OVERVIEW
Pneumocystis aeruginosa is a pneumonia caused by the bacterium Pneumocystis aeruginosa, with a higher incidence in the elderly, infants and young children, patients with pre-existing chronic respiratory disease, and those with impaired immune function.
Causes
Aerobacillus is a gram-negative bacillus that is widely distributed in nature and the intestinal tract of humans and animals. It is a common causative agent of community-acquired and hospital-acquired Aerobacillus pneumonia.
Symptoms
1. fever, cough, sputum, dyspnea, cyanosis and other symptoms
2. Heavy systemic symptoms and obvious toxic symptoms. Easily complicate with pyothorax, meningitis, sepsis, pericarditis and so on.
Examination
1. The white blood cell count is obviously increased, the neutrophil count is increased, and the nucleus may be left shifted. Platelet count may be decreased in some severe patients.
2. X-ray chest radiograph or lung CT shows bronchopneumonia, lobar pneumonia, or solid changes in the lung segments. The lower lobe of the lungs are mostly involved, and diffuse bronchopneumonia or capillary bronchitis changes may also be present. It may appear as a cornified shadow, often fusing at the base of the lung, and about 30% develop a pustular chest. Pneumonia absorption may form pulmonary blisters.
3. Positive sputum, pleural fluid or blood cultures are more diagnostic.
Diagnosis
1. Clinical manifestations Repeated infection or nosocomial infection on the basis of existing systemic or pulmonary diseases, with fever, cough, sputum, cyanosis or shock in severe cases, which may be accompanied by signs of pleural effusion.
2. Routine blood tests The white blood cell count is often increased, but may be normal or decreased. Neutrophil count may not be obvious, but there are left shifted nuclei or toxic granules.
3. Sputum examination Sputum smear or culture may find aerobic bacilli (gram-negative bacilli).
4. X-ray chest radiography or lung CT shows multiple, lobular patchy lesions in both lungs, which may be fused to form a large patchy shadow, and small abscesses or cavities may be seen in the lesion area. If the infection is inhalational, the lesions are mostly in the lower lobes of both lungs. In the case of hematogenous infection, there are multiple scattered nodules or patchy shadows.
Treatment
1. Symptomatic treatment Take measures such as antipyretic, rehydration, sedation, oxygen therapy, nebulization, lung percussion.
2. Antibiotic treatment In order to improve the cure rate of this disease, sputum culture and drug sensitivity test should be done early to guide the clinical use of drugs. Before the results of drug sensitivity, it is generally appropriate to use antibiotics with synergistic effects in combination, such as: (1) ampicillin-sulbactam intravenous drip; (2) three generations of cephalosporins: cefoperazone sodium intravenous drip; ceftriaxone sodium intravenous drip; (3) severe patients, especially those with shock, can be directly applied to carbapenems: meropenem or imipenem.
Prevention
Active and effective treatment of chronic diseases prone to pulmonary infection, rational application of antibiotics and immunosuppressants; for respiratory machines, arterial and venous catheters and other kinds of interventional manipulation of therapeutic instruments, strict anti-pollution measures should be adopted.
Nursing care
1. Strengthen nutrition, supplement water, and ensure smooth drainage of sputum.
2. pay attention to the strict sterilization of the sick room and respiratory therapy instruments; medical personnel should pay attention to the aseptic operation to avoid causing medical infection.
3. Long-term bedridden patients should be turned over diligently and supplemented with chest percussion therapy, and those who have the conditions can use the shaking bed to do continuous rotation position therapy, in order to promote the excretion of respiratory secretions and alleviate the retention of secretions in the lower part of the lungs.