Gonococcal peritonitis

　　淋球菌性腹膜炎是怎么引起的？简述如下：

　　一、发病原因

　　1、淋球菌性腹膜炎多继发于患者自身其他部位的淋球菌感染，如急性盆腔腹膜炎，大多数继发急性淋球菌性输卵管炎，输卵管渗出物经伞端流入腹腔，引起局限性盆腔的炎症；急性原发性淋菌件腹膜炎，是由阴道淋菌播散引起；急性弥散性腹膜炎，则由于输卵管淋球菌积脓、卵巢淋球菌脓肿或盆腔淋球菌脓肿破裂而引起。

　　2、淋球菌性腹膜炎的病原体为淋病双球菌，系1879年奈瑟氏所发现，故又名奈瑟淋病双球菌(Neisseriagonorrhoeae)，呈卵圆形或肾形，成对排列，其大小为0.6～0.8mm，一般存于多形核白细胞的胞浆内，革兰染色阴性；普通培养基上不生长，可在3％～10％CO2条件下用巧克力血液琼脂培养基或含有万古霉素、黏菌素及制霉菌素的Thayer-Martln培养基方能生长。

　　二、发病机制

　　人类是淋球菌的惟一天然宿主，主要侵袭黏膜组织，并引起局部炎症性反应：广泛充血、水肿、浆液性渗出，继而化脓，结缔组织增生。

　　淋球菌感染机体涉及不同的阶段，包括黏附、侵入、细胞内生存及诱导宿主反应等。体外组织及器官培养研究表明，淋球菌通过多种黏附素黏附于非纤毛上皮细胞，通过一种涉及肌动生蛋白微丝和微管的内在化作用(internalization)进入上皮细胞，经穿胞(transcytosis)和胞吐(exocytosis)通过基底层进入上皮下层。淋球菌通常定居上皮下层，诱发炎症反应，偶尔细菌进入血流引起播散性感染。在感染及传播过程中淋球菌需适应宿主环境，逃避宿主的防御机能。淋球菌适应及免疫逃避的机制包括表面成分的抗原变异、利用宿主成分、以及抵抗不利环境及吞噬细胞的攻击。

　　淋球菌性腹膜炎引发什么疾病？简述如下：

　　1、淋球菌可随血流到达全身，引起播散性淋球菌感染，如淋球菌性关节炎、淋球菌性皮炎、淋球菌性腱鞘炎、淋球菌性心内膜炎、淋球菌性脑膜炎和淋菌性肝周围炎等。

　　2、单侧或两侧下腹部疼痛，少数为转移性下腹部疼痛，但较其他腹膜炎轻，常尿频、尿急、尿痛、尿道灼痛，既往在半年内常有类似症状。有不洁性接触病史。

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　　What are the typical symptoms of gonococcal peritonitis?

　　What are the symptoms of gonococcal peritonitis? Briefly described as follows:

　　1. Lower abdominal pain

　　2. Peritoneal irritation sign

　　2. Abdominal tenderness during palpation, mainly in the lower abdomen or lower right abdomen, with rebound tenderness and marked muscle tension.

　　During acute pelvic peritonitis, gynecological examination may show severe tenderness, full fornix; cervical activity is poor, and inflammatory masses can be felt in the adnexa, with the right side being more obvious.

　　How to prevent gonococcal peritonitis?

　　Gonorrhea is a disease mainly transmitted by sexual intercourse. Gonococcal peritonitis often occurs secondary to gonococcal infection in other parts. Therefore, preventive work must start from the basic links.

　　1. Promote healthy sexual habits, change harmful sexual behaviors, and avoid extramarital contact.

　　2. It is recommended to use condoms during sexual activity to prevent cross-infection of gonorrhea.

　　3. People with acute gonorrhea at home should receive corresponding isolation and treatment. This includes disinfection of items such as washing basins, underwear, bath towels, and tracing, examination, and treatment of sexual partners within one month.

