushingaira pamusoro Legionella.

Zvinofungidzirwa kuti kuwedzera macrolides ( "midecamycin", "Azithromycin", "Erythromycin", "Clarithromycin"), vanoshingaira pamusoro Legionella uye fluoroquinolones uye rifampicin. Pakati fluoroquinolones aanoda "ciprofloxacin", "ofloxacin", "Moxifloxacin", "Gatifloxacin" "Levofloxacin". "Rifampicin" uye "Doxycycline" neapo kunogona kushandiswa. Akagadzwa zvinotevera mubatanidzwa zvinodhaka:

• Mumiririri Beta-lactam boka ive chinhu empirical zano - "ceftriaxone" 1 giremu intramuscularly kaviri pazuva dzimwe maawa 12;
• macrolide mukati ( "Azithromycin 500" kamwe pazuva kana "Erythromycin 500" 6 p \ zuva, kana "Clarithromycin 500" kaviri pazuva, kana "midecamycin 400" 3-4 kanomwe pazuva);
• fluoroquinolones pamwechete ineffectiveness maviri makirasi yaivapo zvinodhaka ( "Ciprofloxacin 400» nomutsinga 2-3 kanomwe pazuva, "Levofloxacin 500 'nechomukati kamwe pazuva," Moxifloxacin 400 "kamwe pazuva).

Sezvaratidzwa, wokutanga mutsetse mishonga ndivo macrolides. Zvisinei, nokuti kuti chete kudzvinyirira rinokosha basa mabhakitiriya, asiya mupenyu (bacteriostats), pamwe vakafungira legionellosis kana zvimwe SARS Zvinokurudzirwa kushandisa fluoroquinolones. Macrolides vari chete panguva yakakwirira dose, uye chete vamwe vavo ( "midecamycin" uye "Roxithromycin") aigona kuva bactericidal nomugumisiro. Kunyange kana basa yakadzikama uye nomazvo Zano inorwisa utachiona kurapa, murwere anoda kufefetedza rutsigiro, uyewo aizomupa kurapa agadzirise rwarisa-muchetura kuvhunduka.

Kazhinji kurapwa ichi rinoitwa munyika yevanenge, apo murwere mazuva 3-5 asati Kudzikamiswa. Zvadaro kurapwa kuri kuitwa nenzira kutapuriranwa mupanda kana pulmonology. Uyezve, yavaipora haana Nenyaya Iyi nemigumisiro X-ray: infiltrative mimvuri mu mifananidzo inenge mwedzi kana kupfuura. Uye zvose Legionella nemabayo kurapwa rinovapo mazuva anenge 20 uye zvakawanda. Mushure zvinoerera, murwere anofanirawo kuchengetwa outpatient, vachishanyira vepo chiremba nguva mana pagore.