Legionellosis: cututtuka, ganewar asali, magani

Legionella - a HALITTAR na kwayoyin cuta da za su iya haifar da tsananin ciwon huhu da kuma alveolitis a manya. Da farko rubuta annoba kwanakin baya zuwa 1976 shekara, a lokacin da a Philadelphia saboda tsananin ciwon huhu daga 4.400 mahalarta na majalisa, "American Tuli" mutu 35 Tsohon soji. Total 221 mutane zama da rashin lafiya, da kuma mace-mace kudi da cutar ya 15.4%. Wannan shi ne - legionellosis. Duk abin game da haddasawa, cututtuka da kuma lura da wannan cuta da aka ƙoƙarin gane rikketsiologi Makdeyt da Shepard. Kuma bayan watanni 6 daga ranar da fashewa daga cikin pathogen gano kuma mun sami matakan magance shi.

Microbiological faye hali na causative wakili

Kamar yadda ya juya daga baya malaman, ya sa ta a bacteria Legionella pneumophila. A nasa ne da category na anaerobes cewa zai iya zama a cikin wani yanayi ba tare da oxygen. Yana ba ya samar da spores da capsules, m microbe yana da wani cell bango kuma tana nufin gram korau jinsunan. A daidai wannan rashi na ta jure da tilasta nemi hanyoyin da za a tsira hade tare da mutum aiki.

Da fari dai, Legionella ne kwayuka m, inda aka kare daga tsarin na rigakafi. Na biyu, "jiran" mutum legionella a m wuraren ga shi, inda suka ji dadi - a cikin shawa, a cikin waha kan gabatarwa da kuma motocin sanye take da iska-motsa jiki naúrar. Dumi ruwa da karfe bututu sa shi yiwuwa a ninka kwayoyin. su ne ma aiki a cikin jam'iyya da cyanobacteria a cikin dumi ruwa da kuma bututu tare da dumi ruwa. Saboda wannan dalili, kamar 16% na dukkan ciwon huhu ɓullo da tare da sa hannu na ɗaya ko fiye jinsunan Legionella.

A total akwai game da 50 damuwa da kwayoyin cuta na HALITTAR alaka da yawan tasonomicheskomu pneumotropic kwayoyin HALITTAR Legionella. Su tsokane legionellosis (Legionnaires 'cuta, ko) Yanã, cututtuka da kuma lura da ilimi makircinsu wanda aka riga aka sani. Yanzu game da baza kamuwa da cuta, pathogen hulda siffofi da kwayoyin, kazalika da ci gaba da cutar da isasshen bayani. Yana kuma ba ka damar ƙoƙari ya rage mace-mace daga Legionella ciwon huhu da kuma alveolitis.

Wajen kisa da kuma yaduwa halaye

A irin wannan cuta a matsayin legionellosis, cututtuka da kuma tsanani daga cikin yanayin dogara a kan halaye da kwayoyin. Tare da isasshen rigakafi tsaro yadda ya dace da mutane, har ma da maimaita lamba ba zai iya samun rashin lafiya. Duk da haka, tare da rage ta ayyuka yiwuwar kamuwa da cuta ƙaruwa sau da yawa. Bugu da ƙari, immunocompromised marasa lafiya, ciki har da kwayar cutar HIV da suke da alaka kamuwa da cuta, da bayyanar cututtuka na Legionnaires 'cuta ne yafi tsanani, kuma tsawon lokaci na rashin lafiya.

A kwayoyin shiga jiki ta hanyar da numfashi tsarin da kuma ta hanyar raunuka. Nau'i na farko shi ne mai numfashi droplets. Da yiwuwar raba tare da Legionella ruwa droplets samar da ANNOBA halaye. Amma, duk da rashin lafiya mutane a cikin tawagar aiki a cikin wannan dakin, idan su rigakafi da aka saukar da. Contact hanya ne mafi rare, amma ba cire. A wannan yanayin, da bayyanar cututtuka na Legionnaires 'cutar gida, watau a cikin yankin na ciwo ko a fata lalacewa, da kuma tsarin - ãyõyin maye.

