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aspergillosis
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Name of disease
According to the pathogenicity of pathogenic bacteria, it can be divided into pathogenic fungi and conditional pathogenic fungi. Pathogenic fungi themselves are pathogenic, and conditional pathogenic fungi are low in pathogenicity and usually do not infect normal people, but those who are exposed to a large number of normal people or those with low immune function are susceptible to infection.
- TCM disease name
- aspergillosis
- Multiple population
- People with low immune function
- transmissibility
- There is no
catalogue
Deep mycosis refers to the disease caused by pathogenic fungi invading not only skin and mucous membrane but also deep tissues and internal organs. Fungi are widely distributed in nature, and some fungi can infect human body and cause disease. Pathogenic fungi are divided into two categories: ① primary pathogens: such as histoplasmosis, cryptococcus neoforme, blastomyces and so on. ② Conditional pathogenic bacteria: such as candida, Aspergillus, mucor, etc. Deep mycosis is often secondary infection, mostly in diabetes,
hemopathy
,
Malignant tumor
, extensive burns, severe malnutrition or other chronic wasting diseases on the basis of onset. Or long-term use of antibiotics,
glucocorticoid
Immunosuppressant, causing the flora in the body to imbalance or inhibit the body
Immune response
And induce. Aspergillosis is a disease caused by the pathogenic Aspergillus mould. Pathogenic bacteria mainly invade the lungs through the respiratory tract, such as heart, can also invade the skin, mucous membrane. Severe cases may occur
septicemia
Other organizations and systems are affected. In recent years, some aspergillus species have been shown to cause cancer.
It is the most common and occurs in chronic lung diseases. Clinical manifestations are divided into two types:
① Aspergillus bronchus -
pneumonia
A large number of aspergillus spores are caused by inhalation
Acute bronchitis
If the hypha invads the lung tissue, it will cause extensive invasive pneumonia or localized granuloma, and may also cause necrosis, suppuration, and the formation of multiple small abscesses, and the onset of high fever or irregular fever, cough,
dyspnea
Green purulent sputum, chronic recurrent cough, hemoptysis and so on
phthisis
The symptoms. Pulmonary signs are not or two asked coarse wet rales. The X-ray room
Increased lung texture
Diffuse patchy fuzzy shadows and clumpy shadows can be seen in the lungs.
② Spheroidal pulmonary aspergillosis is common
bronchiectasis
,
phthisis
Such chronic lung diseases occur on the basis of mycelium physique to regenerate the lung
endocoel
Medium reproduction, aggregation and with fibrin and
Mucosal cell
It forms a spherical mass that does not invade other lung tissue. Most patients showed no symptoms or primary symptoms, or fever, cough, shortness of breath, phlegm and mucus, including green particles. Because there is a rich network of blood vessels around the bacteria, repeated hemoptysis can be seen on X-ray examination of the lung circle
Aspergillus bulb
Suspended in the void, forming a
crescent
Clear area, has important diagnostic value.
Allergic system
Inhales a large amount of dust containing aspergillus spores, causing
Allergic rhinitis
,
Bronchial asthma
Bronchitis or degenerative pulmonary aspergillosis. Wheezing, coughing, and phlegm may occur several hours after inhalation, and may be accompanied by fever. Most patients are relieved in 3-4 days, if the above symptoms recur after re-inhalation, a large number of eosinophils and mycelia can be detected in the sputum. The growth of Aspergillus fumigus was observed in culture, eosinophilia in blood (>1.0×109/L) and IgE in serum (>1000ng/ml).
Most common in primary and
Secondary immune deficiency
Yes. Aspergillus mostly enters the blood circulation from lung lesions and spreads to multiple organs throughout the body. Leukemia,
Malignant lymphoma
Cancer, chronic lung disease, long-term use of antibiotics and
corticohormone
Etc., is the cause of the disease. The clinical manifestations vary with the affected organs, and the most common symptoms are fever, systemic intoxication and embolism. Involving the intima, myocardium or pericardium, causing suppuration, necrosis and granuloma, central nervous system involvement
meningitis
and
Brain abscess
. The digestive system and liver are often involved.
