Legionellosis: iimpawu, isifo, unyango

Legionella - a sodidi lwe iintsholongwane ezinokubangela inyumoniya kakhulu kwaye alveolitis abadala. abhalwe kuqala Imihla bhubhane umva kunyaka-1976, xa ePhiladelphia ngenxa inyumoniya kakhulu phakathi nxaxheba 4.400 le nkongolo, "American NdinguMkhosi" wafa 35 amagqala. Bebonke abantu 221 wagula, kwaye izinga lokusweleka esi sifo yaba 15.4%. Yiloo nto - legionellosis. Yonke ngoonobangela, iimpawu kunye nonyango lwesi sifo zaye uzama uku bana phandle rikketsiologi Makdeyt kunye Apha ndingumhambi. Ke kaloku, emva kweenyanga ezi-6 ukusuka kumhla kokuqhambuka pathogen ezichongiweyo kwaye sifumana amanyathelo ukulusiphula iingcambu.

abalinganiswa ekuzakuqalwa yomenzeli causative

Kwathi kanti abaphengululi kamva, esibangelwa igciwane Legionella pneumophila. Ku fanele ukuba udidi anaerobes ukuba mbi imeko ingekho i-oksijini. It aluyiyo imbewu kunye njengezingxobo, leentsholongwane esiqinileyo akukho donga yeseli yaye libhekisela gram iintlobo ezimbi. Ngelo ukuswela efanayo emzimbeni wayo kwanyanzeleka ukuba ukujonga iindlela ukusinda ezinxulumene nemisebenzi yabantu.

Okokuqala, Legionella yinto amaphelo intracellular, apho biyela amajoni omzimba. Okwesibini, i "ukulinda 'legionella kwabantu kwiindawo ezingalindelekanga kuye, apho baziva bekhululekile - egeza, echibini lokuqubha kwisakhiwo kunye Kwizithuthi iyunithi air-moya. amanzi ashushu imibhobho yesinyithi kwenza kube lula ukuba phinda iintsholongwane. ukuba nazo ezisebenzayo ngokumanyene icyanobacteria emanzini eshushu kunye nemibhobho ngamanzi ashushu. Ngenxa yesi sizathu, malunga nama-16% azo zonke yinyumoniya iyaphuhliswa inxaxheba kweentlobo enye okanye ngaphezulu Legionella.

Xa iyonke kukho abamalunga nama-50 iintlobo iintsholongwane ze sodidi enxulumene inani eziphilayo tasonomicheskomu pneumotropic kowazo Legionella. Baqumbisa legionellosis (isifo amabutho ', okanye) ebangela, iimpawu kunye nonyango kwezikim nokubhala esele eyaziwa. Ke kaloku, malunga ukosuleleka yintsholongwane, pathogen intsebenziswano features kunye ephilayo, kwakunye nokuphuhliswa sifo babe nolwazi olwaneleyo. Kwakhona likuvumela ukuba ukuzama ukunciphisa ukufa evela Legionella semiphunga kunye alveolitis.

Okugula andise iimpawu

Xa isifo ezifana legionellosis, iimpawu nobukhali imeko kuxhomekeke iimpawu eziphilayo. Enesidingo omzimba ukusebenza ukukhusela abantu, nkqu zoqhagamshelwano ngokuphindaphindiweyo akakwazi bayagula. Nakuba kunjalo, kukho ukwehla imisebenzi yalo amathuba ukunyuka yosulelo amaxesha amaninzi. Ngaphezu koko, izigulane immunocompromised, kuquka usulelo ezinxulumene ne-HIV, iimpawu zesifo amaRoma 'Kuninzi kakhulu kwaye ixesha elide lokugula.

Igciwane ongena umzimba ngokusebenzisa inkqubo yokuphefumla yaye amanxeba. Uhlobo lokuqala zamathontsana zemiphunga. Amathuba ngokwabelana amathontsi amanzi Legionella zinika iimpawu zayo epidemiological. Ngokusisiseko, bonke abantu abagulayo kwiqela ukusebenza kwigumbi elinye, ukuba ngumsebenzi wabo uvikivwa. Iinkcukacha indlela ngakumbi inqabile, kodwa ngaphandle. Kulo mzekelo, iimpawu zesifo amabutho 'ekuhlaleni, oko kukuthi kummandla enxebeni okanye umonakalo eluswini, kunye nenkqubo - iimpawu ukunxila.

