Pneumococcal infection - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

Pneumococcal disease - a group of infectious diseases caused by pneumococcus, have a general prevalence, affecting mainly the child population and manifest a variety of symptoms with possible development of meningitis, pneumonia, sepsis.

Pneumococcal infection is quite common on the planet.However, in Russia the registration of cases the infection is difficult because of the lack of all-embracing diagnosis of acute respiratory diseases.Pneumococcal meningitis in Russia on average diagnosed in 10 children aged 0 to 2 years per 100 000 population, and this figure is quite high.The incidence of sepsis (blood poisoning), pneumococcal etiology of 100 cases per 100 kb pneumococcal pneumonia is 1,200 cases per 100.t.n. and pneumococcal otitis - 22,000 cases in the so-called 100According to the figures it is clear that pneumococcal disease is much more common than we think.We must not forget that it is a high frequency of severe infections that can lead to long-term recovery of health and disability and advers

e outcome.

Pathogen - Streptococcus pneumoniae or Streptococcus pneumoniae, is a member of the normal flora of the upper respiratory tract.Normally, the carrier meets one or more types of pneumococci, the rate of which varies from 5-10 to 60-65%.Streptococcus pneumoniae - a gram (microscopy Gram stained blue) coccus, surrounded by a polysaccharide shell, which contains antifagin.It prevents the destruction antifagin (phagocytosis) by leukocytes pneumococci.This shell allows to elude pneumococcus from the immune system of a young child from 0 to 2 years.Immune cells are already an adult to cope with the neutralization of pneumococcus.This feature is the reason for the prevalence of pneumococcal disease in young children.

now known 84 serotypes of pneumococci, pathogenic for humans.The main types of pneumococcus, occurs in young children and are responsible for the overwhelming number of cases of this infection, used in the development of vaccines for specific prevention.

Pneumococci are unstable in the environment.Are killed by the action of conventional disinfectants at t - 600 killed within 10 minutes.However, resistant to drying.The dried sputum can survive for about 2 months.

Today there is a big problem of antibiotic resistance - that is, the stability of pneumococci to a number of antibacterial drugs, which creates additional difficulties in the treatment of disease.

causes of pneumococcal disease

source of infection are: 1) patients with symptomatic form of the disease, 2) carriers of pneumococci.Infected media source of infection - nasopharyngeal mucus, mucus of the bronchial tree (sputum).

main mechanism of infection - aerogenic and path - airborne.Infection occurs when you sneeze, cough, conversation with the source of infection.The most likely to be infected persons who are in direct contact with the source of infection (sneezing and coughing - is an aerosol cloud of 3 meters in diameter).

human susceptibility to pneumococcal infection is high.Family outbreaks and outbreaks in children's groups.

infection risk groups:
1) Children under 2 years, which immune cells are unable to fight the pathogen.Children first six months of life have a maternal antibody, the amount of which after 6 months of life is greatly reduced, and therefore increases the risk of infection.
2) Children and adults with immune deficiency (chronic respiratory diseases, cardiovascular, diabetes, renal failure, liver cirrhosis, HIV infection, cancer, disease, blood disease).
3) Age immunodeficiency (individuals older than 65 years).
4) Persons with tobacco and alcohol.

Symptoms

pneumococcal infection How infection develops?The input gates of pneumococcal infection are the mucous membranes of the oropharynx and respiratory tract, where pneumococcus may be a long time without causing any pathogenic influence.Of great importance in the development process has further resistance (resistance) of the input gate of infection.

