Legionellosis: tohumate, te tātaritanga, maimoatanga

Legionella - he puninga o huakita e taea meinga kakā nui me te alveolitis i roto i ngā pakeke. tuhia Tuatahi ngā rā urutā hoki ki 1976 tau, ka i roto i Philadelphia e tika ana ki te kakā nui i roto i nga kaiuru 4,400 o te Congress, mate "American Rihiona" 35 hoia. ka mate Tapeke 221 iwi, me te auau te tahuti nei o te mate ko 15.4%. Ko reira - legionellosis. i tamata mea katoa e pā ana ki te take, tohu me te maimoatanga o tenei mate ki te feruri i roto i rikketsiologi Makdeyt me Shepard. A i muri i te 6 marama i te rā o te pakarutanga o te tukumate tāutuhia me kitea e tatou mehua ki te aro i te reira.

kiripuaki Microbiological o te kaihoko pūtake

Ka rite ki tahuri reira i roto i ngā pūkenga i muri mai, meinga e te huakita Legionella pneumophila. No te reira ki te kāwai o te anaerobes e taea te tīariari i roto i te taiao, kahore te hāora. e kore e hanga i te reira i pua me capsules, microbe mārō kua kahore taiepa pūtau me pā ki te karamu momo kino. I te hē ano o tona pākia takoha ki te titiro mō ngā huarahi ki te ora e pā ana ki mahi a te tangata.

Tuatahi, Legionella ko he werau intracellular, te wahi e tiakina ai i te pūnaha ārai mate. Tuarua, ko te "tatari" legionella tangata i roto i nga wahi ohorere hoki ia, i reira ratou ongo'i fiemālie - i roto i te ua, i roto i te puna kaukau i runga i nga whare, me ngā waka rawa ki te wae rangi-conditioning. wai me te mahana whakarewa putorino kia taea reira ki te tini huakita. He hoki ratou itoito i roto i te roto ki te cyanobacteria i roto i nga wai mahana me putorino ki te wai mahana. Hoki tenei take, āhua 16% o te kakā katoa whakawhanakehia ki te whai wāhitanga o tetahi atu ranei momo o Legionella.

I roto i te katoa i reira e pā ana ki te 50 taumahatanga o huakita o te puninga e pā ana ki te maha o kaiao pneumotropic tasonomicheskomu puninga Legionella. whakapataritari ratou legionellosis (mate Legionnaires ', ranei) ai, tohu me te maimoatanga o te kaupapa matatau e e mohiotia kua. Na e pā ana ki te horapa o te mate, āhuatanga tukumate pāhekoheko ki te rauropi, me te te whanaketanga o te mate i nui ngā mōhiohio. Ka taea anō hoki ki a koe ngana ki te whakaiti i te tahuti nei i Legionella kakā me alveolitis.

Atu tahumaero me te whakatö āhuatanga

I roto i te mate pērā i legionellosis, tohu me te pakeke o te huru tei runga i te āhuatanga o te rauropi. Ki te rawaka tōtika korero ārai o te iwi, ara ki te whakapā hia e kore e taea te tiki mate. Heoi, ki te hekenga i o ona mahi te tūponotanga o piki mate maha nga wa. Ano, tūroro immunocompromised, tae atu mate HIV-e pā ana, nga tohu o te mate Legionnaires 'he nui atu nui, me te wā roa o te mate.

tomo te huakita te tinana i roto i te pūnaha romahā me te i roto i te patunga. Ko te momo tuatahi ko te rūrūtia romahā. Ko te taea o te faaiteraa i ki Legionella rūrūtia wai whakarato ona āhuatanga tahumaero. Fele, te iwi mate katoa i roto i te rōpū e mahi ana i roto i te ruma kotahi, ki te tuku iho to ratou wātea i te mate te. Ko nui atu te utu, engari e kore e waho Whakapā ara. I roto i tenei take, nga tohu o te mate rohe Legionnaires ', arā i roto i te rohe o te patunga ranei kino kiri, me te pūnaha - tohu o te haurangi.

Ture o te mate e pā ana ki te peculiarities o te mate e kore anake, engari ano hoki ki tau huru o te rōpū o te iwi. I takoto te reira e te pakeke ake maha me te ake tino tangata kino 40 tau, neke atu rānei. Women me tamariki whiwhi mate iti pinepine. Tēnei āhuatanga e āhei ki a koe te wehewehe i waenganui i legionella kakā e Mycoplasma. maha Mycoplasmas pā iwi taitamariki, ahakoa o te ira tangata.

