Legionellosis: izimpawu, uphethwe, ukuphathwa

I-Legionella iyinhlobo yebhaktheriya engabangela ukukhuphuka okukhulu kwe-pneumonia ne-alveolitis kubantu abadala. Isifo sokuqala esibhaliwe sabuya ngo-1976, lapho ama-veteran angama-35 efa ePhiladelphia ngenxa ye-pneumonia eqinile phakathi kwabangu-4 400 ababambe iqhaza kwiCongress of the American Legion. Abantu abangu-221 babulala, kanti izinga lokufa lesi sifo laliyi-15.4%. Lona yi-legionellosis. Konke mayelana nezimbangela, izimpawu kanye nokwelashwa kwalesi sifo wazama ukuthola ama-rickettsiologists uMcDead noShepard. Futhi izinyanga ezingu-6 emva kokugqashuka kwesifo, i-pathogen yabonakala futhi yathola izinyathelo zokulwa nayo.

Izici ezincane ze-microbiological ye-pathogen

Njengoba kamuva kutholakala ososayensi, i-agent causative yi-bacterium Legionella pneumophila. Kungokwesigaba se-anaerobes esingaba khona endaweni ngaphandle kwe-oxygen. Ayifuni ama-spores nama-capsules, i-microbe ayikho udonga oluqinile lweseli futhi lingezinhlobo ze-Gram-negative. Ngesikhathi esifanayo, ukuphikisana kwesimo sakhe somzimba kusishukumisela ukuba sibheke izindlela zokusinda, ezihlobene nomsebenzi obalulekile womuntu.

Okokuqala, i-legionella iyi-parasite ye-intracellular, lapho ivikelekile ngokweqile kwisistimu yomzimba. Okwesibili, i- "Legionella" ilinde umuntu ezindaweni ezingalindelekile, lapho ekhululekile - eshaweni, echibini, emakamelweni nasezimotweni ezinezimo zomoya. Amanzi afudumele namapayipi zensimbi enza kube lula ukuphindwa ngamabhaktheriya. Futhi bahlanganyela ngokugcwele nge-cyanobacteria emagodini afudumele namapayipi ngamanzi afudumele. Ngenxa yalesi sizathu, cishe amaphesenti angama-16 azo zonke izifo zomoya ezikhula ngokubamba iqhaza kwezinto eziningana zeLegionella.

Kunezinhlobo ezingaba ngu-50 zebhaktheriya zalolu hlobo lwesimo se-taxonomic uchungechunge lwezilwane ze-pneumotropic ze-genus Legionella. Bathukuthelisa futhi i-legionellosis (noma izifo ze-legionnaires), izimbangela, izimpawu kanye nezinqubo zokwelapha ezikwazi ukukwazi ukwelashwa sezivele ziyaziwa. Manje kunolwazi olwanele mayelana nokusabalala kokutheleleka, okuphawulekayo kokuxhumana kwe-pathogen nomzimba, kanye nokuthuthukiswa kwesifo. Lokhu kubuye kuvumele imizamo yokunciphisa ukufa kweLegionella pneumonia kanye ne-alveolitis.

Izici zokuziphatha nokusabalalisa

Ngesifo esinjenge-legionellosis, izimpawu nokuqina kwalesi simo kuxhomeke ekuziphatheni komzimba ngokwawo. Ngokuphumelela ngokwanele kokuvikela omzimba, umuntu akakwazi ukugula ngisho nokuxhumana okuphindaphindiwe. Kodwa-ke, ngokunciphisa emisebenzini yayo, amathuba okutheleleka ananda izikhathi eziningi. Futhi ezigulini ezinama-immunodefaces, kuhlanganise nalabo abangelwa ukutheleleka ngegciwane lesandulela ngculazi, izimpawu ze-legionellosis zibizwa kakhulu, futhi isikhathi sokugula sikhulu.

I-bacterium ingena emzimbeni ngokusebenzisa uhlelo lokuphefumula kanye nesilonda. Uhlobo lokuqala luyisifo sokuphefumula. Ukuhlelwa kwe-legionella ngamaconsi amanzi kunika izici zayo ze-epidemiological. Ngokuvamile, bonke abantu abavela embuthaneni abasebenza egumbini elifanayo bayagula, uma ukuzivikela kwabo kuncipha. Indlela yokuxhumana ingavamile, nakuba ingabanjwanga. Kulokhu, izimpawu ze-legionellosis zibonakaliswa endaweni yangakini, okungukuthi, endaweni yokulimala noma ukulimala kesikhumba, kanye nesistimu - izibonakaliso zokudakwa.

