Legionellosis: zizindikiro, matenda, mankhwala

Legionella - ndi mtundu wa tizilombo zomwe zingachititse chibayo kwambiri ndi alveolitis akuluakulu. Woyamba wolembedwa masiku mliri ku chaka cha 1976, pamene ku Philadelphia chifukwa chibayo aakulu mwa ophunzira 4.400 ya msonkhano wa, "American Legiyo" anafa 35 anamenyela. Total anthu 221 anadwala, ndi amafa matendawa anali 15,4%. Iyo ndiyo - legionellosis. Zonse zimene zimayambitsa, zizindikiro ndi mankhwala a matenda anali kuyesera kuti muganize rikketsiologi Makdeyt ndi Shepard. Ndipo pambuyo pa miyezi 6 kuchokera tsiku la mliri wa tizilomboto kuzindikiridwa ndi ife tikupeza miyeso kulimbana izo.

Microbiological mapangidwe a nthumwi causative

Mwamwayi akatswiri ina, chifukwa cha bakiteriya Legionella pneumophila. Adzaupereka kwa gulu la anaerobes kuti pakhale m'banja popanda oxygen. Zilibe kupanga spores ndi makapisozi, olimba tizilombo toyambitsa matenda alibe pakhoma mchipinda ndipo amatanthauza galamu mitundu negative. Pa akusowa womwewo wa kagayidwe ake kukakamizidwa kufunafuna njira kuti apulumuke kugwirizana ndi zochita za anthu.

Choyamba, Legionella ndi tiziromboti okhudza maselo ambiri, kumene kutetezedwa chitetezo cha m'thupi. Chachiwiri, "kuyembekezera" legionella anthu mu malo zosayembekezeka iye, komwe omasuka - akusamba, mu dziwe losambira pa malo ndi magalimoto okonzeka ndi mpweya unit. madzi ndi kutentha zitsulo mipope n'zotheka kuti kuchulukitsa tizilombo. iwo alinso yogwira mwa cyanobacteria mu madzi ofunda ndi mapaipi ndi madzi ofunda. Pachifukwa ichi, pafupifupi 16% ya chibayo onse anayamba ndi nawo mtundu umodzi kapena kuposa Legionella.

Okwana pali pafupifupi 50 tizilombo ta mabakiteriya a mtundu zokhudzana ndi chiwerengero cha zamoyo tasonomicheskomu pneumotropic mtundu Legionella. Zoyambitsa legionellosis (matenda Asilikali achiroma, kapena) zimapangitsa, zizindikiro ndi chithandizo cha ziwembu kulemba amene kale. Tsopano za kufala kwa matenda, tizilomboto mogwirizana zimaonetsa ndi chamoyo, komanso ngati chitukuko cha matenda ndi mfundo zokwanira. Njirayi imaperekanso inu kuyesa kuchepetsa imfa ku Legionella chibayo ndi alveolitis.

Odwala ndi kafalitsidwe makhalidwe

Mu matenda monga legionellosis, zizindikiro ndi zovuta chikhalidwe zimadalira makhalidwe a chamoyo. Ndi okwanira m'thupi Mwachangu kuteteza anthu, ngakhale ndi kukhudzana mobwerezabwereza kudwala. Komabe, ndi kuchepa ntchito zake Mwina ukuwonjezeka matenda nthawi zambiri. Komanso, odwala immunocompromised, kuphatikizapo matenda zokhudzana ndi HIV, zizindikiro za matenda Asilikali achiroma 'ndi mochuluka kwambiri ndi yaitali matenda.

Bakiteriya tikalowa m'thupi mwa dongosolo kupuma ndipo kudzera mabala. Yoyamba ndi m'malovu kupuma. Kutheka kuuza Legionella m'malovu madzi kupereka tingachidziwe AIDS. Kwenikweni, anthu onse odwala mu timu ntchito muchipinda chimodzi, ngati chitetezo chokwanira awo ndi adatchithisira. Contact njira zambiri osowa, koma mulibemo. Pankhaniyi, zizindikiro za matenda Asilikali achiroma 'kwanuko, mwachitsanzo m'dera la bala kapena kuwonongeka khungu, ndipo dongosolo - zizindikiro za kuledzera.