Aspergillus is a filamentous fungus, which is a common conditional pathogenic fungus, causing human diseases, including Aspergillus fumigatus and Aspergillus flavus.
Aspergillus is widespread in nature and is found in soil, air, plants, wild or domestic animals and the fur of birds. It is also common in fields, horse stalls, cattle stalls, barns, etc. It can be parasitic on the skin and upper respiratory tract of normal people, and is a conditional pathogen. Normal people have a certain resistance to aspergillus and do not cause disease. Aspergillus disease is mostly secondary, when the body resistance is reduced, the pathogen can pass
Cutaneous mucosa
Injury or inhalation of the respiratory tract, and then into the blood circulation to other tissues or organs to cause disease.
Allergic system
Inhalation of aspergillus spores can trigger an IGE-mediated change response to bronchospasm.
Aspergillus most commonly invades the bronchus and lungs, and may invade the sinuses,
Meatus acusticus externus
, eyes and skin, or through blood spread to all organs of the body. The early stage of the lesion was diffuse infiltration and exudation. Late stage necrosis, suppuration or granuloma formation. A large number of mycelium can be found in the lesion. It can be caused by mycelium penetrating blood vessels
vasculitis
, perivasculitis, thrombosis, etc., and thrombosis causes tissue ischemia and necrosis.
The specimen taken from the affected area is directly smeated or cultured. Mycelium or aspergillus spores can be seen on the smears, and aspergillus growth can be seen in culture. Aspergillus is a common contaminating bacteria in the laboratory, and it must be repeated smear or culture, multiple positive and the same strain to have diagnostic value.
Biopsy of damaged tissue or lymph nodes can confirm the diagnosis based on fungal morphology. Especially for disseminated aspergillus, it can be diagnosed in time.
1. Actively treat the primary complications and remove the cause.
2, strictly master the indications of antibiotics, glucocorticoids and immunosuppressants, as little or no use of these drugs as possible.
3, strengthen care and support therapy, supplement vitamins and trace elements.
1. Nystatin
(1) Local drug use: It can be made into oil, cream, powder, solution, etc., the concentration is 100000 U/g or /ml matrix containing nystatin, and a dose-type local rub is used according to the specific situation of the patient, 2-4 times a day.
(2) Oral: intestinal
Candidiasis
Nystatin can be given orally, 200,000 to 400,000 U per day for newborns, 400,000 to 800,000 U per day for children under 2 years of age, and 1 to 2 million U per day for children over 2 years of age, divided into 3 to 4 times before meals, for a course of 7-10 days. Oral absorption is not easy, all by
excrement
Discharge. Adverse reactions include nausea, vomiting and diarrhea.
(3)
Atomized inhalation
: Applies to respiratory system
Candidiasis
Nystatin 50,000U dissolved in 2ml0.09% sodium chloride solution atomized inhalation.
2. Dimorphomycin B is a polyene antibiotic
It binds with sterols on the fungal membrane, changes the permeability of the membrane, destroys the bacteria, and plays a bactericidal role. Is the current treatment
cryptococcosis
Histoplasmosis and systemic disease
Candidiasis
The drug of choice is less effective against mycosis.
(1)
Intravenous infusion
Start with a small dose, 0.1mg/kg per day, if there is no adverse reaction, gradually increase to 1-1.5 mg/kg per day, the course of treatment 1-3 months. Dilute with 5% glucose solution for intravenous injection, the concentration does not exceed 0.05-0.1 mg/ml, slowly
Intravenous infusion
Each dose should take at least 6 hours to complete. High concentration is easy to cause
phlebitis
Rapid drop rate can cause convulsions, frequent heart rhythm, sudden drop in blood pressure, and even cardiac arrest.