Amaphethini wokufiphaza ahlobene hhayi kuphela nezici zokuzivikela, kepha futhi nezici zonyaka zeqembu labantu. Kunqunywa ukuthi amadoda aneminyaka engama-40 nangaphezulu ajwayelekile futhi anzima kakhulu. Abesifazane nezingane bagula kancane kancane. Lesi sici senza sikwazi ukuhlukanisa i-legionellosis pneumonia kusuka ku-mycoplasmal. Ama-Mycoplasma avame ukubathinta abantu abasha kungakhathaliseki ukuthi bazocansi.

Inkambo yokwelapha ye-legionella ukutheleleka

Njengoba isifo esinjalo njenge-legionellosis, izimpawu aziveli ngesikhathi sokuxhumana okuyisisekelo, kodwa emva kwesikhathi sokukhushulwa. Kumele kuhlale ezinsukwini ezingu-2-10: isikhathi esinikeziwe esivela eLegionella yomzimba siyancipha, kodwa umsebenzi wezinqubo ze-pathological uyingcosana, okwenza amancane (subclinical) aveze. Ukutheleleka kwenzeka ngandlela-thile elula, ebonakala nge-influenza-like syndrome, noma ngohlobo lwe-pneumonia enezilonda ezinzima zendlela yokuphefumula.

Uhlobo lokuqala lokugeleza kwe-legionellosis luhlobene namakhono amahle okuzivikela omzimba. Ngenxa yokuxhumana nokutheleleka, i-legionellosis enamandla yokuphefumula iqala njengenhlobo ye-bronchitis. Lolu hlobo lwenkambiso yezokwelapha lubizwa nge-Pontiac fever. Uhlobo lwesibili lwesifo yi-legionellosis pneumonia. Kubi kakhulu futhi kuqhubeka nokufa okuphezulu.

Kumele uqaphele ukuthi umkhuhlane wePontiac awunamandla kakhulu, yi-legionellosis engesiyingozi kakhulu. Izifo ze-Legionnaires (izimpawu zesifo zifana nalezo ezinye izifo zomoya ezinamandla ) yi-manifestation ye-legionellosis pneumonia yezinkinga ezimbi, okuvame ukuholela emphumela wokubulala wabantu abagulayo.

I-Legionellosis, enezibonakaliso ezinzima kakhulu, nayo ifanelwe ukuhlukaniswa. Le-alveolitis yindlela enzima kakhulu ye-pneumonia, okwenza ukweqiswa komzimba futhi kunciphise amathuba okubuyiselwa. Kulesi simo, kufanelekile ukugqamisa izinhlobo ezimbili zeLegionellosis, kuye ngokuthi indawo yokuvelaphi. Leli yi-legionellosis yesibhedlela kanye ne-sporadic, okuwukuthi, ngaphandle kwesibhedlela. Ukuxilongwa kwesibhedlela legionellosis kusebenza kuphela uma izibonakaliso zemitholampilo zibonakala emva kwezinsuku ezimbili noma ngaphezulu kusukela ngesikhathi sokubekwa emnyangweni weziguli.

Izimpawu zezimpawu ze-Pontiac fever

I-Pontiac fever iyisibonelo senkambo encane yesifo esinjenge-legionellosis. Izimpawu ze-legionellosis zalolu hlobo zifana ne-influenza noma i-parainfluenza enamandla: isiguli sikhathazekile yi-fever high (38-39 degrees), kubonakala cishe amahora angu-36 emva kokuxhumana kokuqala nesifo. Futhi, ukuqina komzimba nokukhanda ikhanda kukhula, ukukhwehlela owomile kuqala. Ngezinye izikhathi, ikakhulukazi lapho umkhuhlane ungaphezu kwama-38 degrees, ukuhlanza kuyaqala.

Ngokumelene nesifo somkhuhlane, izimpawu ezihambisana nazo ziyahlupha: ukoma, umlomo owomile, wehlisa inani lomchamo. Kukhona ubuhlungu esifubeni, nakuba lesi sibonakaliso sithinta kakhulu i-legionella pneumonia esithinta isikhalazo kunokuba ne-Pontiac fever. Ngezinye izikhathi, i-photophobia, ukuphazanyiswa kokucabanga nokugxila kokubheka kungabhekana nesimo sokudakwa, nakuba ngemuva kokuphola, njengombuso, azikho izinkinga zemvelo yezinzwa.

