Klebsiella( Klebsiella infection) - Causes, symptoms and treatment. MF.

In the world, diseases caused by conditionally pathogenic microorganisms are quite common, among which the klebsiella occupies a leading position. Depending on the state of the human immune system, this pathogen can cause both a mild infectious disease and severe septic manifestations.

Klebsiella is a conditionally pathogenic microorganism that is a member of the Enterobacteriaceae family. The name derived from the name of the German scientist, bacteriologist and pathologist of her discovered - Edwin Klebs. Microbiologically, these gram-negative rods( for Gramm coloration, do not have a specific violet stain) are small( 1.0 * 6.0 μm), fixed, arranged both singly and singly, and also by chains. They are facultative anaerobes( able to reproduce in the absence of oxygen, but with its presence do not lose their vitality).Klebsiella are able to form a capsule, due to which they are stable in the environment. They have O-antigens( about 11) and K-antigens( about 70), which differ within the genus.

Several species of klebsiella are distinguished: Klebsiella pneumoniae( Friedlander's stick), Klebsiella oxytoca, Klebsiella rhinoscleromatis( Frisch-Volkovitch stick), Klebsiella ozaenae( Abel-Lavenberg wand), Klebsiella terrigena, Klebsiella planticola. The most frequent pathogens of human diseases are K. pneumoniae( responsible for pulmonary tissue damage) and K. oxytoca( causing bowel damage).Also, when exposed to different types of Klebsiella, weakened faces, newborns and infants may experience nasal and upper respiratory tract, eye( conjunctivitis), meningitis, sepsis, and urogenital damage.

In normal physiological conditions, Klebsiella is a representative of the normal flora of the digestive system( intestine), more often it is K. pneumoniae. Normally the content of Klebsiella in 1 g of bowel movements should not exceed 105 microbial cells. Klebsiella is also present on the skin, the mucous membrane of the human respiratory tract and warm-blooded animals. Klebsiella retains its viability in soil, water, dust, food( can multiply in dairy products in the refrigerator).Klebsiella is a fairly frequent manifestation of nosocomial infection.

Causes of Klebsiella infection

Source of infection is a person with a Klebsiella infection and a Klebsiella carrier. Klebsiella comes into the intestines with poor observance of the rules of personal hygiene - from dirty hands, fruits and vegetables and so on. Transmission factors - contaminated food most often( milk, meat products, vegetables, fruits).A patient with pneumonia is able to infect others by airborne droplets( with coughing and sneezing).

Susceptibility to infection is universal, however, the risk group for this infection is: children of newborns and infants due to imperfections in the immune system;elderly persons with age-related immunodeficiency;persons with acquired immunodeficiency( chronic diseases, diabetes, oncology, blood diseases, patients after organ and tissue transplantation);persons suffering from chronic alcoholism.

In the human body klebsiella form endotoxin ( lipopolysaccharide capsule klebsiella), which is formed when the microbe is destroyed and is the cause of an infectious-toxic reaction( fever, intoxication); thermostable enterotoxin , which causes damage to the intestinal epithelium and the effusion of fluid in the lumen of it( liquid watery stools); membrane toxin , which affects the cells and has hemolytic activity.

Symptoms of Klebsiella infection

The incubation period may vary from a few hours to a week.

Lesion of the lungs( Klebsiella pneumonia).
Called predominantly K. pneumoniae. Characteristic is the appearance of multiple inflammatory foci in lobes of the lungs with a tendency to their fusion( i.e., an increase in the area of ​​inflammation).In patients, the temperature reaction( fever from 37.5 to 39 °), symptoms of intoxication( weakness, chills, sweating), cough at first dry, then with the discharge of sputum purulent sputum with blood streaks and an unpleasant odor odor, dyspnea. When listening to the lungs, weakening of breathing from the side of inflammation, dry and wet wheezing, with tapping dullness of percussion sound. When X-ray - the focus of infiltration( inflammation) in the lobes of the lungs( more often the process begins with the upper lobe of the right lung) with a tendency to merge. With the timely begun treatment, the process can be interrupted, but with delayed care, the spread of infection and development of sepsis( damage to other organs and systems) is possible. Mortality from Klebsiella pneumonia is quite high - up to 36% due to the severe course and attachment of the septic process with the defeat of many organs( kidneys, liver, meninges and others).

Nose and upper respiratory tract infection.
Rhinoscleroma ( called K. rhinoscleromatis) is characterized by the formation of granulomas on the nasal mucosa and upper respiratory tract. In these granulomas, the Klebsiella are localized. The patient has a strong stuffiness in the nose, mucopurulent discharge with a specific odor. In the aftermath, the granulomas are sclerosed.
Chronic diseases of the nasopharynx and trachea , called K. ozaenae( "fetid runny nose"), is characterized by the development of atrophy of the mucous membrane of the nose and bones of the nasal cavity, resulting in a purulent secret with a fetid odor, crusts almost completely covering the nasal cavity. In the upper respiratory tract, a viscous purulent secret also forms, which is difficult to remove. The patient has a runny nose with a purulent discharge, a sore throat, a cough with expectoration of purulent mucus. The temperature reaction can be expressed, and maybe subfebrile( up to 38 °).

Lesion of the gastrointestinal tract.
Called more often K. pneumoniae, less frequently K. oxytoca. It can be manifestations of acute gastritis ( inflammation of the gastric mucosa), in which the patient is concerned about pain in the stomach, heartburn, nausea, decreased appetite. More often klebsiella causes damage to the small and large intestines with the development of acute enteritis or enterocolitis - acute onset, temperature of different severity, general weakness, nausea, abdominal pain more often cramped, liquid stool with pathological impurities - blood, mucus and fetid odor. The duration of the acute period is 2-5 days.