Malamulo a matenda kugwirizana osati ndi peculiarities wa chitetezo chokwanira, komanso ndi zaka khalidwe la gulu la anthu. Padatsimikiza kuti kawirikawiri ndiponso kwambiri amuna kudwala zaka 40 kapena kuposa. Akazi ndi ana kudwala kwambiri. Mbali imeneyi zimathandiza inu kusiyanitsa chibayo legionella ndi Mycoplasma. Mycoplasmas zambiri zimakhudza achinyamata, kaya mwamuna kapena mkazi.

The matenda zochita za matenda ndi Legionella

Mu matenda monga legionellosis, zizindikiro sanalembedwepo kuyambira kukhudzana koyamba, ndipo pambuyo nthawi makulitsidwe. Iwo ayenera kutenga za 2-10 masiku: nthawi ino mu thupi wachulukitsa legionella, koma pathological njira ntchito ndi otsika, zomwe zimabweretsa zing'onozing'ono (subclinical) zizindikiro. Infection kumachitika kapena njira zosavuta, n'lodzaza ndi matenda chimfine kapena mtundu wa chibayo ndi thirakiti aakulu kupuma.

Yoyamba amagwirizana ndi otaya legionellosis wabwino luso zoteteza wa chamoyo. Chifukwa cha kukhudzana ndi matenda pachimake kupuma kukhala legionellosis ndi mtundu matenda. Mtundu kumene matenda amatchedwa pamtengo malungo. Mtundu wachiwiri wa matenda - Legionella chibayo. Ndi kwambiri ndipo amapezeka ndi imfa mkulu.

Dziwani kuti pamtengo malungo - osachepera matenda aakulu, ndiye zochepa oopsa legionellosis. matenda Asilikali achiroma '(zizindikiro matenda zofanana ndi mbali zina chibayo atypical) kumasonyeza Legionella chibayo, kwambiri, nthawi zambiri amapha wodwalayo.

Gawo ndilo zofunika kuonetsetsa legionellosis, ndilo matenda ambiri. Iwo alveolitis - mawonekedwe choopsa cha chibayo kuti boosts kawopsedwe thupi ndi kuchepetsa mosavuta kuchira. Ndi kupereka mawonekedwe awiri a legionellosis, malingana ndi malo zosayembekezereka. Iwo nosocomial legionellosis ndi ayi, kuti ndi dera zinazake. Hospital matenda a legionellosis amaloledwa yekha ngati zizindikiro matenda anaonekera pambuyo 2 masiku kapena zambiri kuchokera nthawi danga mu unit n'kupuma.

Zizindikiro khalidwe la pamtengo malungo

malungo pamtengo ndi chitsanzo cha otaya matenda a m'mapapo monga Legionella pneumophila. Zizindikiro izi legionellosis chikhalidwe amafanana fuluwenza kapena parainfluenza lolemera: Wodwala yosemphana ndi mkulu kutentha (38-39 ° C), lomwe limapezeka pambuyo pa 36 maola pambuyo padzuwa koyamba. Komanso anayamba kwambiri myalgia, kupweteka kwa mutu, chifuwa yadzuwa n'kuyamba. Nthawi zina, makamaka malungo pa 38 digiri, akufotokozera kusanza.

Zizindikiro nkhawa m'munsili limodzi ndi kuchuluka kutentha: ludzu, pakamwa youma, utachepa mkodzo linanena bungwe. Komanso, kupweteka m'chifuwa, ngakhale Mbali imeneyi ndi zambiri chikugwirizana ndi Legionella chibayo zokhudza pleura, osati ndi pamtengo malungo. Nthawi zina pa maziko a kuledzera limapezeka photophobia, maganizo mkhutu ndi ndende, koma pambuyo achire, monga ulamuliro, zosokonezeka ubongo palibe.