Dokokin cuta hade ba kawai tare da peculiarities na rigakafi, amma kuma tare da shekaru halayyar wani rukuni na jama'a. An tabbatar da cewa mafi yawa, kuma mafi tsanani da rashin lafiya maza masu shekaru 40 ko fiye da shekaru. Mata da yara samun lafiya kasa sau da yawa. Wannan yanayin ba ka damar rarrabe tsakanin legionella ciwon huhu da Mycoplasma. Mycoplasmas sau da yawa rinjayar matasa, ko da kuwa jinsi.

The asibiti Hakika na kamuwa da cuta da Legionella

A cikin irin wannan cututtuka kamar legionellosis, da bayyanar cututtuka ba faruwa tun da farko lamba, da kuma bayan da shiryawa zamani. Ya kamata kai game 2-10 kwana: a lokacin wannan lokaci a cikin jiki na ninka legionella, amma pathological tafiyar matakai aiki ne low, wanda ya haddasa qananan (subclinical) ãyõyi. Kamuwa auku ko da sauki hanya, ana halin da mura-kamar ciwo, ko da irin ciwon huhu mai tsanani numfashi fili.

Nau'i na farko da ake dangantawa da ya kwarara daga legionellosis kyau m ikon da kwayoyin. A sakamakon lamba tare da m na numfashi kamuwa da cuta ci gaba legionellosis da mashako irin. Wannan irin na asibiti hanya ne ake kira Pontiac zazzabi. Nau'i na biyu na cuta - Legionella ciwon huhu. Shi ne mafi tsananin azãba kuma ya auku tare da high mace-mace.

Shi ne ya kamata a lura da cewa Pontiac zazzabi - a kalla a tsanani cuta, shi ne kawai kasa hatsari legionellosis. Legionnaires 'cuta (cuta cututtuka su ne m tare da siffofin wasu atypical ciwon huhu) na bayyana Legionella ciwon huhu, mai tsanani, sau da yawa m ga mãsu haƙuri.

A rarrabuwa ne ma wajibi ne don ware legionellosis, wanda shi ne mafi tsanani bayyanar cututtuka. Yana alveolitis - mai tsanani nau'i na ciwon huhu cewa boosts jiki ta yawan guba da kuma ta rage da alama na dawo. Yana kuma shi ne ya samar da biyu siffofin legionellosis, dangane da wurin da ya faru. Yana nosocomial legionellosis da kuma harben, da cewa shi ne al'umma-samu. Asibitin ganewar asali legionellosis ne izini kawai idan na asibiti ãyõyi bayyana bayan 2 ko fiye kwanaki daga lokacin da sarari a cikin keken naúrar.

Halayyar bayyanar cututtuka na Pontiac zazzabi

Pontiac zazzabi misali ne na kwarara daga huhu cututtuka irin Legionella pneumophila. Alamun wannan yanayi legionellosis kama mura ko parainfluenza nauyi: Patient tamkar high zazzabi (38-39 ° C), wanda ya bayyana bayan game da 36 hours bayan na farko daukan hotuna. Kuma ci gaba da zafin myalgia, ciwon kai, tari bushe fara. Lokaci-lokaci, musamman da zazzaɓi kan 38 digiri, tasowa amai.

damu rakiyar cututtuka tare da kara yawan zafin jiki: ƙishirwa, bushe baki, rage fitsari fitarwa. Har ila yau, zafi a cikin kirji, ko da yake wannan alama ne mafi related to Legionella ciwon huhu da ke shafar da pleura, maimakon tare da Pontiac zazzabi. Lokaci-lokaci a kan bango na maye bayyana photophobia, illa tunani da natsuwa, amma bayan dawo da, a matsayin mai mulkin, neurological rikitarwa ba su da samuwa.

