Overview.
Mycobacterium avium is an opportunistic pathogen that causes inflammation of the lungs and tends to occur in patients who have been hospitalized for a long period of time or who have a lowered body resistance and are more severely ill. The organism is resistant to many commonly used antibiotics, making treatment difficult and mortality high. The disease can be infected at multiple sites throughout the body. Commonly, it is urinary tract infection, with symptoms such as urinary pain and urgency. Nosocomial infections caused by Fusobacterium avium have been increasing in recent years. The incidence of lower respiratory tract infections is highest among infected cases.
Etiology
Fusobacterium respiratory tract infections can be exogenous or endogenous. Fusobacteria can be detected in the pharynx, oral cavity, secretions, sputum and bronchial washings of normal people, and are transient bacteria of the upper respiratory tract. Sputum is probably the most important bacterial source of nosocomial transmission of Fusobacterium avium pneumonia, but it is currently believed that the most important is respiratory infection caused by Fusobacterium avium brought in by respiratory artificial tubes and nebulizers, masks, humidifying bottles, and ventilator tubes. Community-acquired Fusobacterium indolentum pneumonia is increasingly being reported, and its risk factors are mainly alcohol consumption and smoking.
Fusobacterium is a conditionally pathogenic bacteria, and most of the infected people are hospitalized or those with significantly reduced body resistance, such as malignant tumors undergoing chemotherapy, radiotherapy, glucocorticoid treatment, the elderly, and infants and young children.
Symptoms
1. Symptoms
Sharp onset of illness, chills, high fever, body temperature can be as high as 40 ℃, irregular heat pattern. Violent cough, sputum viscous, yellow pus, in the lung abscess formation can be seen in a large number of viscous pus sputum, up to hundreds of milliliters per day, a few patients with blood in the sputum, dyspnea is obvious. Gastrointestinal symptoms commonly include nausea, fear of food, vomiting, and diarrhea. The disease can be infected in multiple places. The most common is urinary tract infection, with symptoms such as painful urination and urgency.
2.Physical signs
In secondary Mycobacterium avium subspecies lung infection, most of them have pre-existing underlying diseases or respiratory tract infections. The disease starts slowly and does not improve under antibiotic treatment, and the clinical symptoms of infection worsen. Signs: obvious systemic failure, cyanosis, shortness of breath. There is chronic lung abscess or bronchial dilatation. Infection may have pestle finger, anemia face, chest physical examination breath sounds decreased (affected side) and wet rales, rales (both lower lungs are common), with sepsis manifested as pleural effusion signs, accompanied by septicemia infection may have splenomegaly.
Examination
1. Laboratory examination
Leukocyte count is elevated, usually between (10～20)×109/L, neutrophils 80%～90%, sometimes with abnormal liver function. Sputum culture detects Mycobacterium avium.
2. Other auxiliary examinations
X-ray chest radiographs show patchy shadows in the middle and lower fields of the lungs, a few are large shadows, and translucent areas are seen in patchy dense shadows, which are multiple. If there is pleural effusion, the X-ray sign of pleural effusion can be seen.
Diagnosis
Mainly by bacterial culture, but it should be noted that in order to determine the immobilized bacilli, the following conditions must be met:
1. Signs and symptoms of respiratory tract infection;
2. 2 or more consecutive sputum cultures with Fusobacterium growth;
3. immobilized bacilli are pure culture or dominant.
Fusobacterium indolentum infection should be suspected when the following clinical conditions occur:
1. Infections or double infections occurring in hospitalized patients with decreased body resistance (ICU), patients in custodial wards, patients with artificial airways and patients treated with ventilators;
2. when the clinical manifestations seem to be gram-negative bacterial infections, but the efficacy of ampicillin and cephalosporin antibiotics is not good;
3. long-term use of a variety of antibiotics respiratory tract infection can not be controlled. For suspected patients, secretions or sputum should be taken repeatedly for culture.
