Pneumocystosis

Pneumocystosis (synonym Pneumocystis pneumoniais a disease of the lungs caused by Pneumocystis proceeding with a high temperature and severe shortness of breath; the Causative agent of pneumocystosis - Pneumocystis Carini, which refers to the simplest.
Pneumocystosis spread throughout the world. Get pneumocystosis mostly infants, weakened and premature. Older children are parasite-vectors, sometimes they have the expressed clinical picture of the disease. Sources of the infection are dogs, cats, sheep, goats, rodents.
The clinic of the disease has been studied enough yet. The incubation period 30-40 days.
In the clinical course of pneumocystosis there are three stages. The first stage lasts from 3 days to several weeks. Early symptoms of the disease are refusing the breast, weight loss, paleness, shortness of breath. In the second week of the disease is marked dry cough. However, changes in the lungs percutere and auscultatory remain scarce. In the second stage of the disease on chest x-ray detected in the lungs focal shadows, sometimes drain, which Alternate with lobular areas swellings and atelectasis. X-ray picture in this period of the disease caused exudative reaction parenchyma of the lung. At the third stage of illness vozduhonosnye lung tissue is restored, but the long-term remains seal interstitial tissue, shortness of breath. Death at pneumocystosis can occur due to asphyxia as a result, all decreasing respiratory surface of the lungs.
The diagnosis is based on epidemiological data, clinical picture, the results of x-ray and laboratory (detection of this pathogen in tracheal mucus) research.
Treatment. Patients designate rational nutrition, stimulating therapy (blood transfusion, plasma, the introduction of gamma globulin), oxygen. For the treatment of pneumocystosis used Akrikhin, osarsol and other
Prevention includes a complex of anti-epidemic measures (isolation of the patient, disinfection of faeces, sputum, linen and other household items). The staff serving premature and weakened children, examined for pneumocystosis. A careful control of rodents and insects.

Pneumocystosis (pneumocystosis, pneumonia parasitaria; synonym pneumocystogram pneumonia) - interstitial pneumonia, the causative agent is Pneumocystis.
Etiology. The disease is caused by Pneumocystis carinii. The length of 2-3 microns, width 1,5-2 MK. The form of oval or round. The parasite is surrounded by thick mucous membrane, which is by the method Mac Manus is painted in red and violet. The cycle of the parasite is depicted in Fig. 1. The differential diagnosis should be borne in mind that in the studied material may contain morphologically similar to the parasite yeast fungi and Cryptococcus. In the diagram (Fig. 2) summarizes the main differences between these organisms.
Most researchers relates P. carinii to the type of Protozoa, class Sporozoa. Parasites are located in a frothy mass in the lumen of the alveoli of the lungs and bronchi. In some cases, they can be found in the cytoplasm of faguoqitirute cells.
Besides man, parasites found in many animals: pigs, rats and mice, rabbits, rabbits, pigs, cats, dogs and other
Described asymptomatic carriers of parasites in adults, which may be the source of infection. More often it is the staff of hospitals. In some cases, the infection from animals - carriers of parasites; infection occurs by airborne or through contaminated food.
Pneumocystosis is observed in the form of sporadic cases and outbreaks, usually in institutions for children of early age (hospitals, orphanages, Department for premature infants), but described isolated cases of pneumocystosis and in older children and even adults who, for example, leukemia, Hodgkin's disease and other Disease often progresses hard and gives a high percentage of mortality.
Pathological anatomy. From pneumocystosis more likely to die prematurely born malnourished children under the age of 4 months. At showdown marked acrocyanosis, frothy discharge from the nose. The mucous membrane of the larynx, trachea, and large bronchi pale, in the lumen of them - foamy content. Light increased in volume, under the pleura can be a chain of air bubbles, sometimes dotted haemorrhage. At the touch of a light fabric fleshy, the front edge of emphysematous; on the cut surface is uniform grayish-bluish, airless, separated viscous, scarce. In smears of detachable found Pneumocystis.
Diagnosis decides histological examination of the lungs, which is determined by two features: 1) interstitial pneumonia with a thickening of the alveolar walls, infiltrated lymphoid, macrophage and plasma cells; 2) the presence in the lumen of the alveoli frothy content representing of this pathogen with dark cores surrounded by pale colored shell (round or oval shape).
The structure of this pathogen is well revealed when plating method Gomory. Sometimes frothy content can be found in the alveolar walls.
The clinical picture. The incubation period of 8 to 10 days, but most of 30-40. The disease develops gradually. The child refuses the breast, easily tired, not putting on weight, frequent phenomenon of parenteral dyspepsia. Gradually develops and respiratory syndrome. Characteristic of interstitial pneumonia Triada - cyanosis, dyspnea with the sharp increased respiration up to 80-120 in 1 minute, dry, obsessive cough - there is only 2-4 weeks, i.e. in the II stage of the disease. The temperature often normal, increases only when complications.
Despite pronounced respiratory syndrome in the midst of illness, physical data remain scarce: the breath does not change a single fine basal rales tapped in paravertebral areas; some patients fine basal rales rich, but not permanent.
Percussion little changed, sometimes, a slight decline in paravertebral.
In contrast, poor physical data there is a rich and very peculiar x-ray picture, reflecting the staging process. At the very beginning of the development of respiratory syndrome find Peregrebnoe bilateral seal of low intensity. In the midst of disease detected cloud ("cotton") parts dimmable, mainly in the upper fields both lungs, interspersed with lobular areas swellings; when subpleural the location of the latter may happen to their break with the formation of dry pneumothorax. Sometimes it is possible to detect small atelectasis. Pleura and vnutritorakalnah nodes remain intact. In stage III of vozduhonosnye lung tissue is restored and foremost a seal interstitial tissue, which lasts for several weeks and even months after clinical recovery.
For pneumocystosis wavy, continues until 4-8 weeks, but death may occur earlier.
The diagnosis. Lifetime diagnosis of pneumocystosis is based on epidemiological, clinical and radiologic data, and the discovery of this pathogen in tracheal mucus taken catheter (gram stain - Weigert). Serology is a reaction of binding complement, and skin test with antigen (aqueous extract from the lungs of the victims of patients) - cannot be considered reliable diagnostic indicators. Skin test in small children often nonspecific and immunological features in children of this age, and especially in frail so low that and disease Pneumocystis pneumonia reaction of binding complement can be negative.
Treatment. When oxygen deficiency assign oxygen. This treatment is only possible in stage I, II, it does not achieve the goal and recommend a maximum stay of the patient in the fresh air. Antibiotics affect bacterial flora and, in particular, Staphylococcus, often activated when pneumocystosis. You need age-appropriate diet, rich in vitamins, as well as stimulation of the body - gamma-globulin, blood transfusion.

Fig. 1. The development cycle of Pneumocystis carinii: 1 - free specimen of the parasite; 2-4 - division of the parasite; 5-7 - stage sporogonic development.
Fig. 2. Differences in the structure: Pneumocystis carinii (1), yeast fungi (2) and Cryptococcus (3) (scheme).