Laws izifo ezinxulumene hayi kuphela awohluke sifo, kodwa kunye nobudala uphawu liqela labantu. Kwakugqitywa kwelokuba ngokufuthi ngakumbi yaye nangakumbi kakhulu abantu abagula abaminyaka yobudala eyi-40 okanye ngaphezulu. Abafazi kunye nabantwana begula kakhulu rhoqo. Olu phawu likuvumela ukwahlula phakathi legionella pneumonia Mycoplasma. Mycoplasmas ivame abantu abatsha, kungakhathaliseki ukuba yindoda.

Ikhondo kwezonyango ukosuleleka Legionella

Xa izifo ezifana legionellosis, iimpawu musa kwenzeke ukususela qha lokuqala, kwaye emva kokuba okuthatha. Kufuneka kuthathe malunga 2-10 iintsuku: ngeli thuba sexesha emzimbeni sandisa legionella, kodwa umsebenzi iinkqubo lwezidumbu iphantsi, nto leyo ebangela minor (subclinical) imiqondiso. Usulelo kwenzeka okanye indlela elula, ixubile ezifana nomkhuhlane syndrome, okanye uhlobo yinyumoniya ne phecana kakhulu zemiphunga.

Uhlobo lokuqala linxulunyaniswa ukugeleza legionellosis ubuchule elungileyo ibakhusela eziphilayo. Ngenxa yoko uqhagamshelwano kunye usuleleko ezihlasela zosulele ngokuphefumla ukuphuhlisa legionellosis ngohlobo yomoya. Olu hlobo ke lonyango kuthiwa Pontiac fever. Uhlobo lwesibini lwesifo - pneumonia Legionella. Kuyinto kakhulu ngakumbi kwaye kwenzeka nge yokufa.

Kubalulekile ukuphawula ukuba Pontiac fever - ubuncinane sisifo esibi, oko kuphela legionellosis akanangozi. izifo amaRoma '(iimpawu zesifo twatse anezinto yezinye pneumonia Nedlac) Leyo yindlela abonakalisa ngayo Legionella pneumonia, kakhulu, ngokufuthi ezibulalayo umguli.

Ulwahlulo kuyimfuneko kwakhona yokwaba legionellosis, nto leyo iimpawu bumandundu. It alveolitis - uhlobo kakhulu yinyumoniya ukuba kuyenza zinetyhefu umzimba kunye ngokunciphisa amathuba okuba achache. Kwakhona kukubonelela iintlobo ezimbini legionellosis, kuxhomekeka kwindawo ingenzeka. It legionellosis nosocomial kwaye manqapha, oko kukuthi uluntu ezifunyanwa. Hospital isifo legionellosis ugunyazisiwe kuphela ukuba iimpawu yezonyango wabonakala emva kweentsuku-2 okanye ngaphezulu ukusuka kwixesha isithuba kwiyunithi zokubhala.

Iimpawu uphawu Pontiac fever

fever Pontiac ngumzekelo nokungena izifo zemiphunga ezifana Legionella pneumophila. Iimpawu le legionellosis nature bafana umkhuhlane okanye parainfluenza enzima: Nomonde ephazamisana lobushushu eliphezulu (38-39 ° C), ebonakala emva kweeyure ezimalunga 36 emva kokuba sesichengeni lokuqala. Kwakhona kuphuhliswa myalgia kakhulu, intloko ebuhlungu, ukhohlokhohlo owomileyo iqala. Maxa wambi, ingakumbi izidanga ngumkhuhlane phezu 38, iphuhlisa nokugabha.

Iimpawu ochaphazelekayo ehamba kukhatshwe obushushu banda: unxano, umlomo owomileyo, sinciphise umchamo kwimveliso. Kwakhona, iintlungu esifubeni, nangona lo msebenzi ezihambelana Legionella inyumoniya ochaphazela pleura, kunokuba kunye Pontiac fever. Ngamanye amaxesha kwisiqalo kunxilwe ivela photophobia, ukucinga kakuhle kunye ingqondo, kodwa emva kwakhona, njengokuba umthetho, izigulo luvo azifumaneki.

