Overview.
Pulmonary trichinosis is an infectious disease of the lungs caused by pathogenic bacteria of the order Trichinella. Although rare, it develops rapidly and has a high mortality rate. Clinically, Trichoderma and Rhizoctonia are more common, the former mainly invades the lungs, the latter more involved in the sinuses, eyes, brain and digestive tract, and can be hematogenously disseminated throughout the body. Pulmonary trichothecosis can be a primary infection, can be secondary to sinus lesions or trichothecene sepsis.
Etiology
The fungi that cause pulmonary trichomycosis belong to the subphylum Splicea, Trichoderma, Trichoderma, Trichoderma, and are caused by other families in the Trichoderma order, such as Tephrosporium, Klebsiella, Koch, and Bottle molds. Among them, Trichoderma, Trichoderma, Platyhelminthes are the most common 3 types of fungi causing pulmonary trichomycosis, and 3 types of rhizoctonia caused by the most common, especially the less rooted Rhizoctonia and Rhizoctonia mycorrhizal fungi.
Symptoms
Clinical manifestations are nonspecific pneumonia, which may present with chest pain, dyspnea, and hemoptysis. The incidence of this disease is higher in patients with leukemia and lymphoma, and primary pulmonary trichothecenes can also occur in patients with diabetes mellitus. The prognosis is poor and the mortality rate is high.
Examination
1. Direct microscopic examination
Specimens from the upper turbinate scraping, sinus aspirate, sputum and biopsy specimens, etc., with 20% potassium hydroxide made of wet film direct microscopy, can be seen typical thick-walled refractive filaments, diameter of 6 ~ 15 microseconds, can also be seen in the expansion of the cells and curved mycelium. Sporangial peduncle grows directly from the mycelium, and the mycelium can be branched at right angles.
2. Bacterial culture
Clinical specimens will be inoculated in maltose medium without actinomycetone, potato medium and common sand medium, 37 ℃ or 25 ℃ culture, growth is faster, the initial colony surface is cotton-like, white, gradual change to gray-brown or other colors. The onset of trichinosis is dangerous, and trichinella often contaminate sputum and the environment, so direct microscopic examination is often more meaningful than culture.
3.X-ray examination
X-ray chest film shows nonspecific pneumonia and pulmonary infarction.
Diagnosis
Diagnosis is mainly based on triggering factors, clinical manifestations, bronchial or focal secretions, culture of bronchoalveolar lavage fluid, and biopsy of lung tissue to find Trichoderma can be diagnosed. The presence of short, thick, branching and non-separated Trichoderma filaments in the vessel wall is most diagnostic in tissue sections.
Treatment
Pulmonary trichomycosis has a high morbidity and mortality rate due to its aggressive onset. Amphotericin B and surgical debridement, treatment of concomitant diseases, correction of electrolyte disorders, correction of acidosis, etc. have efficacy, and the morbidity and mortality rate began to decrease.
1. Antifungal drugs
(1) Amphotericin B is extracted from Streptomyces nodosus, which has good efficacy in this disease and the best effect of intravenous drip.
(2) Flucytosine It has been reported that this drug has a synergistic effect with rifampicin or tetracyclines or with amphotericin B.
(3) Liposomal amphotericin B can reduce the toxicity and increase the prevention and treatment effect of amphotericin B.
2. Surgical dilatation
Remove as much necrotic tissue as possible. Amphotericin B can easily reach the lesion, and should be cleaned and drained when there is paranasal sinusitis, and the eyeball should be removed if there is retinal artery embolism, ophthalmia, or ocular involvement.
3. Control of underlying diseases
Correct acidosis and dehydration in diabetic patients, but it is not easy to treat in immunosuppressed patients with hormones, leukemia or chronic kidney disease, immune and metabolic disorders.
Prevention
The pathogen of the disease is conditionally pathogenic bacteria, susceptible patients should be timely treatment of systemic diseases, improve the body’s resistance. If the disease occurs, in addition to timely treatment, should also avoid cross-infection of other bacteria.