Differential diagnosis
It is very difficult to differentiate Fusobacterium inducensum pneumonia from other gram-negative bacterial pneumonia, unless the clinical presentation is characterized by typical sputum of Pseudomonas aeruginosa or Escherichia coli infection. If other gram-negative bacteria are also growing in the bacterial culture, it may be a mixed infection. In this case, the bacterial count should be used to determine whether there is a co-infection with Fusobacteria.
Treatment
In recent years, multidrug-resistant strains of Fusobacterium indolentum have appeared, and clinical trials have proved that the new generation of quinolone ciprofloxacin, oxfloxacin, and enrofloxacin all show high antibacterial activity against Fusobacterium indolentum. Third-generation cephalosporins, such as cefotaxime; and fourth-generation cephalosporins, such as cefepime and cefpirome can be used in multi-resistant Fusobacterium pneumonitis. In some cases, amikacin (butacarbazone) and tobramycin can still be used if they are sensitive. Since most patients with this disease have underlying diseases and obvious systemic failure, nutritional supportive therapy is more important, and lipids, amino acids, vitamins, plasma and fresh blood should be supplemented as appropriate.
Prognosis
Due to the increasing severity of drug resistance of Fusobacterium indolentum and untimely diagnosis and treatment, the morbidity and mortality rate is higher than that of general bacterial infections.
Questions you may be concerned about
What is the cure rate for Fusobacterium indolentum pneumonia in the elderly?
Currently there is no specific statistical data on the cure rate of Fusobacterium avium pneumonia in the elderly, but in general, the cure rate is relatively high if the health condition is relatively good and there is no drug resistance; however, the cure rate is lower if the health condition is poor and there is drug-resistant bacterial infection.
1. Relatively high cure rate: If the elderly are in good physical condition, without life-threatening complications, can take the initiative to cough and expel phlegm to ensure that the phlegm drainage is smooth, their own resistance is strong enough, nutritional status is good, and the infected bacteria are sensitive to antibiotics, relatively speaking, the cure rate is high.
2. lower cure rate: if the elderly physical condition is poor, there are cerebrovascular disease sequelae, malnutrition malignant disease and other conditions, or refractory drug-resistant bacillus, bacillus pneumonia cure rate is relatively low, and may even be due to respiratory failure and life-threatening.
It should be noted that, even if the drug-resistant strain of infection, do not arbitrarily use a variety of antibiotics, so as to avoid adverse drug reactions complications, etc., affecting the cure.
When pneumonia exists in the elderly, it is recommended to consult a doctor promptly to avoid delaying treatment.
Prevention
The outbreaks and epidemics of Fusobacterium avium occur mainly in hospitals, and the main preventive measures are:
1. Actively treat the primary disease, eliminate the triggering factors of Fusobacterium avium infection as soon as possible, and stop the use of hormones in a timely manner. For the use of damage to the body’s immunity treatment of patients, such as radiotherapy and chemotherapy patients should be actively given supportive treatment and strengthen the nutrition, patients with a significant decline in blood image should be more attention. For chronic lung disease patients hospitalized during the treatment should also strengthen the nutrition, enhance its resistance.
2. Limit the abuse and long-term application of antibacterial drugs, especially the application of broad-spectrum antibiotics that have obvious effects on normal flora and easily cause bacterial dysbiosis.
3. Wards should strictly disinfect all kinds of respiratory treatment instruments, especially tracheal intubation and cannula, sputum suction tubes, nebulized inhalers, and ventilator tubes, so as not to bring Fusobacteria directly into the respiratory tract and cause infections.
4. Pay attention to air sterilization in respiratory wards and infant wards.
5. Strictly sanitize the hands of the medical staff and even the accompanying staff.
6. The relics and supplies of patients with Fusobacterium avium infection or original infection should be thoroughly cleaned and sterilized.
7. Hospitals should establish a routine method of detecting Fusobacterium avium so that Fusobacterium avium infection can be detected in a timely manner.