Klebsiella ( klebsielleznaya infection) - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

in the world are diseases caused by opportunistic pathogens fairly common, including Klebsiella occupies a leading position.Depending on the state of the human immune system, this pathogen can cause a lung infection and severe septic manifestations.

Klebsiella (Klebsiella) - opportunistic pathogen that is a member of the family Enterobacteriaceae.The name received from the name of the German scientist, pathologist and bacteriologist who discovered it - Edwin Klebs.Microbiologically is gram-negative rods (Gram staining have specific violet staining) of small size (1.0 * 6.0 mm), fixed, located both in pairs and alone, as well as chains.They are facultative anaerobes (able to multiply in the absence of oxygen, but if any do not lose their viability).Klebsiella capsule capable of forming, by which are stable in the environment.Are O-antigens (about 11) and K antigens (70), which are different in kind.

There are several species of Klebsiella : Klebsiella pneumoniae (Friedlander coli), Klebsiella oxytoc

a, Klebsiella rhinoscleromatis (stick-Frisch Volkovich), Klebsiella ozaenae (Wand Abel-Lavenberga), Klebsiella terrigena, Klebsiella planticola.The most common human pathogens - is K. pneumoniae (responsible for the loss of lung tissue) and K. oxytoca (causing bowel disease).Also under the influence of different types of Klebsiella in debilitated persons, newborns and infants may experience injury of the nose and upper respiratory tract, eyes (conjunctivitis), meningitis, sepsis, lesion of the genitourinary system.

Under normal physiological conditions, Klebsiella is a member of the normal flora of the digestive system (intestines), more often it is K. pneumoniae.Normally, the content of Klebsiella in 1 g faeces must not exceed 105 microbial cells.Klebsiella also present on skin, mucous membrane of the respiratory tract of human and warm-blooded animals.Klebsiella retains its viability in soil, water, dust, foods (can multiply in milk products in the refrigerator).Klebsiellez is fairly common manifestation of nosocomial infection.

Causes klebsielleznoy infection

source of infection - people, patient klebsielleznoy infection and medium Klebsiella.Klebsiella falls into the intestine with poor personal hygiene - with dirty hands, fruits and vegetables and so on. transfer factors - contaminated foods more often (milk, meat products, vegetables, fruits).The patient with pneumonia can infect others by droplets (coughing and sneezing).

Susceptibility to general infection, but the risk group to the appearance of the infection: children and newborn infants due to the imperfection of the immune system;elderly people with age-related immune deficiency;persons with acquired immune deficiency (chronic diseases, diabetes, cancer, blood disorders, patients after transplantation of organs and tissues);persons suffering from chronic alcoholism.

In humans, Klebsiella form endotoxin (lipopolysaccharide capsule Klebsiella), which is formed during the destruction of the microbe is the cause of infectious and toxic reactions (fever, intoxication); heat-stable enterotoxin , causing damage of the intestinal epithelium and the effusion of fluid into the lumen (loose, watery stools); membranotoksin , striking the cell and has hemolytic activity.

Symptoms of infection klebsielleznoy

incubation period may be different - from several hours to a week.

defeat of the lungs (pneumonia klebsielleznaya).
Called preferably K. pneumoniae.Characterized by the appearance of inflammatory lesions in multiple lobes of the lungs with a tendency to merge them (that is, an increase in the inflammation area).Patients temperature reaction (fever of 37.5 to 39 °), the symptoms of intoxication (weakness, chills, sweating), cough at first dry, then with purulent sputum character with streaks of blood and an unpleasant fetid odor, shortness of breath.When listening to the weakening of breathing lungs from inflammation, dry and crackles when rapping dullness.When X-ray - infiltration lesions (inflammation) in the lung lobes (usually the process begins with the upper lobe of the right lung) with a tendency to merge.With time begun treatment process fails to terminate, however belated assistance possible spread of infection and sepsis development (lesion of other organs and systems).Mortality from pneumonia klebsielleznyh large enough - up to 36% due to heavy flow and joining septic process with the defeat of many organs (kidney, liver, meninges, and others).

defeat nose and upper respiratory tract.
Rinoskleroma (called K. rhinoscleromatis) is characterized by the formation of granulomas in the mucosa of the nose and upper respiratory tract.These granulomas are localized and Klebsiella.The patient has severe congestion in the nose, muco-purulent discharge and odor.In consequence of granulomas creating sclerosis.
chronic disease of the nasopharynx and trachea , caused K. ozaenae ( «fetid rhinitis"), characterized by the development of atrophy slizitoy membranes of the nose and nasal bones, causing purulent secretion allocated with offensive odor, crust formation, almost completely covering the nasal cavity.In the upper respiratory tract as a viscous purulent secret that trudnoothodim.The patient has a runny nose with purulent discharge, sore throat, cough with purulent expectoration of mucus.The temperature reaction can be severe and may be low grade (do38 °).

Involvement of the gastrointestinal tract.
Called increasingly K. pneumoniae, rarely K. oxytoca.This may be a manifestation of acute gastritis (inflammation of the mucous membrane of the stomach), in which the patient worried about the pain in the stomach, heartburn, nausea, decreased appetite.Most Klebsiella causes damage to the small and large intestine with the development acute enteritis or enterocolitis - acute onset, the temperature varying severity, weakness, nausea, abdominal pain, often cramping in nature, diarrhea with pathological impurities - blood, mucus and fetid odor.The duration of the acute period of 2-5 days.

defeat urinary and genital systems.
One of the most frequent manifestations of the lesion of the genitourinary system of man is pyelonephritis, cystitis, prostatitis, and the process can proceed in the form of acute and chronic forms as.Data for disease symptoms do not differ from the lesions caused by other microorganisms.