Ko te akoranga haumanu o te mate e Legionella

I roto i taua mate rite legionellosis, e kore e nga tohu puta mai te whakapā tuatahi, a i muri i te wā heki. kia tango i te reira e pā ana ki 2-10 ra: i roto i tenei wā o te wā i roto i te tinana e whakamahatia legionella, engari he iti mahi tukanga pathological, e ai iti (subclinical) tohu. puta mate ranei te ara ngāwari, he āhuatanga e syndrome rewharewha-rite, ranei i te momo o te kakā ki nui wahi romahā.

e pā ana te momo tuatahi te ki te rere o legionellosis kaha paruru pai o te rauropi. Ka rite ki te hua o te whakapā ki te mate romahā whakapeka whakawhanake legionellosis i te momo Bronchitis. ka karanga tenei momo o te akoranga haumanu te Pontiac kirika. Ko te momo tuarua o te mate - kakā Legionella. Ko reira atu nui, me te puta ki te tahuti nei tiketike.

E tano ia tapao e Pontiac kirika - i te iti rawa i te mate nui, he reira anake legionellosis iti mōrearea. mate Legionnaires '(he ōrite ki ngā āhuatanga o ētahi atu tohu mate kakā mohiotia) ko te faaiteraa o Legionella kakā, nui, maha mate mo te manawanui.

He tika ano hoki te whakarōpū ki te tohatoha legionellosis, i te mea te tohu tino nui. alveolitis reira - he puka nui o te kakā e huhua te tāoke o te tinana, me te mā te whakaiti i te tūponotanga o te ora. Reira he hoki ki te whakarato e rua momo o legionellosis, i runga i te wahi o te tupu rānei. Te reira i legionellosis nosocomial me tāmutumutu, e ko whiwhi-hapori. mana Hospital tātaritanga o legionellosis te anake, ki te puta mai te tohu haumanu i muri i te 2 atu ranei nga ra i te wa te wāhi i roto i te kōwae pahoho.

tohu āhuatanga o Pontiac kirika

He Pontiac kirika he tauira o te rere o mate pūkahukahu pērā i Legionella pneumophila. Tohu o tenei legionellosis āhua rite rewharewha parainfluenza taimaha ranei: manawanui disturbs nui pāmahana (38-39 ° C), e puta i muri i pā ana ki 36 haora i muri i te puaretanga tuatahi. whakawhanakehia hoki myalgia kaha, ānini, haamata mare maroke. He wā, rawa ki te kirika mo 38 nga nekehanga, whakawhanake ruaki.

tohu haere tahi āwangawanga tahi e nui haere te pāmahana: matewai, mangai maroke, heke putanga mimi. Ano, mamae i roto i te pouaka, ahakoa he whai pānga atu ki Legionella kakā e pā te kiripūkahu, nui atu i ki Pontiac kirika tenei āhuatanga. He wā i runga i te whakamārama o te haurangi puta photophobia, whakaaro waimaero me te kukū, engari i muri i te ora, kia rite ki te tikanga, e kore e wātea pōauautanga neurological.

Ko taa'eraa e rite legionellosis kitea reira: e kore e tonu kitea nga tohu, rite te whakapā tuatahi ki te mate. Na kua putu kotahi te tinana tukumate nui puta ratou. Te āhua i te manawanui ki te kia e puta mai katoa o nga tohu haumanu kahore matua, e ko, ki te whakamārama o te hauora whānui. Na te reira e ona ake whakatikatika me taea hoatu ara ki te tātaritanga ta'etotonu "meningitis", no te mea ka tīmata hoki tenei mate rite te rewharewha.

Tohu o hota Legionnaires '

He maha tohu o te mate Legionnaires ', mate a legionnaire, puta i mua o te whakaaturanga, no te mea ki te papamuri o disorders immunological, ka taea e te wā heki muri ake ki te 3 wiki. huaina ana tēnei wā ko te wā prodromal me whakaatu āhuatanga noa: ko te aroaro o te kirika iti, uaua ngoikore, sweating me te hāhā o te manawa i te kawenga marama, maremare. Heoi, te nuinga o te wā heki e wahi mo te 2-10 ra anake. Katahi nga tohu katoa, kahore wā prodromal, arā hoki ki te whakamārama o te hauora whānui, ko te take ki a Pontiac kirika rite.

I roto i te mate pērā i Legionella kakā (legionella), tohu me ratou whakaahuatanga kore e whakawhirinaki i runga i te tauhohenga immunological o te manawanui, me tona manawanui tinana. kawea te mate te kaha a taea arahi ki te mate. Te tīmatanga, i reira he kirika e pā ana ki + 39-40 nekehanga, e kore ai e waiho, ki te mamae te manawanui he ārai e pā ana ki HIV ranei ki therapy cytostatic. Fakataha ki kirika kotahi te mare, me te pouri i roto i te pouaka. I te tīmatanga e kore e wehea anake mare maroke me te sputum.