Abin lura shi ne cewa kamar yadda legionellosis fili take: bayyanar cututtuka su ne ba nan da nan da ya bayyana, kamar yadda na farko lamba tare da kamuwa da cuta. Kuma da zarar jiki ya tara isasshen pathogens suka bayyana. A haƙuri alama ya zama cewa duk na asibiti ãyõyi bayyana ba tare magabata, wato, kan bango na overall kiwon lafiya. Shi ya sa da kansa sabawa da kuma iya bayar da Yunƙurin zuwa tsoma bakin ganewar asali "meningitis", saboda wannan cuta ma ta fara a matsayin wani mura.

Alamun Legionnaires 'ciwon huhu

Mutane da yawa cututtuka na Legionnaires 'cuta, Legionnaire ta cuta, auku a gaba da zanga-zanga, saboda kan bango na immunological cuta, da shiryawa zamani zai iya wuce har zuwa 3 makonni. Wannan zamani ne ake kira prodromal lokaci da kuma nuna kowa siffofin: gaban kananan zazzabi, tsoka rauni, sweating da nakasa daga 'ya'yan numfashin a sassauƙa, tari. Duk da haka, mafi yawan shiryawa zamani faruwa ne kawai ga 2-10 kwanaki. Sa'an nan dukan cututtuka ba tare da prodromal lokaci, watau ma kan bango na overall kiwon lafiya, kamar yadda shi ne yanayin da Pontiac zazzabi.

A irin wannan cuta a matsayin Legionella ciwon huhu (legionella), da ãyõyinMu, kuma siffarsu ba zai dogara ne a kan immunological reactivity na haƙuri kuma ya jiki jimiri. Cutar da ake kwashe dauke da kuma iya kai ga mutuwa. Da farko, akwai zazzabi game da + 39-40 digiri, wanda bazai, idan haƙuri shan wahala wani immunodeficiency hade tare da HIV, ko da cytostatic far. Tare da zazzabi da zarar wani tari da, wani nauyi a cikin kirji. Da farko kawai bushe tari da kuma sputum ba rabu.

A daidai wannan kusan nan da nan za a fara ta da sha raɗaɗin a cikin kirji, saboda kamuwa da cuta (Legionella) Yanã fibrinous pleural effusion da Alveoli. Kuma duk wadannan m Legionellosis: cututtuka, ganewar asali, magani da kuma hangen nesa da wannan ne ma m. Tare da data siffofin da cutar da mãsu haƙuri yana da dyspnea, mai guba buga, na numfashi alkalosis, muni da babban bayyanar cututtuka da rage regenerative iya aiki na jiki.

Common fasali na ganewar asali legionellosis

A lokacin da irin kamuwa da cuta kamar yadda legionellosis, bincike da kuma magance da nasu mawuyaci. Da fari dai, ba tare da kayan aiki ga chromatography ko Elisha dogara ƙayyade da pathogen ne kusan ba zai yiwu. Na biyu, ko da idan wani daga cikin zabin Legionella sputum wuya. Abu na uku, ba tare da yiwuwar dogara tabbatar da dalilin da kwayoyin da ya sa aka cuta, likita yana zuwa amfani da beta-lactam maganin rigakafi a matsayin wajen empirical antimicrobial far.

Domin mafi yawan beta-lactam resistant legionella saboda ta kwayuka wuri a cikin jiki. Yana kuma rage tasiri na rigakafi don yaki da kamuwa da cuta, kuma qara adadin gubobi da cewa suna da tsari detrimental effects. Saboda ganewar asali ya zama kamar yadda azumi kamar yadda zai yiwu. Idan da yiwuwar dakin gwaje-gwaje tabbatar da causative wakili na Legionnaires ba su da samuwa, likita yana zuwa rubũta empiric magani regimen tare da yin amfani da macrolide ko fluoroquinolone maganin rigakafi.