Disorders of the urinary and reproductive systems.
One of the frequent manifestations of damage to the human urogenital system is pyelonephritis, cystitis, prostatitis, and the process can take the form of acute and in the form of chronic forms. These diseases are not distinguished by symptoms from lesions caused by other microorganisms.

Sepsis caused by Klebsiella.
Occurs in weakened patients, infants, as well as with reduced immunity in adults. Because this gram is a "-" microorganism, then endotoxin is formed upon destruction. Endotoxin is one of the main factors in the initiation of infectious-toxic shock in the treatment of Klebsiella sepsis. Another feature of this process is the defeat of the vascular link of various organs and systems. There is also involvement in the septic process of many organs - the lungs, kidneys, liver, meninges.

Complications of klebsiella infection

Complications can occur when severe manifestations( sepsis, severe pneumonia) are pulmonary edema, infectious-toxic shock, hemorrhagic syndrome, cerebral edema.
Immunity after the transferred klebsielleznoy infection type-specific, unstable. Repeatedly you can be ill.

Features of Klebsiella infection in children under one year( infants)

At this age, imperfect immunity takes place, which is manifested by insufficient protection of the child's organism with respect to infectious agents, and with infection, the danger of developing severe forms of infection with generalization of the process( i.e., involving several organs and systems).One of the frequent manifestations in infants is the intestinal dysbiosis due to the growth of Klebsiella colonies in the intestine. A small increase in the number of Klebsiella may not be accompanied by the appearance of symptoms. However, a small patient may experience dyspepsia( frequent regurgitation, refusal to eat, weight loss, stool disorders - frequent with a sharp odor).When these symptoms appear, an important rule for parents is to contact the pediatrician and examine the baby's feces. Timely diagnosis and prescribed treatment can prevent more serious problems with late treatment.

Diagnosis of Klebsiella infection

Preliminary diagnosis is always clinical. Specific symptoms specific for this infection are not present, therefore preliminary diagnose without etiological decoding.
The final diagnosis is after a laboratory examination. Materials for research include bowel movements, sputum, nasopharyngeal mucus, oral cavity, spinal fluid, urine, bile, infiltrates and nasal crusts, sectional material. The choice of material depends on the clinical form of the infection.
Methods of investigation:
1) Bacterioscopy( strokes are stained by Gram) - with microscopy, thick gram-negative rods are seen, located singly, in pairs or in chains.
2) Bacteriological method( leading) - culture of the material on nutrient media( selective medium K-2, medium Endo and Ploskireva and others) with subsequent analysis of growing colonies of microorganisms. After 24 hours, the growth of colonies of greenish-yellow and blue color with metallic luster is visible.
3) Serological methods( rarely used) are the agglutination( RA) and indirect hemagglutination( RNGA) reaction with the serum of the patient. Diagnostic titer 1: 160 and above. It is recommended to study the paired sera taken after 2 weeks with a 4-fold increase in the antibody titer.
4) Additional diagnostic methods - blood test, urine, coprogram, instrumental diagnostic methods.

Treatment of Klebsiella infection

Tactics of treatment is largely determined by the form of the disease( which system or body
is affected), and the severity of the manifestations, and it is determined only by the attending physician. With lesions of the intestine and mild manifestations( no complaints or they are insignificant, and an increase in Klebsiella in feces is small), an outpatient complex treatment using bacteriophages and probiotics.

1) Bacteriophages ( "Bacteriophage Klebsiella pneumonias", "Pyobacteriophage polyvalent
purified liquid" and "Bacteriophage klebsiella polyvalent") is prescribed before meals 3 times a day. Single doses: 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 does not take the medication badly, it can be prescribed in an enema once a 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 older - 50 ml. The course of treatment is set by the doctor, usually 5-10 days.
2) Probiotics ( bifidumbacterin, probifor, acipol, acylact, bifiform, linpex,
biovestin, bifilong, normoflorin, primadofilus and others) are prescribed for at least 10 days, and preferably 14-21 days, taken 2-3 times inday before meals. Single doses are different for each drug.

In case of damage to other systems and the presence of complaints in patients, as well as more severe manifestations of Klebsiella, another tactic of treatment is recommended.

1) Hospitalization in a hospital for clinical reasons( small children, severe form of
infection).For the period of fever bed rest. Diet with the rules of mechanical and chemical shining of the digestive tract. Abundant drinking regime during intoxication.
2) Etiotropic therapy with the prescription of antibacterial drugs .Before the start of the
treatment, all materials for laboratory testing are taken and while the results are being prepared, the therapy will be empirical( that is, preparations with the possible coverage of a wide range of microorganisms are prescribed), and a drug specifically acting on the Klebsiella is added. Often, the antibiotics of the starting group and the septic treatment coincide. In practice, semisynthetic penicillins, 3-4 generation cephalosporins, aminoglycosides, tetracyclines, and sometimes fluoroquinolones are used. The drug is chosen only by a doctor to avoid mistakes in the appointment and formation of resistant Klebsiella strains.
3) Pathogenetic therapy ( aimed at reducing fever, intoxication, prevention of
and elimination of complications of infection).
4) Asynchronous therapy ( probiotics, antiemetics,
expectorants, herbal preparations can also be prescribed) depending on the form of the infection and the leading syndrome.

Prevention

Nonspecific prophylaxis( vaccine) is not developed. Preventative measures are reduced to hygienic education of children, strengthening of immunity, timely treatment of chronic diseases and infections.

Doctor infectious diseases Bykova N.I.