Kuyaphawuleka ukuba legionellosis kuyabonakala; iimpawu ibonakale, njengoko qha yokuqala kunye usulelo. Kwaye xa umzimba sele efunde Iintsholongwane ngokwaneleyo kuvela. Isigulane kubonakala ukuba zonke iimpawu yezonyango wabonakala ngaphandle ababelawula ngaphambi, oko kukuthi, kwimvelaphi yezempilo jikelele. Kwenza uhlengahlengiso zayo kwaye zinokubangela ukuba isifo ngokungafanelekanga "meningitis", Ngokuba lo sifo uqala nomkhuhlane.

Iimpawu pneumonia aseRoma '

Iimpawu ezininzi izifo amabutho ', isifo Legionnaire likaThixo, kwenzeka kwangaphambili Kumboniso, ngokuba kwimvelaphi ukuphazamiseka ngumzimba, lo okuthatha elinokuthatha ukuya kuma kwiiveki ezi-3. Eli xesha kuthiwa ixesha prodromal kwaye ibonisa iimpawu ezifanayo: ubukho fever encinane, buthathaka kwezihlunu, ukubila nephika mpefumlo umthwalo ukukhanya, ukukhohlela. Noko ke, inkoliso okuthatha lwenzeka kuphela iintsuku 2-10. Ke zonke iimpawu ngaphandle ixesha prodromal, okt kwakhona kwimvelaphi yezempilo jikelele, njengoko kunjalo Pontiac fever.

Xa isifo efana Legionella pneumonia (legionella), iimpawu kunye nenkcazelo yabo iya kuxhomekeka reactivity ngumzimba yomguli kunye nokunyamezela kwakhe ngokomzimba. Esi sifo lwenziwa kakhulu kwaye kunokukhokelela ekufeni. Ekuqaleni, kukho fever malunga + 39-40 degrees, kuba leyo, ukuba isigulane unesifo i immunodeficiency ezinxulumene ne-HIV okanye unyango osebenzayo. Bekunye fever kanye ukukhohlela kunye ubunzima esifubeni. Ekuqaleni kuphela ukhohlokhohlo owomileyo isikhohlela hayi bahlukane.

Ngelo efanayo phantse nangoko aqalise ukuphazamisa iintlungu esifubeni, kuba usulelo (Legionella) ebangela effusion fibrinous pleural kunye alveoli. Kwaye zonke ezi Legionellosis yingozi: iimpawu, uxilongo, unyango kunye ALS kuba oko nayo nantoni na. Kunye iimpawu idatha sifo ogulayo dyspnea, ukothuka ityhefu, alkalosis yokuphefumla, owayephethe iimpawu eziphambili kwaye zinciphisa isakhono okungenisa umzimba.

iimpawu eziqhelekileyo lokufunyaniswa legionellosis

Xa ezifana usulelo njengoko legionellosis, isifo kwaye afumane unyango ube nokuntsonkotha zabo. Okokuqala, ngaphandle izixhobo chromatography okanye ELISA ngokuthembekileyo kumisela gciwane phantse akunakwenzeka. Okwesibini, nokuba naziphi na kukhetho Legionella yesikhohlela nzima. Okwesithathu, ngaphandle kokuba ithuba nokuzimisela oluthembekileyo iintsholongwane leyo eyabangela ukuba esi sifo, ugqirha kufuneka usebenzise nemithi beta-lactam njengendlela unyango olwenziwe elwa.

Kuba inkoliso beta-lactam legionella enganyangekiyo ngenxa kwindawo yayo intracellular emzimbeni. Oku kunciphisa ukusebenza sifo ukuba ulwe usulelo kwaye kwandisa isixa ityhefu ezinempembelelo systemic yingozi. Kuba uphethwe kufuneka ukhawulezise kangangoko kunokwenzeka. Ukuba amathuba elaborathri yomenzeli causative of amaRoma azifumaneki, ugqirha kufuneka ukumisela irejimeni yonyango empiric nokusetyenziswa macrolide okanye antibiotics fluoroquinolone.

uxilongo Physical of Legionella pneumonia

Ngoko nangoko ukuqaphela sifo, ngenxa rhoqo wayo xa kuthelekiswa neminye iminyaka, cishe akunakwenzeka. Ukongeza, kukho malunga-10 izifo, ukuhamba kwisithuba sokuqala kusikhumbuza legionellosis. Iimpawu kunye nonyango amaRoma 'ukuqala ngoko necebo reseach - isabelo antibiotics ezimbini okanye ngaphezulu ebanzi-spectrum kunye ubuninzi coverage kwisizukulwana ezincinane. Wazithwala kwakhona kwaye isifo ngokwasemzimbeni, ngokusekelwe kuvavanyo lwe data enokuzuzwa nge uviwo elula malunga nesigulane eso.

