What Is a Klebsiella Infection?

Keleiboshijun ganran

Klebsiella infection

Introduction to Klebsiella infection

Keleiboshijun ganran

Klebsiella infection

Klebsiella

infection due to Klebsiella

Klebsiella infection. Klebsiella is a gram-negative bacillus of the genus Enterobacteriaceae, which belongs to Klebsiella pneumoniae (also known as pneumoniae), Klebsiella stinkii, and scleroderma R. brevis is closely related to humans. Among them, Klebsiella pneumoniae is the most important, and the diseases it causes account for more than 95% of Klebsiella infections. It is also believed that the above three species are all biochemical types of Klebsiella aerogenes. Klebsiella pneumoniae is an important pathogen of respiratory infections and often causes severe pneumonia. It can also cause serious diseases such as urinary tract infections, biliary tract infections, sepsis, and purulent meningitis. Infections mostly occur in debilitated patients who are hospitalized. Pathogens are often inhaled from the upper respiratory tract, or invaded the human body through contaminated respirators, nebulizers or various catheters. The hands of medical staff also play an important role in cross infection. Pneumoniae has become one of the important pathogens of nosocomial infections, and it occupies the first place in nosocomial infections in some countries. A combination of cephalosporins and aminoglycoside antibiotics such as gentamicin can control Klebsiella infection. Because bacteria are often resistant to many antibiotics, the prognosis of this disease is poor and the mortality rate is high (up to 50% in severe cases).

Klebsiella infection etiology

Klebsiella was first described by German pathologist E. Friedlander in 1882, so it was formerly known as Friedlander. It belongs to the family Enterobacteriaceae and is Gram-negative. Single or short chain, not moving, with obvious capsules. Klebsiella is highly resistant to the outside world and is prone to resistance to most antibiotics. Like other bacteria in the Enterobacteriaceae family, they have O and K antigens (ie, bacterial antigens and capsule antigens). Klebsiella can be isolated in the normal flora of the respiratory and intestinal tract of healthy people, in natural water and in cereals. Under normal circumstances, Klebsiella is not pathogenic, and the onset is related to the host's deficiency in defense function and its inducing factors.

Klebsiella is a Gram-negative bacterium. There are mainly K. peneumoniae, K. ozaenae, and K. rhinoscleromatis. Klebsiella pneumoniae is highly pathogenic to humans and is one of the important conditional pathogens and iatrogenic infections.

Biological characteristics of Klebsiella infection

It is a short and thick bacillus, with a size of 0.5 0.8 × 1 2um, which is arranged individually, in double or short chains. No spores, no flagella, yes

Klebsiella Thicker capsules, mostly pili. The nutritional requirements are not high. Large off-white mucus colonies are formed on ordinary agar medium, which can be picked by inoculating loops and easily drawn into filaments, which is helpful for identification. It can ferment lactose on enterobacteria selective media and present colored colonies.

With O antigen and K antigen, the latter is used for typing. Utilizing the capsule swelling test, the K antigen can be type 82. Klebsiella pneumoniae types 3 and 12; Klebsiella pneumoniae mainly belongs to type 4, and a small number is type 5 or 6; K. rhinosclerosis generally belongs to type 3, but not all types 3 are the bacteria.

The bacteria of this genus were killed at 55 ° C for 30 minutes. It can survive on the medium for weeks to months.

Klebsiella infection

(A) Klebsiella pneumoniae

In 1882, Friedlander was first isolated from the sputum of lobar pneumonia, so it was also called Friedlander bacillus, referred to as pneumonia. The bacteria produce extracellular toxicity complex (ETC), the main components of which are capsular polysaccharide (63%), lipopolysaccharide (30%) and a small amount of protein (7%). Some strains also produce LT and ST enterotoxins. Capsules are also associated with pathogenicity.

This bacterium exists in the human intestine and respiratory tract. Can cause bronchitis, pneumonia, urinary and trauma infections, and even sepsis, meningitis, peritonitis and so on.