N'zochititsa chidwi kuti legionellosis zimaonekera: zizindikiro si litakhala, monga yoyamba ndi matenda. Ndipo kamodzi Thupi anapeza tizilombo toyambitsa matenda mokwanira iwo amaoneka. Wodwala zikuwoneka kuti onse zizindikiro matenda anaonekera popanda akalambula, ndiko, ndi maziko a thanzi akukhudzidwira. Izo zimapangitsa kusintha komanso chimayambitsa matenda wosayenerera "meninjaitisi", chifukwa matenda komanso kwayambira chimfine ndi.

Zizindikiro za chibayo Asilikali achiroma '

zizindikiro zambiri matenda Asilikali achiroma, matenda Legionnaire a, zimachitika pasadakhale chitsanzocho, chifukwa ndi maziko a matenda immunological, nthawi makulitsidwe ukhoza mpaka milungu 3. nthawi iyi akutchedwa prodromal nthawi ndipo ikusonyeza mbali wamba: pamaso pa malungo yaing'ono, kufooka kwa thupi, thukuta ndi kupuma movutikira pa katundu kuwala, kutsokomola. Komabe, ambiri a nthawi makulitsidwe limachitika kwa masiku 2-10. Ndiye zizindikiro zonse popanda nthawi prodromal, mwachitsanzo, komanso ndi maziko a thanzi akukhudzidwira, monga momwe zilili ndi pamtengo malungo.

Mu matenda monga Legionella chibayo (legionella), zizindikiro ndi malongosoledwe awo adzakhala sikukutanthauza reactivity immunological wodwalayo ndi kupirira thupi. matenda ikuchitika kwambiri ndipo kungachititse kuti imfa. Poyamba, pali malungo pafupi + madigiri 39-40, omwe mwina ayi, ngati wodwalayo akuvutika ndi immunodeficiency kugwirizana ndi HIV kapena ndi mankhwala cytostatic. Pamodzi ndi malungo kamodzi chifuwa ndi kulemera mu chifuwa. Poyamba okha youma chifuwa ndi sputum ali sanasiyane.

Pa yemweyo pafupifupi yomweyo anayamba kusokoneza kupweteka pachifuwa, chifukwa matenda (Legionella) zimapangitsa fibrinous pleural effusion ndi alveoli. Ndipo onse awa Legionellosis poopsa: zizindikiro, matenda, mankhwala ndi madokotala ananena zawo chifukwa imeneyi ndi zenizeni. Pamodzi ndi mbali deta ya matenda wodwalayo dyspnea, mantha poizoni, kupuma alkalosis, kukulitsa zizindikiro zazikulu ndi kuchepetsa mphamvu regenerative za thupi.

Nkhani zimene zimapezeka matenda a legionellosis

Amenewa matenda monga legionellosis, matenda ndi mankhwala ndi Kuvuta zawo. Choyamba, popanda zipangizo koromatogarafe kapena Elisa molondola kudziwa tizilomboto kuli kovuta. Chachiwiri, ngakhale aliyense wa kusankha Legionella sputum kovuta. Kachitatu, popanda kuthekera kwa mtima odalirika mabakiteriya kuti zimayambitsa matendawo, dotolo ali ndi ntchito beta-lactam mankhwala monga njira wazotsatira mankhwala antimicrobial.

Pakuti ambiri beta-lactam kugonjetsedwa legionella chifukwa cha malo ake okhudza maselo ambiri mu thupi. Komanso amachepetsa mphamvu ya chitetezo chokwanira kulimbana ndi matenda ndi kuonjezera chiwerengero cha poizoni ndi zokhudza zonse zotsatira zake sizingakhale zabwino. Chifukwa matenda ayenera kukhala mofulumira ngati nkotheka. Ndipo ngati mwina zasayansi kutsimikizira kwa causative wothandizila a magulu a asilikali palibe, dotolo ali ndi mankhwala empiric chithandizo kamwedwe ntchito macrolide kapena mankhwala fluoroquinolone.

