• Pneumococcal infection - Causes, symptoms and treatment. MF.

    Pneumococcal infection is a group of human infectious diseases caused by pneumococcus, which have a general prevalence that affects mainly the children's population and manifests itself with various symptoms with possible development of meningitis, pneumonia, sepsis.

    Pneumococcal infection is quite widespread on the planet. However, in Russia, the registration of cases of this infection is difficult due to the absence of a universal diagnosis of all cases of acute respiratory infections. Pneumococcal meningitis on average in Russia is detected in 10 children from 0 to 2 years per 100 000 population, and this indicator is quite high. The incidence of sepsis( infection of the blood) of pneumococcal etiology is 100 cases per 100 so-called, pneumococcal pneumonia is 1200 cases per 100.t.n., and pneumococcal otitis media - 22000 cases per 100 so-called. According to these indicators it is clear that pneumococcal infection occurs more often than we think. We must not forget that the frequency of severe forms of infection is high, which can lead to long-term recovery of health, disability and an unfavorable outcome.

    Pathogen - pneumococcus or Streptococcus pneumoniae, is a representative of the normal microflora of the upper respiratory tract. Normally, there is carriage of one or several types of pneumococci, the index of which varies from 5-10 to 60-65%.Pneumococcus is a Gram-positive coccus surrounded by a polysaccharide shell that contains an antiphagin. It is the antifagin that prevents the phagocytosis of pneumococci by leukocytes. Such a shell allows to escape the pneumococcus from the immune system of a small child from 0 to 2 years. Immune cells of an adult can cope with the neutralization of pneumococcus. It is this feature that is the cause of the prevalence of pneumococcal infection in young children.

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

    Pneumococci are poorly resistant in the external environment. Died from the action of conventional disinfectants, at t - 600 perished within 10 minutes. However, they are resistant to drying. In the dried phlegm retain viability for 2 months.

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

    Causes of pneumococcal infection

    The source of infection are: 1) patients with clinically expressed form of the disease, 2) carriers of pneumococci. Infected sources of infection are nasopharyngeal mucus, bronchial mucus( sputum).

    The main mechanism of infection is aerogenic, and the path is airborne. Infection occurs when sneezing, coughing, talking to the source of infection. Most susceptible to infection are people who are in direct contact with the source of infection( for sneezing and coughing - this is an aerosol cloud 3 meters in diameter).

    Human susceptibility to pneumococcal infections is high. Possible family outbreaks and outbreaks in children's groups.

    Groups at risk of infection:
    1) Children under 2 years of age whose immune cells are unable to fight the pathogen. Children of the first half of life have maternal antibodies, the number of which after 6 months of life is greatly reduced, and therefore the risk of infection increases.
    2) Children and adults with immunodeficiency( chronic respiratory diseases, cardiovascular system, diabetes mellitus, kidney failure, liver cirrhosis, HIV infection, oncological diseases, blood diseases).
    3) Age-related immunodeficiency( elderly persons over 65 years of age).
    4) Persons with tobacco and alcohol addiction.

    Symptoms of pneumococcal infection

    How does the infection develop? The entrance gates of pneumococcal infection are the mucous membranes of the oropharynx and the respiratory tract, where pneumococci can last for a long time without exerting any pathogenic effect. Of great importance in the development of the further process is the resistance( resistance) of the entrance gate of the infection.

    Risk factors for the development of the disease: hypothermia, reduced local immunity as a result of frequent respiratory infections, stress and fatigue, hypovitaminosis. With a decrease in local resistance, it is possible to develop pneumonia. Getting into the blood, pneumococci can cause sepsis( blood poisoning), and also spread to organs and tissues.

    The incubation period of ( from the moment of infection to the development of the disease) is from 1 to 3 days.

    Disease: 1) Pneumococcal pneumonia( inflammation of the lungs)
    2) Pneumococcal meningitis( inflammation of the pia mater)
    3) Pneumococcal otitis media( inflammation of the middle ear)
    4) Pneumococcal sepsis( blood infection)

    Pneumococcal pneumonia

    Pneumonia is characterized by hightemperature - rise to high( febrile) digits - 38-39 °, chills, severe weakness, muscle pains, shortness of breath, palpitations;soon there is a wet cough with phlegm-purulent sputum( yellowish-greenish in color), sometimes pains in the chest are disturbed when coughing.

    Pneumonia in pneumococcal infections mogzhet be croupous ( sudden onset, fever, pronounced chills, blush on the cheeks, sharp pain in the chest and sputum brown tint - "rusty" auscultation rales, crepitation, "pleural rub"dullness) or focal( arises against the manifestations of acute respiratory infection - there is a weakness, cough, sweating, shortness of breath, phlegm muco-purulent, pain in the small area of ​​the chest, pale skincovers, small and medium bubbling rales are heard).Croupous pneumonia proceeds more severely, it is possible to develop acute respiratory failure, the formation of abscesses, pleurisy.

    Pneumococcal pneumonia

    Focal pneumonia is lighter in severity, however, infiltration resolves in a longer time - up to 4 weeks.

    When to call a doctor: the appearance of high fever with severe weakness, cough with sputum purulent and "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, multiple vomiting and increased sensitivity to all types of irritants are later joined. During the first 12-24 hours from the onset of the meningitis, a detailed picture of meningeal and cerebral syndromes is formed. Appear and rapidly growing meningeal symptoms: stiff neck muscles, Kernig symptom Brudzinskogo etc. For patients characterized by "meningeal posture" or "setter dog pose.".Consciousness is first saved, and then replaced by a state of stunnedness, stopper, coma.
    Cerebrospinal fluid during analysis - flows under pressure, turbid, cytosis of several tens of thousands of cells in 1 μl, neutrophils up to 90%, the protein is often increased.

