Elderly mycoplasma pneumonia

　　Pneumonia caused by Mycoplasma pneumoniae in the elderly is an acute respiratory infection accompanied by pneumonia. Mycoplasma pneumoniae is between viruses and bacteria, can grow on cell-free culture media, has no cell wall, contains RNA and DNA, and produces energy through metabolism. It is often confused with the L form of bacteria, and their colonies are similar. Mycoplasma is a pathogen for many animal diseases, and currently, there are 8 known human mycoplasmas. Only Mycoplasma pneumoniae can cause respiratory tract infections, it can ferment glucose and produce hemolysin, and can completely dissolve the red blood cells of sheep and guinea pigs within 24-48 hours. This can be distinguished from other mycoplasmas. Other mycoplasmas can cause urinary and reproductive system infections, generally do not invade the respiratory tract. Mycoplasma pneumoniae often causes upper respiratory tract infections without pneumonia, and can also cause asymptomatic infections. Reports from abroad all show that the incidence of mycoplasma pneumonia has increased significantly in recent years.

　　The complications of elderly mycoplasma pneumonia mainly include the following aspects:

　　1, Nervous system
　　Central and peripheral nervous system lesions may appear 4 weeks after infection. Manifestations include aseptic meningitis (usually transient), meningoencephalitis, polyneuritis; severe cases may have transverse myelitis, seizure attacks, even mental disorders, but rarely cause death.

　　2, Blood system
　　It occurs 2-3 weeks after onset, mainly including autoimmune hemolytic anemia, thrombocytopenic purpura, disseminated intravascular coagulation, and other conditions.

　　3, Cardiovascular system
　　Mild cases may only show ECG abnormalities, while severe cases may develop pericardial effusion, cardiac insufficiency, and arrhythmia.

　　4, Musculoskeletal system
　　Specific muscle pain and joint pain may occur within 2 weeks of onset, mainly affecting large and medium joints, with characteristics of multiple joints, migratory, and slow relief, and may show polymorphic erythema.

　　5, Other
　　Gastrointestinal symptoms: anorexia, nausea, vomiting, diarrhea, etc., ulcerative stomatitis, conjunctivitis, and sinusitis. For elderly patients, there may be various atypical manifestations. Fever is usually low-grade, high fever and chills are rare, and a considerable number of cases have no fever; symptoms are mainly manifested as lassitude, disturbance of consciousness, and anorexia, often accompanied by electrolyte disorders; especially for those with poor diet, common symptoms include hypokalemia and hyponatremia.

　　The onset of the disease is relatively slow, mainly表现为pharyngitis, bronchitis, and 10% of pneumonia. The main symptoms include chills, fever, fatigue, headache, general malaise, irritating dry cough, accompanied by mucous sputum, purulent sputum, even blood-tinged sputum, severe cases may have shortness of breath, severe cough, and occasional chest pain; may also have nausea, anorexia, vomiting, diarrhea, joint pain, myocarditis, pericarditis, hepatitis, peripheral neuritis, meningitis, skin macules and papules, and other extrapulmonary manifestations.

　　With aging, the physiological structure and function of the human body change, and the elderly are more prone to pneumonia and death. These changes include reduced cough reflex, kyphosis, and other factors, in addition to other conditions such as severe hypoxemia, pulmonary edema, acidosis, and azotemia, all of which increase the susceptibility to concurrent pneumonia; changes in the defense function of the elderly body include increased mucus secretion in the lung tissue, weakened cilial movement, reduced phagocytic activity of polymorphonuclear leukocytes, and a significant lack of T cell function associated with aging, all of which create opportunities for microbial invasion.

　　In recent years, there has been a gradual upward trend in elderly mycoplasma pneumonia infections. Health education should be provided to elderly patients with the above risk factors, especially those with chronic heart, lung, liver, kidney diseases, as well as long-term use of corticosteroids, immunosuppressants, advanced tumor stages, and diabetic patients to avoid contact with pneumonia patients, which can reduce the chance of infection. During the epidemic period of mycoplasma pneumonia, indoor air should be kept circulating, and the room air should be disinfected by boiling vinegar at regular intervals. It is advisable to avoid public places, persist in physical exercise to enhance immunity, and pay attention to the seasonal changes of pneumonia, especially for elderly COPD (Chronic Obstructive Pulmonary Disease) patients. If there is a suspicion of mycoplasma pneumonia, it is necessary to go to the hospital for further examination in a timely manner to make an early diagnosis.

