Keshu pneumonia

　　How is Keshu pneumonia caused? The following is a brief description:

　　1. Causes of Disease

　　Borrelia burgdorferi parasites are located in the cytoplasm of cells, usually spherical or cigar-shaped, and have strong resistance to physical and chemical factors. They can survive for at least 30 minutes at 50°C, and can only be inactivated after being exposed to temperatures between 60°C to 70°C for 15 to 30 minutes. They can be preserved for a long time at -70°C and after freezing-drying. They can survive in contaminated soil for several months to one year, so inhaling aerosols formed from contaminated soil is very easy to cause disease. Borrelia burgdorferi has phase variation, and the pathogen newly isolated from animals or ticks belongs to the first phase. After passage in chicken embryos, it becomes the second phase, and only the second phase can cause complement fixation reactions with convalescent and early serum samples. Borrelia burgdorferi is pathogenic to guinea pigs, hamsters, and chicken embryos, with guinea pigs being the most commonly used experimental animals.

　　2. Pathogenesis

　　After Rickettsia bellii invades the body, it first grows and reproduces in local monocytes, then enters the blood circulation to form rickettsialemia, and spreads to small blood vessels and the heart, liver, lung, kidney, brain, and other organs, forming inflammation. Some cases die due to severe illness. Autopsy confirmed that the pulmonary lesions are diffuse inflammation infiltration with lobar distribution, similar to lobar consolidation of pneumococcal pneumonia, but the alveolar exudate is rich in monocytes, lymphocytes, and fibrinogen, containing only a small amount of neutrophils and red blood cells, which can be distinguished from bacterial pneumonia dominated by neutrophils. The alveolar exudate also contains alveolar macrophages. Rickettsia bellii can be seen in alveolar macrophages. Tissue sections show that rickettsia mainly exists in the vacuoles and cytoplasm of the infected cells. If fluorescent-labeled antibodies are used, immunohistochemical methods are more conducive to clear observation. Due to the infiltration of macrophages, lymphocytes, and plasma cells, thickening, congestion, edema, and necrosis of the alveolar wall can be seen. Necrosis and inflammatory infiltration can also occur in the bronchial mucosa.

　　Chikungunya fever pneumonia can be complicated by pleurisy. The main clinical manifestations are chest pain, cough, chest tightness, shortness of breath, and even respiratory distress. When infectious pleurisy or pleural effusion is secondary to infection, it may be accompanied by chills and fever. Pleurisy caused by different etiologies can be accompanied by the clinical manifestations of the corresponding diseases.

　　The incubation period of Chikungunya fever pneumonia is 12-39 days, with an average of 18 days. The onset is usually acute, with a few cases being slower, and the symptoms are generally as follows:

　　1. Fever.At the beginning, accompanied by chills, headache, myalgia, and fatigue, fever rises to 39-40℃ within 2-4 days, showing remittent fever pattern, lasting for 2-14 days. Some patients have night sweats. In recent years, many patients have shown a relapsing fever pattern.

　　2. Severe headache.Headache is an outstanding feature of this disease, commonly seen in the forehead, behind the orbits, and the occiput, and often accompanied by myalgia, especially in the lumbar and gastrocnemius muscles, and can also be accompanied by joint pain.

　　3. Pneumonia.About 30-80% of patients have pulmonary lesions. Dry cough and chest pain begin on the 5th to 6th day of the disease course, with a few having mucous or blood-streaked sputum. Physical signs are not prominent, and sometimes fine moist rales can be heard. X-ray examination often shows segmental or lobar opacity around the lower lobe of the lung, with thickening and infiltration around the lung or bronchial walls, resembling bronchopneumonia. Pulmonary lesions are most prominent around the 10th to 14th day of the disease, and disappear within 2 to 4 weeks. Occasionally, pleurisy or pleural effusion may occur.

　　4. Hepatitis.Liver involvement is relatively common. Patients may have symptoms such as anorexia, nausea, vomiting, right upper quadrant pain, etc. The liver may be enlarged, but to varying degrees, with a few reaching 10 cm below the costal margin, and tenderness is not significant. Some patients may have splenomegaly. Liver function tests often show increased bilirubin and transaminases.

　　5. Endocarditis.About 2% of patients with chronic fever have endocarditis, manifested as long-term irregular fever, fatigue, anemia, clubbing, heart murmur, and dyspnea. Secondary valvular lesions are mostly seen in the aortic valve, and mitral valve can also occur, associated with pre-existing rheumatic disease. Chronic fever refers to a disease that lasts for several months or more than a year after an acute fever, and is a multisystem disease that can present with pericarditis, myocarditis, pulmonary and myocardial infarction, meningitis, myelitis, interstitial nephritis, and other conditions.