　　What examinations should be done for gonococcal peritonitis? Briefly described as follows:

　　First, peripheral blood picture

　　White blood cell count > 15×10^9/L, neutrophilic granulocytes increased.

　　Second, bacteriological examination

　　1. Secretion Microscopy

　　Urethral (male) or vaginal secretion microscopy: there may be a large number of red polymorphonuclear leukocytes, with some cells containing gonococci. Gonococci are Gram-negative, oval or round, often arranged in pairs, with flat or slightly concave contact surfaces between the two bacteria. The length of the bacterial body is about 0.7 μm, and the width is about 0.5 μm, but there may be differences in size between the two bacteria. Most polymorphonuclear leukocytes do not contain gonococci, but many leukocytes often contain 1 to several pairs, even dozens of pairs of gonococci, and gonococci are often located within the cytoplasm. In patients with gonorrhea with a longer disease course or who have been treated, the number of gonococci in the secretion smear is less, sometimes appearing as single, tetrahedral, and octahedral, and often located outside the cells.

　　2. Gonococcus Culture

　　Culturing gonococcus is the only method recommended by WHO for the screening of gonorrhea and is also the 'gold standard' for diagnosis.

　　3. Catalase Test

　　It is one of the important preliminary diagnostic tests for gonococcus. Gonococcus can produce catalase during the growth process. After 24-48 hours of culture, the colonies are treated with catalase reagent (0.5% to 1% dimethyl p-phenylenediamine hydrochloride or tetramethyl p-phenylenediamine hydrochloride solution), and the colonies turn purple-red or even black as a positive reaction. However, not all positive catalase tests are caused by gonococcus.

　　4. Catalase test

　　Gonococci can produce catalase, which can quickly decompose hydrogen peroxide into water and oxygen, forming bubbles, and is used for preliminary identification of gonococci.

　　5. Direct immunofluorescence test

　　Fluorescein-labeled gonococcal antisera (monoclonal antibody) is dropped on the suspected bacteria. When encountering gonococci (antigen), the antibody binds to the antigen, and the bacterial bodies with apple green fluorescence can be observed under a fluorescence microscope. This method is rapid and can also have a positive reaction in dead bacteria.

　　6. Enzyme reaction

　　Gonococci have special enzymes that can cause the chromogenic substrates of certain enzymes to change color, thereby distinguishing them from other Neisseria, and are used in clinical identification of gonococci.

　　What are the dietary principles for gonococcal peritonitis? Briefly described as follows:

　　1. Eat more high-protein, high-vitamin (especially vitamin A) foods to facilitate the recovery of the condition.

　　2. Quit smoking and drinking.

　　3. Do not eat greasy foods, avoid eating salty and spicy foods.

　　The treatment methods for gonococcal peritonitis are described as follows:

　　First, non-surgical treatment

　　1. Systemic antibiotic treatment

　　Penicillin is the first choice, 4.8 to 10 million U/d intravenous drip, added with norfloxacin (flumeprazole) 0.6g/d, for 3 to 5 days. Or penicillin plus metronidazole intravenous drip; ceftriaxone (ceftriaxone, Cefobid) 2g, added to 40ml of glucose solution for intravenous injection, a total of 7 days; erythromycin plus gentamicin, etc.

　　2. Local antibiotic treatment

　　For severe peritonitis, 100ml of 0.5% metronidazole solution and 1.0g of ceftriaxone can be used for intraperitoneal injection once a day, alternating use.

　　Second, surgical treatment

　　1. Indications

　　Patients with severe peritonitis accompanied by systemic toxic symptoms; those who have no effect from non-surgical treatment; patients with intra-abdominal inflammatory masses; patients with severe illness, difficult to exclude other surgical acute abdominal conditions.

　　2. Surgical methods

　　Laparotomy or laparoscopic exploration. The abdominal pus is aspirated during the operation, thoroughly flushed, and double lumen tubes are placed for drainage.