Kuyaphawuleka indlela i-legionellosis ebonakala ngayo: izimpawu azibonakali ngokushesha, njengesikhathi sokuxhumana okokuqala nesifo. Futhi ngokushesha nje lapho umzimba uqoqe izifo ezifuywayo ngokwanele, zivela. Kubonakala sengathi isiguli ukuthi zonke izibonakaliso zemitholampilo ziboniswe ngaphandle kwezinguquko, okungukuthi, ngokumelene nesizinda sempilo ephelele. Yenza izinguquko zayo futhi ingaba yisisekelo sokuxilongwa okungenabulungisa "kwe-meningitis", ngoba lesi sifo siqala njengomkhuhlane.

Izimpawu zeLegionella Pneumonia

Izimpawu eziningi ze-legionellosis, izifo ze-legionnaires, zibonakalise kusengaphambili, ngaphambi kokubonakaliswa, ngoba ngokumelene nesimo sezinkinga zokuzikhukhumeza i-immunction isikhathi sokukhushulwa singadlulela emavikini amathathu. Leli gama libizwa ngokuthi i- prodromal period futhi libonakaliswa yizibonakaliso ezivamile: ukuba khona komkhuhlane omncane, ubuthakathaka emisipha, ukujuluka nokuphefumula nokuzivocavoca okuncane, ukukhwehlela. Noma kunjalo, isikhathi esiningi kakhulu isikhathi sokugxilwa kwenzeka kuphela kwezinsuku ezingu-2-10. Khona-ke zonke izimpawu zizibonakalisa ngaphandle kwenkathi yokudonsa, okuphikisana nesimo sempilo ephelele, njengasekuqaleni komkhuhlane wePontiac.

Ngesifo esinjenge-legionellosis pneumonia (legionella), izimpawu nezici zazo azisekelwe ekusebenziseni ukuzivivinya kwesiguli kanye nokukhuthazela ngokomzimba. Lesi sifo kunzima ukubekezelela futhi kungaholela ekufeni. Ekuqaleni, umkhuhlane uvela cishe + kuka-39-40 degrees, okungenzeka ukuthi awunalo nhlobo, uma isiguli sine-immunodeficiency, ehambisana ne-HIV noma nge-cytostatic therapy. Kanye nomkhuhlane, ukukhwehlela nokukhululeka esifubeni kubonakala ngokushesha. Ekuqaleni, ukukhwehlela kuyomile kuphela, futhi isikhukhula asihlukanisi.

Kanye nalokhu, ubuhlungu esifubeni ngokushesha buqala ukukhathazeka, ngoba ukutheleleka (i-legionella) kubangela ukubonakala kwe-fibrinous effusion emgodini we-pleural nase-alveoli. Wonke ama-legioellese ayingozi kulokhu: izimpawu, ukuxilongwa, ukwelashwa nokubikezela ngoba lokhu nakho kungabaza. Kanye nalezi zimpawu, isiguli senza i-dyspnea, ukuphazamiseka okwesifo esithathelwanayo, isifo sokuphefumula, ukukhuphula izimpawu ezisemqoka nokunciphisa ikhono lokutakula lomzimba.

Izici ezijwayelekile ze-legionellosis

Ngokutheleleka okunjalo njengeLegionellosis, ukuxilongwa kanye nokwelashwa kunenkinga yabo. Okokuqala, ngaphandle kwemishini ye-chromatography noma i-ELISA cishe akunakwenzeka ukuba unqume ngokuqiniseka ukuthi i-agent ye-causative. Okwesibili, ngisho nokuba khona kwayo, ukuhlukaniswa kwe-legionella kusuka ku-sputum kunzima. Okwesithathu, ngaphandle kokuchaza okunokwethenjelwa kwebciwane elibangele lesi sifo, udokotela uphoqeleka ukuba asebenzise ama-antibiotic e-beta-lactam njengendlela yokwelashwa kwe-antimicrobial empirical.

Kwabaningi beta-lactam, i-legionella igxilile ngenxa ye-intracellular indawo emzimbeni. Lokhu kunciphisa nokusebenza kahle kokuzivikela ekulwa nokutheleleka futhi kwandisa inani lezinyosi ezithinta umonakalo ohlelweni. Ngakho-ke, ukuxilongwa kufanele kube ngokushesha ngangokunokwenzeka. Uma kungekho ukuqinisekiswa kwe-laboratory ye-legionellosis pathogen, udokotela kufanele anikeze uhlelo lwemithi yokwelapha ngokusebenzisa ama-antibiotic ama-macrolide noma ama-fluoroquinolone.