Thupi matenda a Legionella chibayo

Pomwepo kuzindikira matenda, chifukwa cha pafupipafupi ake ndi anthu otsika, N'zosatheka. Komanso pali pafupifupi 10 matenda, otaya mu nthawi koyamba amatikumbutsa legionellosis. Zizindikiro ndi mankhwala a magulu a asilikali 'Chotero anayamba zolinga wazotsatira - ntchito awiri kapena kuposa yotakata-sipekitiramu mankhwala ndi pazipita Kuphunzira genera tizilombo. Iwo anagwiritsanso ndi matenda thupi, zochokera aziona deta kuti akhoza kuwapeza ndi kufufuza yosavuta wodwalayo.

Muyeso loyamba legionellosis - malungo, ngakhale sali yeniyeni. Pa yoyamba ndi mtima chidwi weighting kukhala mofulumira mwapang'onopang'ono dyspnea ndi kuwonjezeka, nthawi zina mpweya 40 pa mphindi. Kamodzi nkhawa chifuwa popanda phlegm. Wodwala amatenga mpweya kwambiri, koma kenako amayamba ungapangitse pachifuwa chifukwa cha pleurisy osauka. Pamene legionella pleurisy akufotokozera mofulumira kuposa chibayo pneumococcal.

Auscultatory makhalidwe a legionellosis

Komanso zizindikiro thupi pamaso pa kusintha auscultatory. Wheezing anakhudzidwa m'madera ambiri phapo, kawirikawiri gawo lonse. Komanso, ngati chinthu makina kuunikira legionellosis osiyanasiyana, zizindikiro, matenda ndi mankhwala akuoneka kwambiri. Mfundo ndi iyi: makamaka amakhudza lobes m'munsi, ndipo nthawi zambiri mmodzi wa iwo. Kumanzere - chifukwa chakuti Lobe ake yopapatiza bronchi ndi nthambi ku bronchus chachikulu pa cham'mbali, kupatula mavuto. Kumanja m'munsi Lobe amakhala ndi lalikulu ndi waufupi Lobe bronchus, ndi utsi waukulu pafupifupi molunjika. particles dothi awa agwere kambirimbiri kuposa mu anasiya Lobe m'munsi, ngakhale chabe kuwirikiza kawiri sangakhale ulamuliro zolondola mwamtheradi.

Matenda thupi anaulula crepitus. Ndi zambiri amgwirizano, amene si kawirikawiri. Kuyenera siyanitsa congestive yonyowa finely wheezing, amene anamva ndi kulephera aakulu mtima ndi zizindikiro za posungira madzimadzi mu mapapo. Komabe, chabe anapezazo thupi matenda sangakhoze anamanga. Lifunika lowonjezera ndi mayesero zoimbidwa ndi zasayansi.

Diagnostics chibayo

Awiri chofunika kwambiri njira yodziwira chida monga: bronchoscopy ndi radiography. Nthawi zambiri zilipo njira yachiwiri kupeza fano la zimakhala za chifuwa, kuphatikizapo madera chofuna. Pa radiographs mu ziyerekezo mazunzo ndi noticeable zokwanira lalikulu lobular mthunzi, si zogwirizana ndi kukula kwa moto, pafupifupi pambuyo auscultation.

The chithunzi limasonyeza m'madera a kutupa onse, nthawizina angapo a iwo, kapena kuphatikiza ndi mzake. More kawirikawiri anawona pleural Ulimbo anakuta gawo zosayembekezereka wa Legionella kutupa. Pankhaniyi, pa nthawi imene ndi radiography walandira kutsimikizira kuti wodwalayo ali kutupa kwa minofu ya m'mapapo, adokotala akhoza komanso sanena pamaso pa Legionella.

Bronchoscopy ndi njira zochepa wapatali, pa tanthauzo ena ake. Nkofunika kuti matenda masiyanidwe. Ntchito ndi chovomerezeka kutenga lavage bronchoalveolar, ndi kutha kuzindikira tizilombo toyambitsa matenda kuchititsa chibayo. N'zoona kuti bronchoscopy, zilipo zina contraindications, mmodzi amene ndi zovuta alili.