(2) intraspinal injection or intraventricular injection: limited to the treatment of cryptococcal membrane serious or
Intravenous infusion
A failed case. For intravaginal injection in children, the first 0.1mg is diluted with distilled water (not 0.9% sodium chloride solution), the concentration is not more than 0.25mg/ml (thin is appropriate), or the drug is mixed with 3-5mD of cerebrospinal fluid drained during lumbar puncture and slowly injected together. Up to 0.5mg not lower than 0.7mg. The course of treatment is generally about 30 times, if there are side effects, the drug can be reduced or suspended, and too much drug in the cerebrospinal fluid can be caused
arachnoiditis
Cerebrospinal fluid cells increase, temporary radiculitis, sensory loss,
Urinary retention
Even paralysis, convulsions, if stopped early, most can be relieved.
(3) Side effects of bicycin: nausea, vomiting, abdominal pain, fever,
shiver
Headache, dizziness, anemia, thrombocytopenia, thrombophlebitis, etc., have certain toxicity to inflammation, kidney, hematopoietic system. To reduce side effects, aspirin can be given half an hour before treatment and 3 hours after treatment, in severe cases
Intravenous infusion
Hydrocordesone or dexamethasone. During medication, blood, urine routine and liver and kidney function should be checked every 3-7 days, serum creatinine should be reduced when >2.5mg/dl, urea nitrogen should be stopped after 2 to 5 weeks to return to normal, and then start the administration of small doses, which is easy to occur at the injection site
Thrombophlebitis
The initial infusion site should start from the distal venules of the extremities.
3, 5 - Fluorocytosine
It is an oral systemic antifungal chemical that has food-inhibiting effects on cryptococcus and Candida albicans. It can be used in combination with dimorphomycin B to treat systemic disease
cryptococcosis
The dose is 50-150mg /kg per day, divided into 4 oral sessions for 4-6 weeks. Infant dose should be reduced. Oral absorption is good, the serum concentration is high, the cerebrospinal fluid concentration can reach 64-88% of the serum, easy to develop drug resistance, side effects include nausea, vomiting, rash, neutrophil nucleus thrombocytopenia, liver and kidney damage, and the combination of disex mycin B can reduce drug resistance, the dose can be slightly reduced, the toxic reaction can be reduced, and the course of treatment can be shortened.
4. Clotrimazole is a broad spectrum antifungal drug
1-5% ointment for external skin use, easy to absorb orally, the dose is 20-60mg /kg per day, divided into 3 oral. Systemic deep fungal infection can be used in combination with dimorphous mold B. Side effects include gastrointestinal symptoms, excitement, insomnia,
urticaria
,
leukopenia
ALT elevation, etc.
5. Oral imidazole antifungal drugs synthesized by ketoconazole
It is an imidazole derivative. By inhibiting the synthesis of ergosterol, the permeability of fungal cells is changed, resulting in fungal death. Broad antibacterial spectrum, good oral absorption, low toxicity, yes
Candidiasis
, Aspergillus disease, histoplasmosis and other curative effects were significant. Starting dose: 100mg per day for those weighing less than 30kg, 200-400mg per day for those weighing more than 30kg, 50mg per day for those aged 1-4 years, 100mg per day for those aged 5-12 years, such as children with high doses of 400mg per day, nausea, vomiting, and temporary hypocholesterolemia symptoms can occur
Abnormal liver function
.
6. Fluconazol
Ditriazole antifungal drugs, the mechanism of action and antibacterial spectrum is similar to ketoconazole, in vivo antifungal activity is stronger than ketoconazole, high bioavailability, good oral absorption, has an inhibitory effect on candida, cryptococcus and other
Cerebrospinal fluid
The effective therapeutic concentration of >3 years old is 3-6 mg/kg per day, once orally or by intravenous drip. Side effects include gastrointestinal reaction, rash and occasional
Abnormal liver function
.
1. Specimens should first be taken at the site of infection for smear examination and culture, and the diagnosis can be made when pathogenic fungi are found. Culture of specimens taken from sterile sites
masculine
This is a suspected case.
2. Select the drug according to the infection site and pathogen type.
3. The course of treatment needs to be longer, generally 6 to 12 weeks or longer.
4. Severe infections should be treated in combination with synergistic antifungal agents, which should be administered intravenously to enhance efficacy and delay the development of resistant strains.
5. While using antifungal drugs, the underlying diseases that may exist should be actively treated to enhance the body's immune function.
6. Surgical treatment is required if there are indications.