Ukuxilongwa kwe-legionella pneumonia

Ukuze uqaphele lesi sifo ngokushesha, ngenxa yemvamisa yayo encane, cishe akunakwenzeka. Ngaphezu kwalokho, kunezifo ezingaba ngu-10, ukugeleza kwezikhathi zokuqala ezifana neLegionellosis. Izimpawu kanye nokwelashwa kwe-legionellosis ngalesi sizathu siqala ngehlelo lokubhala - ukuqokwa kwama-antibiotiki amabili noma ngaphezulu okubanzi okubhekene ne-genera yezincane ezincane. Lapha futhi senza ukuxilongwa ngokomzimba, ngokusekelwe ekuhloleni kwedatha engatholakala ngokumane uhlole isiguli.

Isigaba sokuqala se-legionellosis ngumkhuhlane, nakuba kungewona oqondile. Ekutholeni kokuqala nesiguli, ukukhula okusheshayo kokuzizwa komzimba kanye nokwakhiwa kwe-dyspnea, ngezinye izikhathi kuze kufinyelele ku-40 ukuphefumula ngomzuzu, kubonakala. Ngokushesha ukhathazekile ngokukhwehlela ngaphandle kwe-phlegm. Isiguli senza ukuphefumula okujulile, kodwa kamuva kuqala ukuyeka isifuba ngenxa yokuthuthukisa i-pleurisy. Lapho i-legionellosis, i-pleurisy ikhula ngokushesha kunomphefumulo we-pneumococcal pneumonia.

Isici se-auscultatory se-legionellosis

Futhi isibonakaliso sangokomzimba ubukhona bezinguquko ze-auscultatory. Izindawo ezinkulu zamapayipi zithinteka ama-choruses, ngokuvamile kaningi. Kulesi simo, uma ukuhlolwa kwe-legionellosis ngokuzenzekelayo, izimbangela, izimpawu, ukuxilongwa kanye nokwelapha kuzobonakala ngokucacile. Into yilezi: amasheya aphansi athathwe kakhulu, futhi kaningi omunye wabo. Kwesobunxele - ngenxa yokuthi i-lobar bronchus yayo imincane futhi igxuma kusuka e-bronchus eyinhloko engxenyeni, ngokuvamile ihlupheka kakhulu. I-lobe elungile elingaphansi libhekene nokuba khona kwe-lobar ejulile neyifushane ye-brbar, okuyinto ephuma emkhatsini omkhulu. Lokhu kungcola kwehla kaningi kaningi kunokwabelana okuphansi kwesokunxele, nakuba lokhu kuyizibalo kuphela, ezingenakukwazi ukubusa ngokuphelele.

Ekuxilongweni ngokomzimba, kutholakala isidumbu. Kuvamise ukuphindaphindiwe kwamanye amazwe, okwenzeka njalo. Kumele kuqhathaniswe nemigqa emincane, emanzi, emincane ezwakalayo ekuzwakaleni kwenhliziyo engapheli ngezibonakaliso zokugcina amanzi emaphashini. Noma kunjalo, idatha yenyama kuphela ayikwazi ukutholakala. Kudingeka ukuthi ihlanganiswe ngophando lwezinsimbi kanye nelabhoratri.

Ukuxilongwa kwe-Instrumental ye-pneumonia

Izindlela ezimbili ezibaluleke kakhulu zokuxilongwa ngezinsimbi zilandelayo: bronchoscopy kanye radiography. Ngokuvamile indlela yesibili itholakale, ivumela ukuthola isithombe sezitho zomzimba esifubeni, kufaka phakathi izikhwama ezivuthayo. Ku-roentgenogram ukucaciswa okuqondile isithunzi esibucayi kakhulu esibonakalayo, okusobala ukuthi asihambisani nobukhulu be-foci ecatshangwa ngemuva kokukhishwa kwe-auscultation.

Esithombeni, lezi zindawo zokuvuvukala zikhulu, ngezinye izikhathi ziningi noma zihlanganisa. Ukuqothulwa kwe-fibrin ejwayelekile engavamile ekhona endaweni yesifo se-legionellosis. Ngesikhathi esifanayo, esiteji lapho iziqinisekiso sezivele zitholwe yi-radiography ukuthi isiguli sinokuvuvukala kwamathishu emaphaphu, udokotela angase angacabangi nokuba khona kweLegionella.

I-bronchoscopy iyindlela encane engabalulekile, nakuba ibalulekile. Kubalulekile ekuhlunguleni ukuhlukana. Ngesizo salo, kuvunyelwe ukuthatha u-bronchoalveolar ugeze futhi ukwazi ukuhlukanisa i-microbe eyenza i-pneumonia. Yiqiniso, for bronchoscopy kukhona ezinye contraindications, okunye okuyinto ubuhlungu isimo isiguli.

