Overview of Penicillium
Penicillium widely present in nature, some can produce antibiotics such as penicillin and a variety of enzymes and organic acids, most usually contaminating bacteria, a few strains under certain conditions can cause penicilliosis and pulmonary penicilliosis. For non-specific, similar to tuberculosis or pulmonary aspergillosis, can appear cough, cough sputum, hemoptysis, dyspnea, fever, loss of appetite, emaciation, systemic failure and other symptoms. Allergic bronchopulmonary penicillinosis is caused by inhalation of a large number of penicillin spores in a short period of time, which may show temporary pulmonary infiltration, eosinophilia in peripheral blood and sputum, as well as intermittent airway obstruction, chest tightness, laryngeal itchiness and soreness, asthma, urticaria and other manifestations. If the brain is involved, there may be dot or flame hemorrhages in the fundus of the eye, confusion, convulsions, coma and other central nervous symptoms.
Etiology
Most of the genus Penicillium have only asexual stages and a few are found to have sexual stages. The basic characteristic of this genus is that the trophic mycelium is colorless, pale, or distinctly colored.
Symptoms
It is nonspecific, similar to tuberculosis or pulmonary aspergillosis, and may present with coughing, coughing up sputum, hemoptysis, dyspnea, fever, lack of appetite, emaciation, and generalized exhaustion.
Allergic bronchopulmonary penicillinosis is caused by inhalation of a relatively large number of penicillin spores in a short period of time, which can be manifested as temporary pulmonary infiltration, eosinophilia in peripheral blood and sputum, along with intermittent airway obstruction, chest tightness, laryngeal itchiness and soreness, asthma, urticaria and other manifestations of allergic reactions.
If the brain is involved, dot or flame hemorrhage in the fundus of the eye, confusion, convulsions, coma and other central nervous system symptoms may occur. In addition, Penicillium invasion of other parts of the body can also cause non-specific endocarditis, otitis externa, otitis media, urinary tract infection, skin granuloma, onychomycosis, pediculosis and so on.
Examination
1. Sputum, bronchoscopic aspirate, pus and other specimens are taken, and 10% potassium hydroxide film is used for microscopic examination, which shows branching and separation of mycelium and small spores.
2. Bacterial culture on glucose peptone agar and Tsa’s medium, incubated at 25-28 ℃ rapid growth, colonies are fluffy, flocculent, rope or bundle. The surface is mostly blue or gray-green. The substrate can have various colors.
3. X-ray chest film shows focal pulmonary inflammatory infiltration or cavity formation, there are reports of X-ray signs of “soap bubble”, the density is generally very light, the lower lung is more concentrated, soap bubble wall thickness and size is very inconsistent.
Diagnosis
Because of the widespread presence of various penicilli in the surrounding environment, the diagnosis of pulmonary penicilliosis must be careful. The diagnosis can only be confirmed if Penicillium is found in both tissue sections and sputum isolation cultures. If Penicillium is found in the patient’s sputum by direct microscopic examination and culture several times, or cultured from sputum, urine, blood and other ways, or cultured in the living tissue with fungal infection, then combined with the clinical manifestations, the diagnosis can be made as Penicilliosis, but it is necessary to identify the strain further.
Differential diagnosis
Many serious lower respiratory tract diseases such as tuberculosis, lung abscess, mycoplasma pneumonia, lung cancer, and many acute infectious diseases such as measles, whooping cough, acute tonsillitis, etc. are often accompanied by acute tracheobronchitis at the onset of symptoms, which can cause cough. Pay attention to the careful questioning of the medical history, such as whether exposure to toxic substances, whether there is a history of smoking, whether there are other systemic symptoms, history of vaccination, etc., combined with epidemiological data, according to the characteristics of each disease detailed examination, in order to identify. Symptoms of influenza are quite similar to those of acute bronchitis, but the former often presents epidemic outbreaks of varying sizes, with a rapid onset and obvious systemic symptoms, such as high fever, headache, and generalized muscular aches and pains, and the diagnosis can be confirmed on the basis of isolation of the virus and the complement binding test. A few children have recurrent episodes of acute bronchitis, and cystic pulmonary fibrosis and hypogammaglobulinemia should be excluded.
Treatment
The average patient does not require hospitalization. Those with chronic underlying cardiac or pulmonary disease need to be hospitalized for respiratory support and oxygen therapy when inflammation leads to severe hypoxia or hypoventilation. Symptomatic treatment is mainly to stop coughing and expectoration, patients with severe dry cough can be appropriately applied cough suppressant, for patients with prolonged cough, codeine or benzonatate can be used if necessary. If the sputum is thick or sticky, expectorants such as Ambroxol Hydrochloride (Mucosolvan) or Bromhexine can be used. In patients with a family history of croup, inhaled bronchodilators such as salbutamol (wheezing) or terbutaline may be used if croup is detected on examination. Aminophylline or β2-agonists may be used when accompanied by bronchospasm. Those with generalized discomfort and fever as the main symptoms should rest in bed, pay attention to warmth, drink plenty of water, and take aspirin and other antipyretics.
Antibiotics should not be used routinely for those who do not have a clear pathogen. Blind application of antibiotics can lead to the development of drug-resistant bacteria, secondary infections and some other serious consequences. However, if the patient presents with fever, purulent sputum and severe cough, it is an indication for the application of antibiotics. Antibiotic treatment for patients with acute tracheobronchitis can be applied with antibiotics against Chlamydia pneumoniae and Mycoplasma pneumoniae, such as erythromycin orally, or clarithromycin or azithromycin. In the elderly, those with underlying cardiopulmonary diseases can apply oral antibacterial drugs such as macrolides, β-lactams or quinolones. Mycoplasma pneumoniae, Chlamydia and B. pertussis are very sensitive to erythromycin and doxycycline.