小肠结肠炎耶尔森菌肺炎

　　1、发病原因

　　此致病菌是胃肠道炎症、肺炎和肺脓肿的共同病因。肺部感染发生于败血症或原发吸入感染所致。小肠结肠炎耶尔森菌属肠杆菌科，有多种血清型和生物型分布在不同的来源。多数菌株为乳糖不发酵或低乳糖发酵，尿素酶阳性微需氧或兼性厌氧，在一般培养基37℃条件下生长缓慢，分离细菌的适宜温度为22℃。本菌耐寒冷，在低温水中可生存6个月，但对湿热及化学消毒剂敏感。

　　2、发病机制

　　细菌进入肠道后通过肠毒素、细胞毒素及侵袭力致病。小肠结肠炎耶尔森菌首先黏附在回肠下端、盲肠及结肠黏膜，继而侵袭到固有层并引起炎症，形成浅表溃疡，集合淋巴结肿大和肠系膜淋巴结炎。其产生的耐热肠毒素抑制上皮细胞对Na和水的吸收，引起腹泻。若机体抵抗力下降，此菌可进入血流引起败血症和迁徙性病灶。此外，该菌还可诱发自身免疫性疾病，现认为与超抗原活性有关。假结核耶尔森菌进入肠道后常局限在回盲部淋巴结和肠系膜淋巴结，形成化脓性淋巴结炎和肉芽肿病变，偶尔进入血流。

　　The main manifestations include nodular erythema, purpura, urticaria, multiple erythema, Stevens-Johnson syndrome, joint neuropathy, monarticular and polyarticular arthritis, tendinitis, rheumatic polymyalgia, myocarditis, endocarditis, uveitis, glomerulonephritis, thyroid disease, thrombotic disease, etc. These complications appear 1-3 weeks after the acute phase, and most are severe, often requiring hospitalization. Lesions are prone to occur in the skin and connective tissue, and the affected areas are generally sterile. Bacteria are excreted from the feces, and diagnosis relies on serological testing. Common skin symptoms include nodular erythema, polymorphic erythema, Stevens-Johnson syndrome, urticaria, and purpura. The pathogenic effect depends on the formation of immune complexes. The complications of connective tissue are a group of diseases consisting of reactive arthritis and joint pain, including acute polyarticular arthritis, acute monarticular arthritis, acute rheumatic arthritis, acute juvenile rheumatoid arthritis (Still), tendinitis, and perisynovitis. Other complications include myocarditis, pericarditis, uveitis, and glomerulonephritis caused by non-group A streptococci, as well as thrombosis cases, which may be formed by the deposition of Yersinia enterocolitica.

　　1. It is currently believed that this pathogen is a common cause of gastrointestinal inflammation, pneumonia, and lung abscess. Pulmonary infection occurs in sepsis or primary inhalation infection. Clinical manifestations include coughing, shortness of breath, and lung consolidation. There are often gastrointestinal symptoms, a history of animal contact, and a history of ingestion of suspected contaminated food and water. In patients with liver cirrhosis, the exacerbation of liver function failure and the appearance of ascites may occur.

　　The diagnosis of pulmonary infection is based on a history of inhalation or ingestion of suspected contaminated food, clinical manifestations such as coughing and shortness of breath, combined with X-ray findings and etiological diagnosis for comprehensive consideration.

　　Preventive measures include avoiding the contamination of water resources by rodents. Food that has been refrigerated should be heated and boiled before consumption. Those in close contact with patients should frequently wash their hands and avoid contact with sick animals. Patients with liver cirrhosis and weakened immune function have an increased risk of infection with this disease, so it is especially important to ensure the hygiene of food and water. Enhancing human immunity, strengthening physical fitness, and improving the immune function of those with poor physical condition can help prevent this disease. Patients with other chronic diseases may experience a worsening of their condition after infection with Yersinia enterocolitica, and these patients should pay attention to the prevention and treatment of complications. The active immunization vaccine against Yersinia enterocolitica is still under development.

　　1, Laboratory examination

　　Blood or sputum culture may be positive. Gram-negative bacilli may be found in sputum. When there is pharyngeal infection, pathogenic bacteria may be found in pharyngeal secretions. Samples of purulent nodules, ascites, and joint cavity effusion may contain pathogenic bacteria.

　　2, Other auxiliary examinations

　　The X-ray chest film shows nodular dense foci at the base of the lungs, which are caused by hematogenous dissemination of sepsis. The shadowy areas distributed according to the pulmonary segments represent aspiration infection. Widespread blurred foci indicate the formation of purulent thrombi.