Risk factors for the development of the disease: hypothermia, reduced local immunity as a result of frequent respiratory infections, stress and fatigue, hypovitaminosis.By reducing the local resistance may develop pneumonia.Once in the blood, pneumococcus can cause septicemia (blood poisoning), and also spread to organs and tissues.

incubation period (from the time of infection to the development of the disease) - 1 to 3 days.

manifestations of the disease: 1) Pneumococcal pneumonia (pneumonia)
2) Pneumococcal meningitis (inflammation of the pia mater)
3) Pneumococcal Otitis Media (middle ear infection)
4) Pneumococcal sepsis (blood poisoning)

Pneumococcal pneumonia

Pneumonia is characterized by a high temperature - rise to high (febrile) digits - 38-39 °, chills, severe weakness, muscle pain, shortness of breath, heart palpitations;soon it appears cough with expectoration muco-purulent character (color yellow-greenish), sometimes disturbed by coughing chest pain.

Pneumonia in pneumococcal disease can also become lobar (sudden onset, high fever, pronounced chills, blush on the cheeks, sharp chest pain and phlegm brown tint - "rusty" during auscultation rales, crackling, "friction noisepleura ", dullness) or focal (occurs on the background of the manifestations of acute respiratory infection - there is a weakness, cough, sweating, shortness of breath, sputum mucopurulent, pain in the small area of ​​the chest, pale skin, auscultated small and medium bubbling rale).Lobar pneumonia is more severe, may develop acute respiratory failure, the formation of abscesses, pleurisy.

Pneumococcal pneumonia

focal pneumonia lighter in weight, but infiltration is resorbed over a longer period - up to 4 weeks.

When to see a doctor: emergence of high temperatures with severe weakness, cough, and purulent "rusty" character, chest pain.

Pneumococcal meningitis Pneumococcal meningitis

begins acutely with fever up to 40 °, there is a diffuse headache Expander nature.In most patients, later joined by repeated vomiting, increased sensitivity to all kinds of stimuli.During the first 12-24 hours after the onset of meningitis formed comprehensive picture of meningeal and cerebral syndromes.There are growing rapidly and meningeal symptoms: stiff neck muscles, Kernig symptom Brudzinskogo etc. For patients characterized by "meningeal pose" or "pose a gun dog.".Consciousness is first stored and then is replaced by the state of stupefaction, stop, coma.
CSF for analysis - follows pressurized muddy cytosis several tens of thousands of cells in 1 mm, up to 90% of neutrophils are often increased protein.

When to see a doctor: high fever, severe headache, repeated vomiting, neck pain, inability to bend it - all of these symptoms for immediate treatment to the doctor.In infants - high temperature, constant crying, and the child's anxiety - a reason for immediate treatment to the doctor. Meningitis requires urgent medical intervention in a hospital.

Pneumococcal Otitis

Pneumococcal Otitis is characterized by fever, pain in the ear, hyperacusis (sensitivity to auditory stimuli increase).

Pneumococcal sepsis

Pneumococcal sepsis manifests infectious-toxic syndrome (fever, fatigue, headache), enlarged spleen (the patient often does not feel), symptoms of various organ systems (lungs, heart, intestines, kidneys, meninges).

Complications of pneumococcal disease

Complications associated with the development of a clinical form of the disease.If the development of pneumonia should be afraid of acute respiratory failure, heart failure.When meningitis - brain edema with risk of herniation syndrome (cardiac arrest and pulmonary activity).In case of sepsis mortality up to 50% can be expected from any complications.

After undergoing pneumococcal disease formed malonapryazhenny, intermittent, type-specific immunity, which does not protect against re-infection by another serotype of pneumococcus.

Diagnostics

pneumococcal disease 1. The preliminary diagnosis - clinical.Exhibited doctor when viewed from the patient on the basis of suspicious symptoms after the differential diagnosis.Distinguish pneumococcal infection from diseases with similar clinic caused by other bacteria, it is very difficult.The doctors need to exclude other etiologies of pneumonia (staph, strep, Legionella, klebsielleznye and others);other bacterial meningitis, and others.