Jiki ganewar asali Legionella ciwon huhu

Nan da nan gane da cutar, saboda ta comparatively low mita, shi ne kusan ba zai yiwu ba. Bugu da kari, akwai game da 10 cututtuka, da ya kwarara a cikin na farko lokaci reminiscent na legionellosis. A bayyanar cututtuka da kuma lura da Legionnaires 'saboda haka za a fara da empirical makirci - aiki na biyu ko fiye m-bakan maganin rigakafi tare da iyakar ɗaukar hoto danginsu na kwayoyin. Yana kuma da za'ayi da kuma ta jiki ganewar asali, dangane da kimantawa data cewa za a iya samu tare da wani sauki jarrabawa na haƙuri.

A farko rarrabẽwa na legionellosis - zazzabi, ko da yake ba musamman. A farko lamba tare da haƙuri daukan hankali weighting zama hanzari m dyspnea da karuwa, wani lokacin zuwa 40 breaths da minti. Da zarar damu tari ba tare da phlegm. A haƙuri daukan mai zurfi numfashi, amma daga baya ya fara tsunduma cikin kirji saboda da bunkasa pleurisy. Lokacin da legionella pleurisy tasowa da sauri fiye da pneumococcal ciwon huhu.

Auscultatory halaye na legionellosis

Har ila yau jiki ãyõyinSa gaban auscultatory canje-canje. Wheezing shafi manyan yankunan da huhu, yawanci a dukan rabo. Haka kuma, idan wani zalla inji kimanta legionellosis, Yanã, cututtuka da bincike da kuma magani zai zama mafi bayyana. Batun shi ne wannan: yafi rinjayar da ƙananan lobes, kuma sau da yawa daga gare su. Hagu - saboda gaskiyar cewa ta ƙunƙuntar lobe bronchi da kuma rassan kashe daga babban bronchus a wani kwana, kasa wahala. Dama ƙananan lobe ne halin da fadi da kuma gajeren lobe bronchus, shaye daga babban kusan mike. Wadannan datti barbashi fada akai akai fiye da a bar ƙananan lobe, ko da yake shi ne kawai a wannan hasashen cewa ba zai iya zama cikakken m mulki.

A zahirin ganewar asali saukar crepitus. Shi ne mafi dangantakar, wanda ba sau da yawa. Ya kamata a bambanta daga congestive rigar finely wheezing, wanda ake ji da na kullum zuciya maye tare da bayyanar cututtuka na ruwa riƙewa a cikin huhu. Duk da haka, kawai jiki binciken cutar ba za a iya gina. Yana bukatar a complemented instrumental da dakin gwaje-gwaje gwaje-gwaje.

bincikowa da ciwon huhu

Biyu daga cikin mafi muhimmanci da bincike kayan aiki da hanyoyin hada da: bronchoscopy da radiography. Sau da yawa akwai biyu hanya kafin su sami wani image na kyallen takarda daga cikin kirji, ciki har da inflamed yankunan. A radiographs a frontal tsinkaya ne m isa manyan lobular inuwa, ba ya dace da girman da hearth, da kiyasta bayan auscultation.

A hoto ya nuna cikin yankunan da kumburi fadi, wani lokacin dama daga gare su, ko suka ci tare da juna. More wuya gani pleural fibrin rufi rabo a faru na Legionella kumburi. A wannan yanayin, a lokacin da ta radiography ya samu tabbaci cewa haƙuri yana da kumburi da huhu nama, likita iya ba bayar da shawarar gaban Legionella.

Bronchoscopy ne kasa m hanya, a wani muhimmanci har yanzu yana. Yana da muhimmanci ga bambanci ganewar asali. Amfani da ya halatta a yi da bronchoalveolar lavage, kuma ya iya yin gane microbe haifar da ciwon huhu. Hakika, domin a bronchoscopy, akwai wasu contraindications, daya daga wanda yake shi ne mai tsanani daga cikin haƙuri da yanayin.

