Pseudomallei bacillus pneumonia

　　1, Etiology

　　Pseudomallea is caused by pseudomallei pseudomonas (pseudomonaspseudomallei), a rod-shaped bacterium 1-2 μm long and 0.5 μm wide, which can move, is non-spore-forming, non-capsulated, and Gram-negative. This bacterium is an aerobic bacterium that grows well on general culture media, and after 48-72 hours of culture, the colonies are brownish, with honeycomb-like folds on the surface and concentrically arranged. The culture has a strong moldy smell. The filtrate of the culture contains two toxins: one is a necrotic toxin (inactivated by boiling for 4 minutes); the other is a lethal toxin (inactivated by boiling for 15 minutes), which can cause lethal infection in guinea pigs and rabbits.

　　2, Pathogenesis

　　During acute infection, most foci occur in the lungs, and abscesses in other organs are occasional. During subacute infection, lung abscesses tend to spread and can affect the skin, subcutaneous tissue, meninges, brain, eyes, heart, liver, kidneys, spleen, bones, prostate, synovium, and lymph nodes. The characteristic of acute abscesses is peripheral hemorrhage, with a large number of neutrophils infiltrating in the middle zone, and necrotic fragments in the center area, containing a large number of giant cells with 2 to 3 nuclei. Obvious nuclear rupture is an important histological feature. During chronic infection, caseous necrosis is seen in the center of the focus, formed by monocytes, plasma cells infiltration, and granulation tissue formation, without calcification.

　　It can be complicated by laryngeal edema, respiratory distress, frequent epistaxis or coughing up blood-tinged mucus, intermittent dry short cough, and roars in the lung auscultation. Painless edema appears on the external genitalia, breasts, and limbs. The condition develops rapidly with a high mortality rate, almost 100% die of respiratory failure without treatment. Necrotic nodules, ulcers, and scars form on the nasal mucosa, larynx, tracheal mucosa, or skin, and pseudomallei nodules occur in the lungs, lymph nodes, or other parenchymal organs.

　　Type I: Incubation Period

　　Generally within 4-5 days, but there are also cases that develop months, years, or even up to 20 years after infection, so-called 'latent type of Actinobacillus necrophorus'. Such cases are often triggered by trauma or other diseases.

　　Type II: Clinical Types

　　The clinical manifestations are diverse and can be divided into the following types:

　　1. Latent infection:There are no symptoms, and high-titer specific antibodies are only found during serological tests. In the adult male population in epidemic areas, the positive rate is about 6% to 20%. It has been reported that asymptomatic infection cases are occasionally found during routine X-ray film examination.

　　2. Acute localized suppurative infection:It is often due to bacterial infection of broken skin, forming nodules locally, and complicating lymphangitis and lymphadenitis. Patients often have fever and general malaise, which then rapidly progresses to acute septicemia.

　　3. Acute pulmonary infection:This is the most common form of the disease, manifested as primary or hematogenous disseminated pneumonia. The onset is sudden, with chilliness or chills, followed by fever, general muscle pain, headache, cough, chest pain, tachypnea, and wheezing in the lungs. Chest X-ray examination shows consolidation in the lungs, and some may develop thin-walled cavities that persist when the body temperature drops, resembling the X-ray findings of tuberculosis. Some patients may develop progressive dissemination within the lungs or hematogenous dissemination, leading to septicemia.

　　4. Acute septicemia infection:The onset is sudden, with chills, high fever, small pustules on the skin of the head, trunk, and limbs. If pneumonia is complicated, it is often accompanied by severe dyspnea, severe headache, cough, and chest pain. Wet rales and pleural rub are heard in the lungs. X-ray examination often shows irregular nodular shadows throughout the lungs, with a diameter of 4-10mm. These nodules then expand and fuse to form cavities. Patients may also develop arthritis or meningitis, enlargement of the liver and spleen, poor prognosis, rapid progression of the disease, and often death before treatment.

　　5. Chronic suppurative infection:Some patients develop secondary suppurative foci after the acute phase, such as osteomyelitis, suppurative lymphadenitis, subcutaneous abscesses, psoas abscesses, lung abscesses, empyema, liver abscesses, splenic abscesses, and pyelonephritis, among others. These abscesses can form fistulas, become chronic, and cause gradual emaciation and weakness in the patients.

　　There is no effective preventive method. The main prevention is to prevent the infection of water and soil contaminated by the bacteria through the skin and mucous membranes. In conditions where there may be dust contaminated with bacteria, staff should wear protective masks. The excreta and purulent exudates of patients and sick animals should be disinfected with bleaching powder. People with skin abrasions and tears in epidemic areas should strictly clean the wounds, and the source of infection should be disinfected at the end of the epidemic, and measures should be taken to kill insects and rats. Those suspected of being infected should be under medical observation for 15 days. Animals imported from the epidemic area should be strictly quarantined.

　　1. Hemogram: Most patients have anemia, with an increased total white blood cell count during the acute phase, primarily due to an increase in neutrophils.

　　2. Bacterial culture and animal inoculation of blood, sputum, cerebrospinal fluid, urine, feces, and purulent exudates from local lesions can isolate Actinobacillus necrophorus, with a positive Strauss reaction.

　　3. The serum detection indirect red blood cell agglutination test titer above 1:40 and complement fixation test titer above 1:8 have diagnostic significance. The test can be positive within 1 week after the disease, with a positive rate of over 90% in 4 to 5 weeks, and the antibody titer can maintain for about 1 year.