　　Physical examination of patients with this disease may show congestion and edema of the nasopharynx and conjunctiva, with possible enlargement of cervical lymph nodes and rash; chest signs are often not obvious, and pulmonary auscultation may reveal fine moist rales, occasionally pleural friction sounds and signs of pleural effusion.
　　Auxiliary examination
　　1. Chest X-ray X-ray chest film shows increased pulmonary texture, and the lung parenchyma can have polymorphic infiltration, which is more common in the lower lobe and can also be presented as spots, patchy, or uniform hazy shadows. About 1/5 of patients have a small amount of pleural effusion.
　　2. Pathogenic examination The isolation of pneumonia mycoplasma is difficult to be widely applied and is not helpful for early diagnosis.
　　3. Serological examination Serum pathogen antibody titer >1:32, Streptococcus MG agglutination test, titer ≥1:40 is positive, and a continuous increase of more than 4 times twice has diagnostic value. Serum indirect test >1:32, indirect fluorescence test >1:66, indirect immunofluorescence anti-pneumonia mycoplasma IgG >1:16, anti-pneumonia mycoplasma IgM >1:8, affinity enzyme-linked immunosorbent assay can directly detect the antigen of pneumonia mycoplasma, and results can be obtained within 24 hours, all of which have diagnostic significance.

　　Dietary considerations for elderly mycoplasma pneumonia patients:

　　1. Avoid spicy foods

　　Spicy foods are hot in nature, and pneumonia also belongs to a hot disease. The combination of the two heats can exacerbate the condition. Therefore, patients with pneumonia should not add spices such as chili, pepper, mustard, Sichuan pepper, etc., to their diet. Alcohol is also a spicy and hot product that can stimulate the throat and trachea, causing local congestion and edema. Pneumonia patients should avoid alcohol.

　　2. Avoid greasy foods

　　Pneumonia consumes the body's true qi, affects the function of the internal organs, and is prone to reduce digestive function. Foods should be high in nutrition, light, and easy to digest. It is advisable not to eat large fish, meat, or overly greasy foods to avoid affecting the middle burner and impairing the function of transformation and transportation, which may lead to insufficient nutrition.

　　3. Fruits should be consumed in moderation and the varieties should be chosen properly

　　Most fruits are beneficial to this disease, but it is not advisable to eat sweet and warm fruits such as peaches, apricots, plums, oranges, etc., to avoid causing heat and phlegm. If an excessive amount of cold and cool fruits is consumed, it can damage the Yang of the spleen and stomach, impairing the function of transformation and transportation, which is not conducive to the recovery of the disease.

　　The condition of elderly patients with pneumonia is variable, and timely treatment is crucial to avoid life-threatening situations. The treatment methods for elderly mycoplasma pneumonia are as follows:

　　1. Routine treatment
　　The first-line treatment drug for Mycoplasma pneumoniae pneumonia is macrolide antibiotics. In the past, erythromycin was often used for intravenous infusion, but due to its irritation to the gastrointestinal tract and the easy formation of phlebitis at the injection site, it is rarely used in clinical practice now. Now, the new generation of macrolide drugs are often used, which have the advantages of high tissue concentration, long half-life, stronger antibacterial activity, and fewer gastrointestinal reactions, such as roxithromycin 150mg, twice a day, oral; clarithromycin 250mg, twice a day, oral; azithromycin 250mg, twice a day, oral, or 500mg, once a day, intravenous infusion. The course of treatment should be relatively long, with 10-14 days being appropriate; for severe cases, the drug dose can be increased, and the course of the disease can be extended to 21 days.

　　The general treatment effect is good, and there are occasional recurrences. The treatment is still effective after taking the medicine again. For those with severe cough, appropriate cough suppressants should be given. If secondary bacterial infection occurs, targeted antibiotic treatment should be selected according to the etiological examination. Some cases are suspected to be Mycoplasma pneumoniae pneumonia, and it is difficult to differentiate from legionella pneumonia or Streptococcus pneumoniae pneumonia. Macrolide antibiotics and treatment should be首选.

　　2. Optimal treatment plan
　　250ml of 5% glucose + 0.5g azithromycin, once a day, intravenous infusion, course of treatment 1-2 weeks. Or azithromycin (Suhexin) 0.2g, once a day, oral, for 3 consecutive days.

　　3. Rehabilitation treatment
　　For elderly patients, especially those with other cardiovascular and cerebrovascular diseases and other basic diseases such as COPD, coronary heart disease, cerebrovascular disease, diabetes, and so on, attention should be paid to the occurrence of other complications at the same time as the treatment of the disease, such as heart failure, arrhythmia, respiratory failure, electrolyte disturbance, malnutrition, and so on. Back tapping should be performed to promote expectoration. For those with thick sputum, expectorant drugs and ultrasonic atomization inhalation can be given. For those with delayed reaction or unconsciousness, sputum aspiration can be performed with a catheter. Pay attention to fluid replacement and electrolyte supplementation, strengthen nutritional support treatment, and can also be given drugs to enhance immunity, such as thymosin, etc., for intravenous infusion. Pay attention to the adverse reactions of drugs during treatment, and also pay attention to diarrhea, colitis, and other related to the use of antibiotics, drug interactions, such as the use of macrolide drugs with aminophylline drugs, attention should be paid to drug concentration monitoring.