　　How to prevent fever pneumonia? Briefly described as follows:

　　Milk must be boiled or pasteurized before drinking. Patients should be strictly isolated, and their sputum and excreta should be disinfected. Vaccination should be administered to those who come into contact with domestic animals and slaughterhouses, raw milk processing, and laboratory operations in epidemic areas, and prophylactic drug treatment should be given if necessary. Although fever is not the main mode of transmission between humans, when handling contaminated patient blood, urine, sputum, clothing, and post-mortem specimens, gloves and masks should be worn instead of direct hand contact.

　　What examinations should be done for fever pneumonia? Briefly described as follows:

　　1. Blood test.Blood routine examination has little diagnostic value. In the acute phase, peripheral blood leukocytes are mostly normal or slightly increased with mild left shift of the nucleus. Serum transaminases and alkaline phosphatase may be increased.

　　2. Sputum analysis.Sputum is stained with Gram stain, mainly showing a large number of monocytes, as well as lymphocytes and a small number of neutrophils. Rickettsia bellii can be isolated from the sputum after culture.

　　3. Pathogenic examination.Rickettsia bellii can be cultured and isolated from the blood, urine, sputum, cerebrospinal fluid, and pleural fluid of patients. Clinical specimens are inoculated into guinea pigs, hamsters, or chicken embryos. Specific antibodies can appear in the blood of inoculated animals after 4 to 6 weeks. In addition, there is a risk of infection at any time during the isolation process, so routine methods are not used. Operators should be properly protected when necessary.

　　4. Serological examination.The serological diagnostic method for fever is simple, safe, and reliable, and is often used in clinical practice.

　　5. Molecular biological detection.Currently, DNA probes and PCR technology can be used to detect the DNA of Rickettsia bellii in specimens, which has strong specificity and high sensitivity, and can differentiate between acute and chronic infections of Rickettsia bellii.

　　6. Animal inoculation and pathogen isolation.2 to 3 ml of blood from a fever patient is inoculated into the peritoneal cavity of guinea pigs. After the animals develop fever, they are killed and the spleen is pressed onto a slide for examination. Pathogens can be observed within the cytoplasm. Pathogens can also be isolated from the yolk sac of chicken embryos or tissue culture, which must be done in a laboratory with appropriate conditions to prevent the spread of infection.

　　7. X-ray examination.Dispersed patchy shadow in the lung, showing segmental and subsegmental distribution, sometimes presenting with large lobe consolidation signs, most occurring in the lower lobe of one or both lungs.

　　The nutritional therapy methods for pneumonia with fever are as follows:

　　Summary of nutritional therapy methods for pneumonia with fever

　　Composition: Ginger 5 grams, white rice in appropriate amount.

　　Usage: Cook porridge and eat.

　　Indications: Pneumonia with cold and wind closing the lung.

　　Nutritional therapy method two

　　Composition: Ginger 5 grams, scallion white with roots 2 roots, glutinous rice in appropriate amount.

　　Usage: Grind ginger, chop the scallion white, and cook with glutinous rice, add rice vinegar when cooked, and eat while hot.

　　Indications: Pneumonia with cold and wind closing the lung. Symptoms include fever without sweating, dry cough, shortness of breath, no thirst, thin white sputum, thin white or greasy tongue coating, non-red tongue quality, purple fingers, mostly in the wind gate, deep and tight pulse.

　　Nutritional therapy method three

　　Composition: Fungus spores 60 grams, scallion white 7 roots, ginger 7 slices, sweet yeast 2 grains.

　　Usage: Grind the above herbs and mix evenly, then add warm wine to adjust and apply to the chest Shangzhong and Jiwei points.

　　Indications: High fever and dyspnea in children with pneumonia.

　　Nutritional therapy method four

　　Composition: Scallion white 6 grams, mugwort 6 grams.

　　Usage: Mash and apply to the navel.

　　Indications: Fever in children with pneumonia, which has a good effect on reducing fever.

　　Nutritional therapy method five

　　Composition: Garlic.

　　Usage: Mash and apply to the soles of the feet.

　　Indications: Respiratory distress in children with acute laryngitis.

　　Tetracycline, chloramphenicol, and doxycycline are quite effective for the treatment of this disease. Tetracycline is 2g/d, taken orally in four divided doses. Considering medication safety, chloramphenicol can also be replaced with doxycycline, rifampin, erythromycin, and sulfamethoxazole. The adult dose of doxycycline is 200mg/d, for a course of 10 days, and the medication time is up to 1 week after the fever subsides. Chronic high fever can be treated with tetracycline or doxycycline combined with sulfamethoxazole/trimethoprim (combined sulfamethoxazole) (2 tablets per time, 2 times/d) or rifampin (450mg/d) for several days to several months. Other treatments are the same as other rickettsial diseases.