Isibaluli lokuqala legionellosis - fever, nangona akukho ezithile. Xa umfowunelwa wokuqala kunye ekuxabeleni weighting nomonde nje ngokukhawuleza dyspnea oluqhubekayo kunye nokwanda, maxa wambi Ukuphefumla-40 ngomzuzu. Xa ndinexhala ukhohlokhohlo ngaphandle phlegm. Isigulane uthatha ukuphefumla nzulu, kodwa kamva uqala ukuba kungokunivela isifuba ngenxa unepleurisy asakhasayo. Xa legionella unepleurisy iphuhlisa ngokukhawuleza ngaphezu pneumonia Pneumococcal.

iimpawu Auscultatory of legionellosis

Kwakhona imiqondiso enyama ubukho utshintsho auscultatory. Ukutswina abachaphazelekayo kwiindawo ezinkulu kwemiphunga, ngokuqhelekileyo isabelo yonke. Ngaphezu koko, ukuba legionellosis kuphela ngoomatshini ukuvavanya, ebangela, iimpawu, isifo kwaye afumane unyango kuya kubonakala ngakumbi. Ingongoma yile: luhlasela esithinzini asezantsi, yaye ngokufuthi omnye wabo. Ekhohlo - ngenxa yokuba bronchi yayo emxinwa lobe kunye amahlamvu ukusuka bronchus engundoqo kwi-engile, ukubandezeleka ngaphantsi. Ekunene lobe esezantsi lubonakala ngokuba bronchus lobe ebanzi, elifutshane, qeda ukusuka engundoqo phantse tye. Ezi Amasuntswana ukungcola kuwa qho ngaphezu kwi nomhlehlo esezantsi ekhohlo, nangona nje manani ukuba akanakuba ulawulo oluchanekileyo ngokupheleleyo.

On diagnosis emzimbeni kutyhilwa crepitus. Kuyinto mazwe ngakumbi, nto leyo rhoqo. Kufuneka zingahlukaniswa congestive ukutswina zimanzi ezicukucezwe zancinane, ezo sivile ukusilela ngentliziyo ezingapheliyo kunye iimpawu ukugcinwa fluid emiphungeni. Nakuba kunjalo, iziphumo nje emzimbeni uxilongo ayikwazi ukuba yakhiwe. Kuyafuneka ukuba zincediswe iimvavanyo negalelo kunye laboratory.

uxilongo pneumonia

Ezimbini ezona ndlela ezixabisekileyo isixhobo diagnostic ziquka: bronchoscopy kunye ray. Amaxesha amaninzi indlela yesibini ekhoyo ukuze ufumane umfanekiselo nezihlunu esifubeni, kuquka iindawo ebushushwini babo. On radiographs e nayiphi ngokungqalileyo nto buqapheleke ngokwaneleyo ithunzi enkulu lobular, ayingqinelani ubungakanani obuselukhambeni, eliqikelelwayo emva auscultation.

Lo mfanekiso ubonisa iindawo ukudumba banzi, maxa wambi eziliqela ngabo, okanye idibane nenye. Okunye uyibone pleural fibrin sommandla aninasabelo isahlakalo Legionella komtshiso oko. Kulo mzekelo, ngexesha apho yi ray ifumene isiqinisekiso ukuba isigulana na ukudumba inwebu lung, ugqirha kwakhona musa siphakamisa ukuba phambi Legionella.

Bronchoscopy yindlela ngaphantsi ezixabisekileyo, kwi ziyakubaluleka ethile usenalo. Kubalulekile ukuba isifo umahluko. Ukusebenzisa kuvumelekile ukuba ukuthatha lavage bronchoalveolar, kwaye akwazi ukuchonga intsholongwane ebangela isifo sokukrala kwemiphunga. Kakade ke, ukuba bronchoscopy, kukho ezinye Izimo, enye yazo na ubuzaza imeko yesigulane.