(Two) Klebsiella nasty

Referred to as Rhinobacillus, it causes chronic atrophic rhinitis with malodor, as well as sepsis and urinary tract infection.

Abbreviated as Rhizoctonia sclerotiorum, it causes chronic granulomatous lesions, invades the nasopharynx, and causes tissue necrosis.

Susceptibility factors to Klebsiella infection

Factors that increase susceptibility are:

Various chronic diseases that reduce immune function, such as chronic bronchitis, cirrhosis, diabetes and malignant tumors.

Application of adrenocortical hormone and other immunosuppressants.

The use of broad-spectrum antibiotics caused changes in the normal flora.

Various instrument operations and traumatic diagnosis and treatment techniques (such as various catheters, tracheotomy, etc., creating conditions for bacterial invasion).

Pathological changes of Klebsiella infection

Pneumococcal pneumonia accounts for 1 to 2% of bacterial pneumonia, and its pathological changes are similar to those of Streptococcus pneumoniae pneumonia, resulting in consolidation of the lung lobe or segment (alveoli are filled with inflammatory exudates). The difference is that P. pneumoniae grows fast, is destructive, and the exudate is thick and heavy, containing a large amount of

Drugs for Klebsiella infection Pneumoniae with capsules; often cause necrosis, liquefaction, and pleural involvement of the alveolar wall and lung tissue, so the incidence of pulmonary abscesses and empyema is higher than that of Streptococcus pneumoniae pneumonia. Clinical features are sudden onset, with chills, high fever, cough, expectoration, and severe chest pain, and even symptoms of severe poisoning such as disturbance of consciousness, restlessness, and slang. The sputum volume is yellow-green pus and sputum, often bloody. About 25 to 50% of the cases are typical brown-red or red grape sauce-like jelly, and the sputum is extremely sticky and difficult to come out. The disease progresses rapidly. If left untreated, the lesions can expand from one lobe to another, and cyanosis and dyspnea will soon appear. There may also be digestive symptoms such as jaundice and vomiting. The lungs may have only wet sounds or signs of consolidation (reduced respiratory motion on the ipsilateral side, dullness on percussion, increased speech tremor, and hearing tubular sounds). Increased white blood cells. X-ray chest radiographs often show large shadows of the upper right lung with uneven shadows, irregular translucent areas, and interlobular fissures. A few cases show bronchial pneumonia. Pulmonary fibrosis may occur after treatment recovery. Recurrence is common. Abscesses can develop quickly within half of the patients within 4 days of onset, and empyema occurs in about a quarter of cases. Therefore, if the disease is not treated in time, the prognosis is poor.

Clinical manifestations of Klebsiella infection

Klebsiella extrapulmonary infections are not uncommon. It is second only to E. coli in urinary tract infection, and its clinical manifestations and pathogenesis are similar to E. coli infection. There are urinary tract irritation signs such as frequent urination, urgency, and dysuria, and urine culture is positive. It is more common in patients with preexisting inclusion disorders or poor urination (prostatic hypertrophy, urethral stricture, bladder ureteral reflux, etc.), and retention of catheterization and urinary tract device tests are often incentives. Krebs

Drugs for Klebsiella infection Bacterial septicemia occurs frequently in patients with other diseases, and most often occur in hospitalized patients. The condition is dangerous, with symptoms of endotoxemia such as high fever, chills, and sweating. Symptoms of septic shock can occur, such as cold limbs, fine pulse, skin flowering, and decreased blood pressure. The incidence of shock is sometimes as high as 63%. It can also be accompanied by changes in mind, bleeding from the skin and digestive tract, and bleeding from venipuncture sites. About 13% of the cases were complicated with migrating lesions of heart, lung, kidney, and brain. The mortality rate was 37-50%. Most of the deaths were uncontrolled infection or severe toxemia. Klebsiella meningitis has the symptoms and signs of general purulent meningitis: high fever, headache, unconsciousness and stiff neck, and purulent changes in cerebrospinal fluid (significant increase in white blood cell count and protein, low sugar).