2. The final diagnosis is only after laboratory confirmation of the diagnosis.
selected for study: oropharyngeal mucus, sputum, blood, cerebrospinal fluid, inflammatory exudates.Taking a certain kind of material for laboratory studies shall be based on the clinical picture of the disease.
Features: fast pneumococcal deaths in the environment determines the prompt delivery of the material in the laboratory.

main diagnostic methods are:

1. Microscopy Gram-stained smears and by Gisa - microscopically visible lanceolate diplococci.
2. Bacteriological method - planting material for special media (blood agar and serum broth, 10% bile broth)
3. Serological method - the study of blood using an agglutination reaction only confirms the basic diagnosis.

Treatment of pneumococcal infections

1) Basic therapy (regimen, diet).
mode. Hospitalization performed as clinically indicated.At home, patients are treated only with pneumococcal acute respiratory illness.Other forms of infection, especially in children who require hospitalization in order to avoid fatal complications.Unchanged condition is compliance with bed rest for the entire febrile period, as well as to the elimination of complications.
Diet complete with a balanced amount of protein, fat, carbohydrates;except obligate allergens, a sufficient amount of liquid.

2) Causal treatment (antibiotics) - drugs of choice for pneumococcal infections are a group of penicillins, cephalosporins, karbopinemov, vancomycin, depending on the form of the infection.
We must remember to increase the strains of antibiotic-resistant types of pneumococcus, which certainly complicates the search for a therapeutic drug.Only one way out - to determine the sensitivity of pneumococcus allocated to various antibiotics, which take 2-3 days.

3) Pathogenic infusion therapy (correction of the body's functions) includes detoxication therapy, bronchodilators, cardioprotectors, diuretics, funds to improve mikrotsirkulitsii and so on.

4) Pathogenetic and symptomatic therapy (antipyretics, analgesics, anti-inflammatories, antihistamines);

1. Antipyretic (Nurofen, Panadol children, Theraflu, koldreks, Fervex, efferalgan adults) to reduce fever and to improve general well-being.
2. analgesics and anti-inflammatory therapy - ibuprofen, paracetamol, Voltaren, ketorol - relieve pain, in particular when myalgia.
3. Mucolytics (and expectorants) means - acetylcysteine, ambroxol, Lasolvan, bromhexine, bronholitin, Ascoril and so on. Drugs that suppress coughing (sinekod, Codelac, stoptussin), taking with pneumococcal infection is not recommended.
4. Probiotics in the case of medicinal enteritis (linneks, Bifistim, bifidum forte, etc.) in order to activate the normal microflora and control of infection in the lesion.
5) distracted and local therapy include steam inhalations with soda solution, solution of herbs - sage, chamomile (which is important when the catarrhal form and gerpangine);irrigation throat disinfectant to prevent bacterial contamination of the wound site;anti-inflammatory drops in the eye with conjunctivitis.

Can independently take antibiotics for pneumococcal infection?It is undesirable, since the right to determine the required group of antibacterial drugs only by a doctor.Wrong selection of the drug and the dose can lead not only to a lack of treatment effect, but also a significant reduction in immunity and, consequently, deterioration of general condition of the patient.

Prevention of pneumococcal disease

1) Specific - vaccination of infants.
There are two vaccines for immunization: Prevenar 13 and Prevenar 23.
Pneumo-13 is used for the immunization of children from 2 months to 5 years and Pneumo-23 with 2 years of age and older.Vaccines do not contain pathogens and contain purified polysaccharides are the most common types of pneumococci.In addition, the vaccine has therapeutic effect in the remediation of a pneumococcus airway and reducing the number of carriers of pneumococcus.Vaccines are administered in various configurations depending on age.Immunity generated 10-15 days after injection and lasts for five years.Russian Government assmatrivaetsya change Article 9 of the Federal Law "On immunoprophylaxis of communicable diseases", and if it is approved, vaccination against pneumococcus will become mandatory in 2014.

2) non-specific (isolation of patients, maintenance of immunity, vitaminoprofilaktika, timely treatment of acute respiratory infections, exercise, hardening).

infectious disease doctor Bykov NI