Overview of Group B Streptococcal Pneumonia
Group B streptococcal pneumonia refers to pneumonia caused by group B streptococcal infection, which can occur in newborns either directly from the mother or as a result of upstream infection from maternal genital tract parasites during delivery. Group B streptococcal infections are rare in adults, predominantly in mothers, and in rare cases in immunocompromised individuals.
Etiology
The disease is caused by a pulmonary infection with group B streptococci, which can occur in newborns either directly from the mother or by upstream infection from maternal genital tract parasites during labor and delivery. Mothers and a small number of immunocompromised adults, such as patients with diabetes mellitus, chronic liver insufficiency, human immunodeficiency virus (HIV) infection, malignant tumors, and patients receiving immunosuppressive therapy may also become infected with group B streptococci, causing pneumonia.
Symptoms
Most patients have a rapid onset of symptoms, including fever, chills, weakness, cough and shortness of breath, and may have mucus, pus or rust-colored sputum, as well as signs of solid lung lesions, such as wet rales and turbid sounds on percussion.
Examination
1. Blood tests
In systemic infection, the blood white blood cell count may increase significantly up to (20-30)×109/L. In the elderly and immunocompromised patients, the increase of white blood cell count is not obvious.
2. Bacteriologic examination
Blood and respiratory secretions (e.g. sputum, bronchoalveolar lavage fluid, tissue biopsy specimens) are taken for bacterial culture, and group B streptococci can be seen.
3. Cerebrospinal fluid examination
The cerebrospinal fluid of patients with meningitis shows purulent changes, with the appearance of rice soup, protein often above 1g/L, and white blood cell count above 500×106/L.
4.X-ray examination
In X-ray examination, exudate or solid lesions are mostly confined to one or several lung segments in one lung lobe.
Diagnosis
Diagnosis can be made on the basis of clinical manifestations such as fever, chills, weakness, cough and shortness of breath, signs of solid lung lesions such as wet rales and turbid sounds on percussion on physical examination, and the combination of routine blood tests and X-ray findings.
Treatment
1. Antibacterial treatment
Antibacterial treatment should be started as early as possible.
(1) Penicillin aqueous, every 12h intramuscular injection, if shock can be changed to intravenous injection, or until the body temperature drops to normal after 72h to stop using the drug. Discontinuing the drug too early may lead to relapse.
(2) Cefthiophene intramuscularly or intravenously, effective but occasionally with penicillin cross-allergenic, it is advisable to use cefthiophene to do allergy test before using the drug.
(3) Cefazolin intramuscularly or intravenously.
(4) Erythromycin orally, erythromycin resistance is rare.
2. Supportive symptomatic therapy
(1) Bed rest, liquid diet, gradually change to semi-liquid diet or soft food after improvement.
(2) Replenish fluids and electrolytes.
(3) Shock patients should be given oxygen, supplement circulating blood volume, correct acidosis. In severe cases, 0.3% hydrogen peroxide can be injected intravenously, or phentolamine, scopolamine, atropine or isoprenaline can be titrated to improve microcirculation. Do not blindly give large amounts of antihypertensive drugs.
3. Treatment of underlying diseases
Patients with diabetes mellitus, chronic hepatic insufficiency, human immunodeficiency virus infection, malignant tumors, and those receiving immunosuppressive therapy should be treated aggressively for underlying diseases.
Prognosis
In the elderly and infants, the prognosis is poor if treatment is delayed.
Prevention
Reduce risk factors, such as smoking and alcohol abuse; strengthen physical exercise to enhance physical fitness.
Nursing care
1. Fever care
When the fever is high, bed rest should be provided to reduce oxygen consumption, physical cooling can be used, or medication should be applied to lower the temperature as prescribed by the doctor, intravenous replacement of water and salt lost due to fever, and temperature changes should be monitored and recorded.
2. Cough and sputum care
Encourage the patient to take deep breaths, assist in turning over and chest percussion, guide effective coughing, and promote sputum expectoration. If the sputum is thick and sticky, encourage the patient to drink more water, or give nebulized inhalation.