Sepsis caused by Klebsiella.
arises in debilitated patients, infants, and with a decrease in immunity in adults.Since this gram "-" microorganism, the fracture is formed endotoxin.Endotoxin is a major factor in the launch of an infectious-toxic shock at klebsielleznom sepsis.Another feature of this process is the loss of vascular link the various organs and systems.Also, there is the involvement in the septic process of many organs - lungs, kidneys, liver, meninges.

Complications klebsielleznoy infection

Complications can occur in severe its manifestations (sepsis, severe pneumonia) - a pulmonary edema, toxic shock, hemorrhagic syndrome, cerebral edema.
Immunity after undergoing klebsielleznoy type-specific infection, unstable.Re can recover.

Features klebsielleznoy infection in children under one year (infants)

At this age, there is a deficient immune system, which manifests itself insufficient protection of the child's organism against infectious agents and, if infection - a risk of severe infection with the generalization of the process (ie involvementprocess in several organ systems).One of the most frequent manifestations in children is intestinal dysbiosis due to the growth of Klebsiella colonies in the intestines.The slight increase in the number of Klebsiella may not be accompanied by the appearance of symptoms.However, the young patient can be observed dyspeptic symptoms (frequent spitting up, refusal to eat, weight loss, stool disorders - often with a pungent odor).When these symptoms are usually important for the parents - an appeal to the pediatrician and examination of stool baby.Timely diagnosis and prescribed treatment can prevent more serious problems of late treatment.

Diagnostics

klebsielleznoy preliminary diagnosis of infection is always clinical.Specific symptoms, typical for the infection there, so pre-diagnose without etiological decoding.
final diagnosis - after laboratory tests conducted.The material for the research are feces, sputum, mucus nasopharynx, oral cavity, cerebrospinal fluid, urine, bile, infiltrates and crusts from the nose, sectional material.The choice of material depends on the clinical forms of the infection.
Methods:
1) Microscopy (smears stained by Gram) - microscopically visible thick sticks Gram located poodinochno, in pairs or chains.
2) Bacteriological method (leading) - planting material culture media (selective medium K-2, Wednesday and Ploskireva Endo and others), followed by an analysis of the growing colonies of microorganisms.After 24 hours visible growth of colonies of greenish yellow, and blue color with metallic luster.
3) Serological methods (rarely used) - agglutination test (PA) and indirect hemagglutination (IHA) with the patient's blood serum.Diagnostic titer of 1: 160 and higher.Recommended study of paired sera, taken 2 weeks with 4hkratnym increase of antibody titer.
4) Additional methods of diagnostics - the analysis of blood, urine, coprogram, instrumental methods of diagnosis.

Treatment klebsielleznoy infection

Tactics of treatment is largely determined by a form of the disease (which system or organ
amazed), and the severity of symptoms, and determines its only doctor.If it affects the bowel and lung manifestations (no complaints or they are minor, as well as an increase in Klebsiella small stool) treatment of outpatient complex using bacteriophages and probiotics.

1) Bacteriophages ( «Bacteriophage Klebsiella pneumonia", "Piobakteriofag polyvalent
purified liquid" and "Klebsiella polyvalent bacteriophage") shall be appointed before meals 3 times a day.Single doses of up to 6 months - 5 ml, 6 months-1 year - 10 ml, 1-3 years - 15 ml, 3-7 years - 20 ml, 8 years and older - 30 ml.If the patient takes the drug is bad, it can be administered in an enema 1 time per day: up to 6 months - 10 ml, 6 months-1 year - 20 ml, 1-3 years - 30 ml, 3-7 years - 40 ml, 8 yearsand above - 50 ml.The course of treatment is established doctor, usually 5-10 days.
2) Probiotics (bifidumbakterin, Probifor, Atsipol, atsilakt, bifiform, linneks,
Biovestin, bifilong, Normoflorin, primadofilyus and others) are appointed by the rate of not less than 10 days and 14-21 days lechshe, taken 2-3 times aday before meals.Single doses of the different for each drug.

If it affects the other systems and the presence of patients complaints, as well as more severe manifestations of Klebsiella recommended another treatment strategy.

1) Admission to hospital for clinical reasons (young children, severe infection
).For the period of bed rest fever.Diet rules of mechanical and chemical shchazhenija digestive tract.Abundant drinking regime during intoxication.
2) Causal treatment with the appointment of antibacterial drugs .Before treatment
climb all the materials for laboratory research and is preparing the results Tarapov be empirical (ie prescribers to possible coverage of a wide spectrum of micro-organisms), on receipt of the results added drug, specifically acting on it klebsiellu.Often antibiotics starting group and setsificheskogo treatment coincide.In practice it is used: semi-synthetic penicillins, cephalosporins 3-4 generations, aminoglycosides, tetracyclines, fluoroquinolones sometimes.The drug is chosen only by a physician in order to avoid errors and purpose of formation of resistant strains of Klebsiella.
3) pathogenetic therapy (aimed at reducing fever, intoxication, prevention
occurrence and elimination of infection complications).
4) Posindromalnaya therapy (also can be administered probiotics, antiemetic drugs, expectorants
, herbal) depending on the shape and infection leading syndrome.

Prevention

Non-specific prevention (vaccine) is not developed.Preventive measures are reduced to the health education of children, strengthen immunity, timely treatment of chronic diseases and infections.

infectious disease doctor Bykov NI