Laboratory matenda Njira

Gold muyezo matenda a matenda opatsirana - bacterioscopy, mabakiteriya Kusankha ndi kulima ake. Kudzera njira imene imatsimikizirika kuti tizilomboto tizilombo ali mu thupi la munthu uliri panopa chifukwa ichi. Koma mu nkhani ya legionellosis bacterioscopy sizingatheke, chifukwa ndi Legionella mu kuipitsa mbiri kugwa monga zamoyo zina zimene zingachititse chibayo, kaya payekha kapena kukulitsa yake. Chifukwa koromatogarafe kunadetsa ntchito ndi puloteni immunoassay.

Chithandizo cha Legionella chibayo ndi pamtengo malungo

Utumiki wa Health ndi malangizo kuchipatala chifukwa pulmonology alipo ndondomeko lero lili ndi malangizo amene chifuwa ndi chibayo ayenera kusonyezedwa ndi ntchito mitundu iwiri ya wothandizila antimicrobial a sipekitiramu lonse kanthu. Mmodzi wa iwo ndi aminopenicillin kapena cephalosporin. Mtundu yachiwiri ndi macrolide mankhwala. Moyenera poyamba wolungama imabwera microflora m'munsili, pamene macrolides yogwira ndi Legionella.

Akukhulupirira kuti kuwonjezera macrolides ( "midecamycin", "Azithromycin", "mankhwalawa", "Clarithromycin"), yogwira ndi Legionella ndi fluoroquinolones ndi rifampicin. Pakati fluoroquinolones zokonda "ciprofloxacin", "ofloxacin", "Moxifloxacin", "Gatifloxacin" "Levofloxacin". "Rifampicin" ndi "Doxycycline" nthawi angagwiritsidwe ntchito. Kuikidwa ndi kuphatikiza zotsatirazi mankhwala:

• Nthumwi beta-lactam gulu monga mchitidwe wazotsatira chiwembu - "ceftriaxone" 1 galamu intramuscularly kawiri patsiku pa maola 12;
• macrolide mkati ( "Azithromycin 500" kamodzi pa tsiku kapena "mankhwalawa 500" 6 tsa \ tsiku, kapena "Clarithromycin 500" kawiri pa tsiku kapena "midecamycin 400" nthawi 3-4 tsiku);
• fluoroquinolones ndi kupanda makalasi awiri wakale mankhwala ( "Ciprofloxacin 400» m'nsinga 2-3 pa tsiku, "Levofloxacin 500 'm'kati kamodzi patsiku," Moxifloxacin 400 "kamodzi pa tsiku).

Monga taonera, mankhwala mzere oyamba macrolides. Komabe, chifukwa chakuti iwo okha kuletsa ntchito yofunika mabakiteriya, kusiya moyo wake (bacteriostats), ndi amaganiziridwa legionellosis kapena zina SARS Ndi bwino kugwiritsa ntchito fluoroquinolones. Macrolides okha pa mlingo mkulu, ndi ena a iwo ( "midecamycin" ndi "Roxithromycin") yekha angakhale ndi zotsatira bactericidal. Ngakhale pamene amagwira ntchito mu moyenera ndi mwaluso chiwembu cha mankhwala antimicrobial, wodwala ayenera mpweya thandizo, komanso mankhwala kulowetsedwa kukonza ndi matenda mankhwala mantha.

Nthawi zambiri mankhwala ikuchitika odwala mwakayakaya, pamene wodwala masiku 3-5 asanayambe olimba. Ndiye chithandizo imachitika mu chipinda matenda kapena pulmonology. Komanso, ayambe sanali correlate ndi zotsatira za X-ray: mithunzi infiltrative mu zithunzi za mwezi kapena kuposerapo. Ndipo onse Legionella chibayo mankhwala kumatenga pafupifupi 20 masiku ndi zina zambiri. Pambuyo kumaliseche, wodwala ayenera kucitika outpatient, kuyendera dokotala wamba kanayi pachaka.