Laboratory Diagnostic Methods

umgangatho Gold moshilongo kwezifo ezosulelayo - bacterioscopy, iintsholongwane ukhetho kunye nokulima yayo. Esebenzisa le ndlela kube kuvunyiwe ukuba iintsholongwane yayintsholongwane eyosulela kakhulu emzimbeni womntu kunye nemeko yayo yangoku ngenxa oku. Kodwa kwimeko legionellosis bacterioscopy kwenzeke, kuba ne Legionella kwi smear ukuwa nezinye izinto ezinokubangela inyumoniya, nokuba wedwa okanye kubangele ikhondo layo. Ngenxa chromatography zisetyenziswa kakhulu yaye enzyme immunoassay.

Unyango Legionella yinyumoniya kunye Pontiac fever

Ministry of Health kunye neengcebiso zonyango ukuze Pulmonology ekhoyo iprotocol namhlanje zinika isikhokelo ukuba kwemigudu kunye nenyumoniya kufuneka ziphathwe kunye nokusetyenziswa kweentlobo ezimbini arhente elwa of spectrum ezibanzi amanyathelo. Omnye kubo a aminopenicillin okanye cephalosporin. Uhlobo sesibini olwa macrolide. Nokufaneleka kuqala sigwetyelwe amathuba microflora ezihamba, kanti macrolides esebenzayo nxamnye Legionella.

Kukholelwa ukuba ukongeza macrolides ( "midecamycin", "Azithromycin", "Erythromycin", "Clarithromycin"), asebenzayo ngokuchasene Legionella kunye fluoroquinolones kunye rifampicin. Phakathi fluoroquinolones okukhethwayo "ciprofloxacin", "ofloxacin", "moxifloxacin", "Gatifloxacin" "Levofloxacin". "Rifampicin" yaye "Doxycycline" zingasetyenziswa manqaphanqapha. Oqeshwe yindibaniselwano ilandelayo kwamachiza:

• Representative qembu Beta-lactam njengento reseach scheme - "ceftriaxone" 1 gram intramuscularly kabini ngemini kwi iiyure 12;
• macrolide ngaphakathi ( "Azithromycin 500" kanye ngemini okanye "Erythromycin 500" 6 p imini \, okanye "Clarithromycin 500" kabini ngemini, okanye "midecamycin 400" amaxesha 3-4 ngosuku);
• fluoroquinolones kunye kwawo yeeklasi ezimbini ezidlulileyo iziyobisi ( "ciprofloxacin 400» yegazi izihlandlo 2-3 ngosuku, "ngaphakathi kanye ngemini Levofloxacin 500," moxifloxacin 400 "kanye ngosuku).

Njengoko kubonisiwe, amachiza umgca zokuqala macrolides. Noko ke, ngenxa yokuba gqiba nje umsebenzi ebalulekileyo iintsholongwane, eshiya yakhe iphila (bacteriostats), kunye legionellosis okukrokrelwayo okanye ezinye SARS kucetyiswa ukuba usebenzise fluoroquinolones. Macrolides kuphela kwi idosi ephakamileyo, yaye kuphela abanye babo ( "midecamycin" yaye "Roxithromycin") enokuba nempembelelo bactericidal. Nokuba xa yabelwa iskim elungeleleneyo nesemgangathweni unyango elwa, isigulane kufuneka inkxaso umoya, kwakunye nonyango ukumnika ukulungisa kukukhabise esosulelayo-ityhefu.

Amaxesha amaninzi le unyango oluqhutywa kwicandelo labagula kakhulu, apho isigulane ziintsuku 3-5 phambi sinjalo. Ke unyango kuqhutyelwa gumbi esosulelayo okanye Pulmonology. Ngaphezu koko, ukumimitheka akazange masihambelane iziphumo ze X-ray: izithunzi infiltrative kwi imifanekiso malunga ngenyanga okanye ngaphezulu. Kwaye lonke unyango inyumoniya Legionella ithatha iintsuku ezimalunga nama-20 nangaphezulu. Emva obhobhozayo, isigulane kufuneka sigcinwe ezingalaliswayo, ndibuvelela therapist local amaxesha amane ngonyaka.