　　First, Yersinia enterocolitica Pneumonia Dietary Remedy

　　1, Celery Stir-fried鲤鱼 - Ingredients: 250 grams of crucian carp, 50 grams of fresh celery, starch, ginger slices, garlic slices, soy sauce, sugar, vinegar, monosodium glutamate, salt, cooking wine, pickled hot peppers, and vegetable oil. Preparation: Cut the crucian carp into strips, cut the celery into sections, and mix soy sauce, sugar, vinegar, monosodium glutamate, cooking wine, salt, and starch with some stock to create a sauce. Heat a wok over high heat, add oil to 5 degrees, stir-fry the fish strips until they disperse, drain the excess oil, add ginger slices and pickled hot peppers. Stir-fry the celery sections until fragrant, then add the sauce, add some glossy oil, and remove from heat. Benefits: Crucian carp has the effects of clearing heat and detoxifying, promoting diuresis and reducing edema, and relieving cough and chest stuffiness; celery has the effects of calming the liver and clearing heat, removing wind and dampness, and nourishing the spirit and invigorating Qi. Eating crucian carp and celery together is suitable for auxiliary treatment of acute and chronic pneumonia.

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

　　3, Quail Lily Soup - Ingredients: 1 quail, 25 grams of lily, appropriate amounts of ginger, scallion, monosodium glutamate, and fine salt. Preparation: Kill the quail, remove feathers, claws, and internal organs, wash and blanch in boiling water, remove and cut into pieces; separate the lily petals, wash, and set aside. Wash the ginger and scallion, crush the ginger, and cut the scallion into sections. Place a pot on a high heat, pour in some water, add the quail, bring to a boil, add lily petals, ginger pieces, and scallion sections, then turn to a low heat to simmer until the quail is cooked. Add salt and monosodium glutamate, simmer for a few minutes, and 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 removing dampness, and stopping diarrhea; lily has the effects of moistening the lungs and relieving cough, nourishing yin and clearing heat, and calming the mind. Both are 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. Preparation: slice the lean meat, wash and slice the cabbage, and put it in boiling water, remove it when it is just cooked, rinse with cold water, drain the water, and set aside. Place the pot on a high heat, add a little chicken oil and heat it to five degrees, add garlic and stir until golden brown, then add the lean meat and stir-fry together, add fine salt, and cook in the soup. Add the cabbage heart and bring to a boil, then add monosodium glutamate and it is ready to eat. The efficacy of lean meat is to tonify the middle and Qi, and moisten the intestines; the cabbage is mild in nature and sweet in taste, with the effects of clearing heat and detoxifying, resolving phlegm and stopping cough, and relieving irritability and promoting defecation. Eating lean meat and cabbage together is suitable for acute and chronic pneumonia.

　　Second, what foods are good for Yersinia enterocolitica pneumonia patients

　　1. Foods should be high in nutrition, light, and easy to digest, especially in liquid form, such as juice;

　　2. Fresh fruits and vegetables;

　　3. Foods with high oil content, eggs, and other foods rich in vitamin A.

　　Third, what foods should Yersinia enterocolitica pneumonia patients avoid eating

　　1. Avoid spicy and greasy foods. Do not eat large fish, meat, and overly greasy products. 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, and tangerines.

　　3. Avoid cold and cold foods:

　　(1) Various ice drinks;

　　(2) Melons and fruits with cool properties: including watermelons, pears, bananas, kiwis, etc;

　　4. Avoid foods with sour taste: such as vinegar, sour cabbage, pickled vegetables, and fruits like hawthorn, black plum, sour tangerine, etc.; astringent foods: such as white fungus, lotus root nodes, and unripe persimmons, hawthorns, etc.

　　1. Treatment

　　Certain strains are resistant to chloramphenicol, streptomycin, sulfonamides, tetracycline, kanamycin, and ampicillin. Therefore, it is advisable to use third-generation quinolones, such as ofloxacin 600mg/d, taken orally or intravenously in 2-3 doses. Yersinia enterocolitica can produce β-lactamase, and in cases of sepsis, it is advisable to use antibiotics that are resistant to β-lactamase, such as furbenicillin, mezlocillin, cefotaxime, and cefoperazone. The total course of treatment is 3-6 weeks.

　　2. Prognosis

　　The liver function failure of liver cirrhosis patients worsens, and the prognosis is poor.