Izindlela zokuxilonga zeBathole

I-standard yegolide yokuxilonga emkhakheni wezifo ezithathelwanayo yi-bacterioscopy, ukuhlukaniswa kwebhaktheriya nokulima kwayo. Ngendlela ekhonjiswa ngayo ukuthi i-microbe pathogenic isemzimbeni womuntu futhi isimo sayo samanje sivela kulokhu. Kodwa esimweni se-legionellosis, cishe i-bacterioscopy ayinakwenzeka, ngoba kanye ne-legionella, ezinye izinto ezingaba imbangela yokuphefumula ngokwayo noma ukukhuphula inkambo yayo nazo zingena ngaphakathi. Ngakho-ke, i-chromatography ne- enzyme immunoassay ngokuvamile isetshenziswa .

Ukwelashwa kwe-legionella pneumonia ne-fever Pontiac

Izinqubo ezikhona zoMnyango wezeMpilo kanye nezincomo zemitholampilo e-pulmonology ziqukethe imiyalelo yokuthi i-bronchitis ne-pneumonia kufanele iphathwe ngokusetshenziswa kwezinhlobo ezimbili zama-antimicrobial agents of a wide spectrum of action. Omunye wabo u-aminopenicillin noma i-cephalosporin. Uhlobo lwesibili lwe-antibiotic luyi-macrolide. Ukufaneleka kwalowo owayengaphambili kubangelwa ukuthi kungenzeka ukuba ne-microflora ehambisana nalokhu, kuyilapho ama-macrolides asebenza ngokumelene neLegionella.

Kukholelwa ukuthi ngaphezu kwama-macrolides ("Midekamycin", "Azithromycin", "Erythromycin", "Clarithromycin"), kanti i-fluoroquinolones ne-rifampicin isebenza ngokumelene ne-legionella. Phakathi kwe-fluoroquinolones, okuthandwayo kunikezwa "i-Ciprofloxacin", "i-Ofloxacin", i- "Moxifloxacin", "Gatifloxacin", "Levofloxacin". I-Rifampicin ne-Doxycycline ingasetshenziswa ngezikhathi ezithile. Inhlanganisela elandelayo yezidakamizwa inqunywe:

• Ummeli weqembu le-beta-lactam njengengxenye yesikimu sezobuciko - "Ceftriaxone" 1 igremu ngokuphindaphindiwe kabili ngosuku emva kwamahora angu-12;
• Faka i-Macrolide ngaphakathi ("i-Azithromycin 500" kanye ngosuku noma i- "Erythromycin 500" 6 p / ngosuku, noma i- "Clarithromycin 500" kabili ngosuku, noma "i-Midekamycin 400" izikhathi ezingu-3-4 ngosuku);
• I-fluoroquinolones engasebenzi kahle emakilasini amabili edlule wezidakamizwa ("Ciprofloxacin 400" ngokuphindaphindiwe izikhathi 2-3 ngosuku, "Levofloxacin 500" ngomlomo kanye ngosuku, "Moxifloxacin 400" kanye ngosuku).

Njengoba ungabona, izidakamizwa zokuqala zinezinhlayiya. Kodwa-ke, ngenxa yokuthi bavimbela kuphela umsebenzi obalulekile we-bacterium, bewushiya bephila (bacteriostatics), kunconywa ukuthi basebenzise i-fluoroquinolones uma kwenzeka bekhonjelwa i-legionellosis noma enye i-pneumonia e-atypical. I-macrolides kuphela ngomthamo ophezulu kanti ezinye zazo ("i-Midekamycin" ne-"Roxithromycin") ziyakwazi ukuba nomthelela we-bactericidal. Ngisho noma uhlelo olunomthwalo olunamandla lwe-antimicrobial therapy lubekiwe, isiguli sidinga ukusekelwa i-IVL, kanye nokutheleleka kwe-infusion ukuze kulungiswe ukushaqeka okwesifo esithathelwanayo.

Ngokuvamile lokhu kwelashwa kwenziwe labagula kakhulu, lapho isiguli izinsuku 3-5 ngaphambi sinjalo. Khona-ke ukwelashwa kwenziwa gumbi ezithathelwanayo noma Pulmonology. Ngaphezu kwalokho, yokutakula akazange correlate nge imiphumela-X-ray: izithunzi infiltrative ku izithombe cishe inyanga noma ngaphezulu. Futhi zonke Legionella ukwelashwa inyumoniya ihlala izinsuku ezingaba ngu-20 kanye nokunye. Ngemva ocucuzayo, isiguli kufanele futhi kumelwe kugujwe sinenkonzo yokunakekela iziguli emakhaya, ngokuvakashela Umeluleki wasekhaya izikhathi ezine ngonyaka.