　　First, the dietary therapy for Corynebacterium pseudotuberculosis pneumonia

　　1. Celery Sauteed鲤鱼 - Ingredients: 250 grams of crucian carp, 50 grams of fresh celery, starch, ginger slices, garlic slices, soy sauce, sugar, vinegar, refined salt, monosodium glutamate, cooking wine, pickled hot peppers, and vegetable oil. Cut the crucian carp into shreds, cut the celery into sections, mix soy sauce, sugar, vinegar, monosodium glutamate, cooking wine, salt, and starch with soup stock to create a sauce. Heat a wok over high heat, add oil to 5成热, add the fish shreds and stir-fry until separated, drain the excess oil, add ginger slices and pickled hot peppers. Stir-fry the celery sections until fragrant, then add the sauce, add bright oil, and remove from heat. Benefits: Crucian carp has the effects of clearing heat and detoxifying, promoting diuresis and reducing swelling, and stopping cough and relieving shortness of breath; celery has the effects of calming the liver and clearing heat, removing wind and promoting diuresis, and nourishing the spirit and benefiting the qi. Eating crucian carp and celery together is suitable for the auxiliary treatment of acute and chronic pneumonia.

　　2. Rabbit Meat and Mushroom Shreds - Ingredients: 100 grams of cooked rabbit meat, 50 grams of mushrooms, 25 grams of scallion whites, chili oil, soy sauce, vinegar, sugar, sesame oil, sesame paste, Sichuan pepper powder, and monosodium glutamate. Cut the cooked rabbit meat and scallion whites into shreds, and cook the mushrooms. Place the scallions and mushrooms at the bottom, cover with the rabbit meat, and serve in a dish. Dissolve the sesame paste in soy sauce in batches, mix the sesame oil to create a sauce, and pour it over the rabbit meat. Benefits: Rabbit meat has the effects of clearing heat and detoxifying, benefiting the spleen and strengthening the qi, removing dampness and cooling the blood, and promoting defecation; mushrooms have the effects of detoxifying and moisturizing, benefiting the spleen and strengthening the qi, eliminating dampness and stopping diarrhea. Eating rabbit meat and mushrooms together is suitable for treating acute pneumonia.

　　3. Quail and Lily Soup - Ingredients: 1 quail, 25 grams of lily, ginger, scallions, monosodium glutamate, and fine salt. After killing the quail, remove the feathers, claws, and internal organs, wash and blanch in boiling water, remove and cut into pieces; separate the lily into petals, wash, and set aside. Wash ginger and scallions, beat the ginger, and cut the scallions into sections. Place a pot on a high heat, add some water, add the quail, bring to a boil, add lily petals, ginger pieces, and scallion sections, then reduce the heat and simmer until the quail is cooked. Add salt and monosodium glutamate, cover and simmer for several minutes, then serve in a soup bowl. Benefits: Quail meat has the effects of nourishing the five internal organs, benefiting the liver and clearing the lungs, clearing heat and promoting diuresis, and eliminating food accumulation and stopping diarrhea; lily has the effects of moistening the lungs and stopping cough, nourishing the yin and clearing heat, and calming the mind. Eating both together is suitable for acute and chronic pneumonia.

　　4. Lean Meat and Cabbage Soup - Ingredients: 100 grams of lean meat and cabbage heart, a little ginger, garlic, salt, monosodium glutamate, and chicken oil. Cut the lean meat into shreds, wash and cut the cabbage, then cook in boiling water and remove when just cooked, rinse in cold water, drain the water and set aside. Place a pot on a high heat, add chicken oil to about 50% cooked, add garlic and stir-fry until golden, then add the lean meat and stir-fry together, add fine salt, cook in the soup, then add the cabbage heart and bring to a boil, add monosodium glutamate before serving. Benefits: Lean meat has the effects of replenishing the middle energizer and promoting qi, nourishing the intestines and moistening the bowels; cabbage has a neutral nature and sweet taste, with the effects of clearing heat and detoxifying, resolving phlegm and stopping cough, and relieving restlessness and promoting defecation. Eating lean meat and cabbage together is suitable for acute and chronic pneumonia.

　　Second, what foods are good for the body for Melioidosis Bacillus pneumonia?

　　1. Fresh fruits and vegetables.

　　2. Oily fish, eggs, and other foods rich in vitamin A.

　　Third, what foods should not be eaten for Melioidosis Bacillus pneumonia?

　　1. Avoid spicy and greasy foods. Do not eat large fish, meat, and overly greasy items. Pneumonia patients should not add spices such as chili, pepper, mustard, Sichuan pepper, etc. to their diet. Quit smoking and drinking.

　　2. It is not advisable to eat sweet and warm fruits such as peaches, apricots, plums, oranges, etc.

　　3. Avoid cold and raw foods.

　　1. Treatment

　　The treatment plan varies according to the type of disease. For acute septicemia cases, strong antibacterial treatment must be adopted. Early use of two sensitive antibiotics in combination therapy. The dose should be large, and the course of treatment generally needs 30 to 90 days. Tetracycline 80mg/(kg·d) or chloramphenicol 80mg/(kg·d) can be used in combination with kanamycin 30mg/(kg·d), sulfadiazine 120mg/(kg·d), sulfamethoxazole/trimethoprim (combined sulfisoxazole) (4-6 tablets/d) or sulfisoxazole 140mg/(kg·d), etc., for intravenous or intramuscular injection. The antibacterial drugs for subacute or chronic cases are half of the acute phase, but the administration time should be longer, a total of 60 to 150 days. Adjustments should be made according to the side effects of antibacterial drugs. For abscesses, surgical incision and drainage should be performed. For chronic cases that are ineffective with internal treatment,病灶 surgery and incision and drainage can be adopted.

　　2. Prognosis

　　Before the advent of antibiotics, the mortality rate of severe patients was as high as 90% or more. If diagnosed in time and treated with antibiotics for a longer period, the mortality rate would significantly decrease, but the mortality rate of sepsis patients was still as high as 50% or more.