Laboratory bincike Hanyar

Gold misali ga ganewar asali na cututtuka - bacterioscopy, selection kwayoyin da ta namo. Ta hanyar Hanyar an tabbatar da cewa pathogenic microbes ne a cikin jikin mutum da kuma ta yanzu jihar saboda wannan. Amma a yanayin saukan legionellosis bacterioscopy kusan ba zai yiwu ba, saboda da Legionella a shafa fall kamar yadda wasu kwayoyin da cewa zai iya sa ciwon huhu, ko dai kadai ko tsananta tafarkinsa. Saboda ƙara used chromatography da enzyme immunoassay.

Jiyya na Legionella ciwon huhu da kuma Pontiac zazzabi

Ma'aikatar Lafiya da kuma na asibiti shawarwari ga pulmonology data kasance ladabi yau samar da shiriya da mashako da kuma ciwon huhu da ya kamata a bi da tare da yin amfani da iri biyu antimicrobial jamiái na fadi bakan na mataki. Daya daga cikinsu shi ne wani aminopenicillin ko cephalosporin. Nau'i na biyu shi ne wani macrolide kwayoyin. Ya dace farko wajaba alama na rakiyar microflora, alhãli kuwa macrolides aiki da Legionella.

An yi imani da cewa ban da macrolides ( "midecamycin", "Azithromycin", "Erythromycin", "Clarithromycin"), aiki da Legionella da fluoroquinolones da rifampicin. Daga cikin fluoroquinolones son "ciprofloxacin", "ofloxacin", "Moxifloxacin", "Gatifloxacin" "Levofloxacin". "Rifampicin" da "Doxycycline" lokaci-lokaci za a iya amfani da su. Nada ta da wadannan hade da kwayoyi:

• Wakilin beta-lactam kungiyar a matsayin wani kashi empirical makirci - "ceftriaxone" 1 gram intramuscularly sau biyu a rana at 12 hours.
• macrolide ciki ( "Azithromycin 500" sau daya a rana, ko kuma "Erythromycin 500" 6 p \ rana, ko "Clarithromycin 500" sau biyu a rana, ko "midecamycin 400" 3-4 sau a rana).
• fluoroquinolones da ineffectiveness na biyu baya azuzuwan da kwayoyi ( "Ciprofloxacin 400» intravenously 2-3 sau a rana, "Levofloxacin 500 'baxini sau daya a rana," Moxifloxacin 400 "sau daya a rana).

Kamar yadda aka nuna, na farko line kwayoyi ne macrolides. Duk da haka, saboda gaskiyar cewa su ne kawai kashe da muhimmanci aiki da kwayoyin cuta, ya bar ta da rai (bacteriostats), tare da zargin legionellosis ko wasu SARS shi bada shawarar yin amfani da fluoroquinolones. Macrolides ne kawai a wani babban kashi, da kuma kawai da wasu daga cikinsu ( "midecamycin" da "Roxithromycin") zai iya samun bactericidal sakamako. Ko a lokacin da aka sanya wa daidaita da m makirci na antimicrobial far, da mãsu haƙuri yana bukatar samun iska goyon baya, kazalika da jiko far wa gyara wani dauke da kwayar cutar-mai guba buga.

Sau da yawa da wannan magani ne da za'ayi a cikin m kula naúrar, inda haƙuri shi ne 3-5 days kafin karfafawa. Sa'an nan magani aka gudanar a wani dauke da kwayar cutar daki ko a pulmonology. Bugu da ƙari, dawo da bai danganta wa] annan tare da sakamakon X-ray: infiltrative inuwa a cikin hotuna ne game da wata daya ko fiye. Kuma duk Legionella ciwon huhu magani yana game kwanaki 20 da kuma more. Bayan sallama, da mãsu haƙuri ya kamata kuma a lura outpatient, da ziyartar gida ilimin sau hudu a shekara.