    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 young children - high fever, constant crying and anxiety of the child - an occasion for an urgent call to a doctor. Meningitis requires urgent medical interventions in a hospital setting.

    Pneumococcal otitis

    Pneumococcal otitis characterized by fever, pain in the ear, hyperacose( increased sensitivity to auditory stimuli).

    Pneumococcal sepsis

    Pneumococcal sepsis is manifested by an infectious-toxic syndrome( temperature, weakness, headaches), enlarged spleen( which the patient often does not feel), symptoms of various organs and systems( lungs, heart, intestines, kidneys, meninges).

    Complications of pneumococcal infection

    Complications are associated with the development of a particular clinical form of the disease. With the development of pneumonia, one should fear acute respiratory failure, heart failure. When meningitis - cerebral edema with the danger of a wedge syndrome( stop cardiac and pulmonary activity).In the case of sepsis, lethality reaches 50% and any of the complications can be expected.

    After the transferred pneumococcal infection, a low-stress, short-term, type-specific immunity is formed, which does not protect against repeated infection with another serotype of pneumococcus.

    Diagnosis of pneumococcal infection

    1. Preliminary diagnosis is clinical. It is exhibited by the doctor when examining the patient on the basis of suspicious symptoms after a differential diagnosis. To distinguish pneumococcal infection from diseases with a similar clinic, caused by other bacteria, is very difficult. Doctors need to exclude pneumonia of another etiology( staphylococcal, streptococcal, legionellosis, Klebsiella, and others);other bacterial meningitis, etc.

    2. The final diagnosis is made only after laboratory confirmation of the diagnosis.
    For research are selected: oropharyngeal mucus, sputum, blood, cerebrospinal fluid, inflammatory exudates. Taking a certain type of material for laboratory research is carried out taking into account the clinical picture of the disease.
    Features: rapid death of pneumococcus in the external environment determines the rapid delivery of material to the laboratory.

    The main diagnostic methods are:

    1. Microscopy of Gram stained and gysse smears - under the microscope, lancet-like diplococci are visible.
    2. Bacteriological method - sowing material on special media( blood agar and serum broth, 10% bile broth).
    3. Serological method - blood test with agglutination test only confirms the main diagnosis.

    Treatment of pneumococcal infection

    1) Basic therapy( regimen, diet).
    Mode. Hospitalization is carried out according to clinical indications. At home patients are treated only with pneumococcal acute respiratory disease. Other forms of infection, and even more so in children, require hospitalization in order to avoid fatal complications. An indispensable condition is adherence to bed rest for the entire febrile period, and also to the elimination of complications.
    Diet complete with a balanced amount of proteins, fats, carbohydrates;the exception of obligate allergens, a sufficient amount of liquid.

    2) Etiotropic therapy( antibacterial drugs) - the drugs of choice for pneumococcal infection are a group of penicillins, cephalosporins, carbopines, vancomycin, depending on the form of infection.
    It should be remembered about the increase in strains of antibiotic-resistant pneumococcus species, which certainly hampers the therapeutic search for the drug. The only way out is to determine the sensitivity of the released pneumococcus to various antibiotics, which takes 2-3 days.

    3) Pathogenetic infusion therapy( correction of protective functions of the body) includes detoxification therapy, bronchodilators, cardioprotectors, diuretics, agents for improving microcirculation and so on.

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

    1. Antipyretics( nurofen, panadol to children, teraflum, koldreks, fervex, efferlangan to adults) in order to reduce fever and improve overall well-being.
    2. Anti-inflammatory therapy and analgetics - ibuprofen, paracetamol, voltaren, ketorol - relieve pain syndrome, in particular with myalgia.
    3. Mucolytics( and expectorants) - acetylcysteine, ambroxol, lazolvan, bromhexine, broncholitin, ascaril and so on. Preparations that suppress cough( sinecode, kodelak, stoptussin), take with pneumococcal infection is NOT recommended.
    4. Probiotics in the case of development of drug enteritis( linex, bifistim, bifidum forte, etc.) in order to activate normal microflora and fight infection in the lesion.
    5) Distracting and topical therapy includes steam inhalations with a solution of soda, solutions of herbs - sage, chamomile( which is important for catarrhal form and herpangina);irrigation of the pharynx with disinfectant solutions in order to avoid bacterial contamination of the lesion site;anti-inflammatory drops in the eyes with conjunctivitis.

    Is it possible to take antibiotics on pneumococcal infection? It is undesirable, because it is only the doctor who can correctly determine the necessary group of antibacterial drugs. Improper selection of the drug and dose can lead not only to the lack of treatment effect, but also to a significant decrease in immunity, and, consequently, to a deterioration in the general condition of the patient.

    Prevention of pneumococcal infection

    1) Specific - vaccination of young children.
    There are two vaccines for immunization: Prevenar-13 and Pneumo 23.
    Prevenar-13 is used to vaccinate children from 2 months to 5 years, and Pneumo-23 from 2 years and older. Vaccines do not contain pathogens, but contain purified polysaccharides of the most common types of pneumococci. In addition, the administration of the vaccine has a curative effect in the form of sanation from pneumococcus respiratory tract and a decrease in the number of carriers of pneumococcus. Vaccines are administered according to different schemes depending on age. Immunity is produced 10-15 days after administration and lasts for 5 years. The Government of the Russian Federation considers the amendment of Article 9 of the Federal Law "On Immunoprophylaxis of Infectious Diseases" and, if approved, vaccination against pneumococcus will become mandatory in 2014.

    2) Nonspecific( isolation of patients, maintenance of immunity, vitamin prophylaxis, timely treatment of ARI, exercise, hardening).

    The doctor infektsionist Bykova N.I.