I te taua tata timata tonu ki te huraina e mamae i roto i te pouaka, no te mea te mate (Legionella) ai fibrinous effusion pleural me nga alveoli. Na enei Legionellosis kino katoa: tohumate, te tātaritanga, maimoatanga me te waitohunga mo tenei he pāhekeheke hoki. Fakataha ki nga āhuatanga raraunga o te mate he dyspnea, ru paitini, alkalosis romahā, whakahōhā nga tohu matua o te manawanui, me te whakaiti i te kaha whakaora o te tinana.

āhuatanga Common o te tātaritanga o te legionellosis

A, no te whai ratou ake matatini he mate pēnei i legionellosis, te tātaritanga me te maimoatanga. Tuatahi, i waho te taputapu mō te tūrara Elisa ranei reliably whakatau te tukumate he tata e taea. Tuarua, ara ki te sputum tetahi o te kōwhiringa Legionella uaua. Tuatoru, i waho te taea o te faaotiraa pono o te huakita i meinga te mate, kua ki te whakamahi i te paturopi beta-lactam rite te tikanga o te therapy antimicrobial tëtehi te tākuta.

Hoki te nuinga o te beta-lactam legionella ātete no o tona wāhi intracellular i roto i te tinana. Reira te whakaiti hoki te whai huatanga o te wātea i te mate ki te whawhai mate, me te faarahi i te nui o tāoke e whai pānga tuukino nahanaha. No te mea kia rite nohopuku rite taea tātaritanga. Ki te kore e wātea te taea o te taiwhanga haamauraa o te kaihoko fakatupu o Legionnaires, kua ki te whakahau talena maimoatanga empiric ki te whakamahi o te macrolide paturopi fluoroquinolone ranei te tākuta.

tātaritanga tinana o Legionella kakā

mōhio ana tonu te mate, no te mea o tona auau whakaritea iti, he reira i whakaritea e taea. I tua atu, i reira e pā ana ki 10 mate, te rere i roto i te wā tuatahi haamana'oraa o legionellosis. Ko te tohu me te maimoatanga o Legionnaires 'reira timata ki te kaupapa tëtehi - taumahi o rua ranei ake whanui-hihinga paturopi ki puninga kapinga mōrahi o microorganisms. Te reira i kawea ano ki waho me te tātaritanga tinana, i runga i te aro mātai o te raraunga e taea te whiwhi ki te whakamātautau ohie o te manawanui.

Ko te paearu tuatahi o te legionellosis - kirika, ahakoa kahore he reira motuhake. I whakapā tuatahi ki te Taumaha a Tūrongo manawanui te tere dyspnea ahu whakamua me te hua, ētahi wā ki te 40 te whakahā ia meneti. Kia māharahara mare kahore maremare. Ko te manawanui e te manawa hohonu, engari i muri mai haamata ki tohungia te pouaka e tika ana ki te kiripūkahu whakawhanake. A, no te whakawhanake tere atu i kakā pneumococcal legionella kiripūkahu.

āhuatanga Auscultatory o legionellosis

Hoki nga tohu tinana ko te aroaro o huringa auscultatory. Wheezing pāngia ngā wāhi nui o te pūkahukahu, te tikanga he wahi katoa. Ano, ki te he legionellosis pono hangarau arotake, ai, tohu, ka waiho atu kitea tātaritanga me te maimoatanga. Ko te wāhi ko tenei: te nuinga pānga nga matamata o raro, a maha tetahi o ratou. Mahue - e tika ana ki te meka i tona bronchi kuiti taupa me manga atu i te ngōrahi matua i te koki, iti iho te mamae. Matau āhuatanga taupa o raro e te ngōrahi taupa whanui, me te poto, te whakapau i te matua ngā tika. hinga atu pinepine ēnei matūriki paru atu i roto i te taupa i mahue raro, ahakoa he mea he tauanga anake e kore e taea e e e ture tika tino.

I te tātaritanga tinana whakakitea crepitus. Ko reira atu më, e kore te mea maha i. kia kitea te reira i congestive wheezing miro mākū, e kua rongo ki te kore te ngakau ma'i ki tohumate o te pupuri inu i roto i nga pūkahukahu. Otiia, kitenga tinana mere te tātaritanga e taea kore te hanga. Me te reira ki te kia kīnaki e whakamātautau mauhaa me te taiwhanga.

Tātaritanga kakā

E rua o te tino faufaa tikanga taputapu tātaritanga ngā: bronchoscopy me Radiography. E mea pinepine ki wātea tikanga tuarua whiwhi he whakapakoko o nga kopa o te pouaka, tae atu ki te wāhi matia. I radiographs i roto i te ngä frontal he kite atarangi lobular nui nui, e kore e hāngai ki te rahi o te kanga ahi, te whakatau tata i muri i auscultation.

