[Abstract] Objective To investigate the situation of pulmonary tuberculosis combined with pulmonary infection strains and species analysis. Methods From January 2011 to April 2012, 2788 cases of sputum culture of pulmonary tuberculosis patients in the author’s hospital were counted, of which 400 cases had positive results. Among the 400 positive specimens of TB patients with co-infection, 319 cases of Gram-negative bacilli were found, among which 116 cases of Klebsiella pneumoniae, 81 cases of Escherichia coli, and 37 cases of Enterobacter cloacae ranked the top 3. There were 23 cases of gram-positive cocci and 58 cases of fungi. Conclusion Patients with pulmonary tuberculosis can be accompanied by airway changes, Dong Xiaowei, Department of Tuberculosis Internal Medicine, Heilongjiang Tuberculosis Control Hospital
easy for bacteria and other pathogens to grow and multiply, and are more prone to combined bacterial and fungal infections than normal people.
【Key words】 pulmonary tuberculosis; pulmonary infection; pathogenic bacteria
The study of pulmonary tubereulosis with pulmonary infection
Tuberculosis is a chronic wasting disease that is often associated with pulmonary infections due to its long duration and underlying diseases. And the incidence of nosocomial infections in patients with pulmonary tuberculosis has been reported in the literature to be 13.1% [1]. In order to explore the strains of pulmonary infections co-infected by patients with pulmonary tuberculosis, I analyzed the pathogenic bacteria in cases of pulmonary infections co-infected by patients with pulmonary tuberculosis in our hospital from January 2011 to April 2012, and the results are reported as follows.
1 General information
Among the 400 patients in our hospital, 248 males and 152 females aged between 16 and 87 years old were counted. All were clinically confirmed TB patients in our hospital, and all met the diagnostic criteria for TB. [2]
2 Results
Gram-positive cocci were examined in 23 cases accounting for 5.75% of the 400 patients, including 12 cases of Staphylococcus aureus, 5 cases each of Staphylococcus epidermidis and Staphylococcus saprophyticus, and 1 case of Enterococcus faecalis. Gram-negative bacilli 319 cases accounted for 79.75%, including 116 cases of Klebsiella pneumoniae, 81 cases of Escherichia coli, 37 cases of Enterobacter cloacae, 21 cases of Pseudomonas aeruginosa, 18 cases of Serratia marcescens, 9 cases of Acinetobacter baumannii, 9 cases of Klebsiella acidophilus, 6 cases of Pseudomonas aeruginosa and 5 cases of Serratia marcescens. Fungal 58 cases accounted for 16.5%, including 46 cases of Candida albicans
Candida albicans 46 cases, Pseudomonas smoothus 8 cases, Pseudomonas klebsiella 3 cases, Candida tropicalis 1 case. The top ten pathogens are shown in Table 1.
3 Discussion
Tuberculosis, with the increasing rate of initial drug resistance and multidrug-resistant tuberculosis, has become difficult to treat, and it is even more difficult when combined with pulmonary infection. In this paper, among 400 positive specimens, Gram-negative bacilli accounted for 319 cases, Gram-positive cocci for 23 cases, and fungi for 58 cases. It can be seen that Gram-negative bacilli are still the predominant infections, which is consistent with the literature [3]. Based on the information in this paper and the relevant literature, we believe that the following points should be taken into account for pulmonary infections in TB patients.
3.1 Atypical clinical symptoms
Patients with pulmonary infections are typically characterized by fever and purulent sputum, but pulmonary infections in TB patients are often not characterized by these features, and sometimes even clinically serious infections are manifested only by low-grade fever, which can easily lead to misdiagnosis in clinical practice. Some authors have suggested that the possibility of co-infection should be suspected when tuberculosis is improving, or when sputum is negative and any symptoms of unexplained fever, cough, cough aggravation, shortness of breath, or dyspnea appear [4], and we agree with this view.
3.2 Atypical imaging manifestations
Patients with pulmonary infections mostly present with a faint film image of the lung, which is easily confused with the original tuberculosis lesion and leads to atypical imaging presentation. Therefore, it is especially important to improve the ability of clinicians to read films and strengthen the vigilance for cases of pulmonary infection in patients with pulmonary tuberculosis. We believe that the sudden appearance of a new lesion outside the original lesion site should be considered as a possible co-infection.
3.3 Increasing number of cases of fungal infections
With the low immunity of TB patients, various opportunistic infections are becoming more common, especially fungal infections. It has been reported that fungal infections have reached the first place of pathogenic bacteria in TB patients with combined lung infection cases [5]
3.4 Infections with rare and uncommon organisms are not uncommon
The same original unheard of some rare bacteria, rare bacterial infections should also be paid attention to, this paper data in the mucous Serratia marcescens 5 cases, Klebsiella odorata, Enterobacter aerogenes, Proteus mirabilis, Providence bacillus 2 cases each, Serratia marcescens, Serratia liquefaction, Aeromonas hydrophila, Pseudomonas spp, Citrobacter, agglomerative enterobacteria Pseudomonas griseus 1 case each. These types of infections are often insensitive to conventional therapeutic drugs and have poor efficacy, which is one of the problems that confuse doctors. In conclusion: TB patients with co-infection of the lungs have a wide variety of pathogenic bacteria with atypical symptoms, which are easily masked by the primary disease and should be taken seriously by TB physicians.
REFERENCES
(1) Feng Li, Tian Rong, Zhao Yuping, et al. Clinical investigation and analysis of nosocomial lower respiratory tract infections in tuberculosis hospitals
[J]. Chinese Journal of Anti-Tuberculosis, 2000, 22(2):76-78
(2) Tang Shenjie, Gao Wen, eds. Clinical tuberculosis [M] Beijing: People’s Health Publishing House, 2011.
356-356
(3) Jia Lin, Zhang Hong. Analysis of lower respiratory tract bacterial infections in patients with pulmonary tuberculosis [J]. Journal of Clinical Pulmonology 2010.
15(6): 874-875
(4) Wang Z-L, Liu X, Li H-J, et al. Clinical characteristics of nosocomial pulmonary bacterial infection in pulmonary tuberculosis [J].
Journal of Clinical Pulmonology 2011, 16(8): 1274-1275
(5) Cai B.Y., Li Q., Liang Q.T., et al. Analysis of pathogens of pulmonary infections secondary to pulmonary tuberculosis [J].
Journal of Practical Cardiopulmonary Vascular Diseases 2010, 18(2): 120-121