E whakaatu ana te pikitia te wāhi o te mumura whānui, ētahi wā e rave rahi o ratou, ranei hanumi ratou ki tetahi ki tetahi. More uaua kite pleural wahi whakakikorua pūtōtepe i takanga o Legionella mumura. I roto i tenei take, i te wa ka i Radiography kua riro haamauraa e te manawanui he mumura o te kiko pūkahukahu, te tākuta kia hoki e kore e whakaaro ki te aroaro o Legionella.

Bronchoscopy Ko te ara iti faufaa, i kua tonu he tetahi auraa. He mea nui hoki te tātaritanga pārōnaki. Mā te whakamahi i te reira e whakaaetia ki te tango i te lavage bronchoalveolar, a ki te taea ki te tāutu i te microbe meinga te kakā. O te akoranga, mo te bronchoscopy, i reira e etahi contraindications, tetahi o i ko te pakeke o te huru o te manawanui.

Taiwhanga Tātaritanga Methods

paerewa Gold mō te tātaritanga o mate hopuhopu - bacterioscopy, huakita kōwhiringa me tona māra. Na roto i te tikanga e mohiotia ai e papapūata pathogenic kei roto i te tinana tangata, me tona āhua o nāianei e tika ana ki tenei. Otiia i roto i te take o te legionellosis bacterioscopy ngā taea, no te mea ki Legionella i taka pani rite tahi atu kaiao e taea meinga kakā, ahakoa anake ranei whakahōhā tona akoranga. No te mea tūrara piki whakamahia me whākōkī immunoassay.

Maimoatanga o Legionella kakā me Pontiac kirika

Tāhuhu o te Hauora me te tūtohutanga haumanu mō te Pulmonology ngā kawa tenei ra whakarato ārahitanga e Bronchitis a kia tukinotia kakā ki te whakamahi o rua momo o āpiha antimicrobial o whānui o te mahi hihinga. Ko tētahi o ratou ko te aminopenicillin cephalosporin ranei. Ko te momo tuarua ko te rongoā paturopi macrolide. tuatahi whakatikaia tika tūponotanga o tahi microflora, mea macrolides kaha ki Legionella.

Kei te whakapono te reira i e i roto i te tua ki macrolides ( "midecamycin", "Azithromycin", "erythromycin", "Clarithromycin"), kaha ki Legionella me fluoroquinolones me rifampicin. I roto i fluoroquinolones manakohanga "ciprofloxacin", "ofloxacin", "Moxifloxacin", "Gatifloxacin" "Levofloxacin". "Rifampicin" me "Doxycycline" Ka taea te whakamahi wā. Whakaritea e te huinga e whai ake nei o taero:

• Māngai rōpū beta-lactam hei kaupapa hōhonu huānga - "ceftriaxone" 1 karamu intramuscularly rua he ra i 12 haora;
• macrolide roto ( "Azithromycin 500" kotahi te ra ranei "erythromycin 500" \ ra 6 p, ranei "Clarithromycin 500" rua he ra, ranei "midecamycin 400" 3-4 wā he ra);
• fluoroquinolones ki te memeha noa o te akomanga e rua o mua o te raau taero ( "Ciprofloxacin 400» pâmuhia 2-3 wa he ra, "Levofloxacin 500 'roto kotahi te ra," Moxifloxacin 400 "kotahi te ra).

Ka rite ki whakaaturia, te raau taero raina tuatahi he macrolides. Heoi, e tika ana ki te meka e ratou pehi anake te mahi faufaa o huakita, mahue ia ora (bacteriostats), ki te legionellosis whakapae ranei atu mahaha e tūtohu ana ki te whakamahi i fluoroquinolones. He Macrolides anake i te horopeta tiketike, a anake etahi o ratou ( "midecamycin" me "Roxithromycin") i taea whai i te pānga bactericidal. Ahakoa ka te whakaritea ai ki te kaupapa taurite, me te mātau o te therapy antimicrobial, me te manawanui tautoko ventilation, me te whaowhia therapy ki fakatonutonu he ru hopuhopu-paitini.

E mea pinepine kawea tenei maimoatanga i roto i roto i te kōwae tiaki kaha, kei hea he i mua 3-5 ra ki stabilization te manawanui. Na ka whakahaere maimoatanga e i roto i te wehenga hopuhopu ranei i roto i te Pulmonology. Ano, kihai i te whakaora correlate ki nga hua o te X-ray: atarangi infiltrative i roto i te pikitia e pā ana ki te marama, neke atu rānei. A pumau Legionella kakā maimoatanga katoa e pā ana ki 20 nga ra, me te ake. I muri i rere, kia hoki te manawanui kia kitea tūroro, te toro i te kaihaumanu rohe wha nga wa he tau.