Klebsiella infection diagnostic protocol

Acute pneumonia with severe symptoms of poisoning and brown-red jelly sputum. A large number of gram-negative bacilli with capsular sputum or 2 or more sputum cultures to obtain pneumococcus pneumonia can be diagnosed. The diagnosis of sepsis depends on the detection of pneumococcus in the blood, and it should be taken out for culture before antibacterial treatment or during chills and high fever. The discovery or culture of pus or secretions from the affected tissues and organs can confirm the diagnosis of extrapulmonary infections.

Klebsiella infection treatment options

The choice of antibiotics should be based on the severity of the clinical infection. Most pneumococci are sensitive to aminoglycoside antibiotics such as gentamicin, cephalosporins such as cefazolin and cefuroxime (celixin), and oxygen piperazine penicillin. Chloramphenicol and polymyxin are also sensitive. Certain effect. In severe cases, the second or third generation of cephalosporin + gentamicin or amikacin or cephalosporin + oxypiperazine penicillin is recommended.

Purulent meningitis Combination therapy, the course of treatment is at least 2 weeks. If there is empyema, purulent meningitis, etc., puncture and pus should be removed in time, and appropriate antibiotics should be applied locally on the basis of systemic antibacterial treatment. In addition, basic diseases and complications must be actively treated to eliminate factors that can weaken the body's immune function. Strengthening supportive therapies, such as supplying sufficient heat, maintaining water, and electrolytic energy balance, cannot be ignored.

Identification of Klebsiella infection

Klebsiella is distributed in the aquatic environment and also in the intestines of humans and animals. It can cause respiratory, urogenital infections, trauma, sepsis, and diarrhea. Recent research in the medical community has found that because this bacteria is very susceptible to mutation, so The drug resistance is relatively strong, and its harmfulness to human health is also increasing year by year. This paper uses a conventional test method. Based on the basic biological characteristics of Klebsiella, six patients' sputum samples from the outpatient department of Guiyang Fifth People's Hospital in Guizhou Province were combined with MR and VP. Methods The 6 sputum samples were tested.

Therapeutic medication The results showed that the six sputum samples were all negative. Serological tests showed that the six sputum samples were not infected with Klebsiella. Their infection may be caused by other bacteria. It is concluded from the test results that the test results of this method are ideal, the detection degree is good, the practicability is also strong, the test conditions are not high, and the test can be completed under general test conditions.

Klebsiella infection in fox pneumonia Klebsiella

Basic conditions and clinical symptoms

This farm introduced 10 groups of foxes, a total of 50 foxes, became ill 3 days later, and began to show only depression and loss of appetite. The owner immediately used penicillin and streptomycin for injection treatment, but the effect was not obvious. Three died after 2 days, and other conditions were gradually worsening. The clinical manifestations of the sick animals were disturbed by fur, increased body temperature, pale conjunctiva, shallow breathing, occasional cough, nasal discharge, and unstable standing. ?

Postmortem changes

The dead fox necropsy mainly showed congestion and edema of upper respiratory tract mucosa, pulmonary hemorrhage, congestion, and emphysema; the necropsy of chronic disease animals mainly showed purulent pleurisy, inflammatory secretions in the chest cavity, cervical lymph nodes, kidney, liver abscess, and lung "granulation "Swollen" consolidation, pulmonary insufficiency, and small gray-white nodules on the surface. Bacterial isolation

Liver tissue and thoracic cavity secretions were inoculated with common nutrient agar, SS agar, blood agar, broth and anaerobic broth, respectively, at 37 ° C.

fox After 24 hours of incubation, gray-white sticky colonies grew on the common nutrient agar and blood agar. They were picked by inoculating loops and easily drawn into filaments; they did not grow on SS; both broth and anaerobic broth were cloudy and produced a large amount of gas. The smears of the cultures on the plate and in the broth were Gram-stained as negative Brevibacillus, blunt at both ends, and densely stained, in a single, paired, and short-chain arrangement.

Biochemical test

(1) Take white, thick, smooth single colonies growing on a plate and inoculate the trisaccharide iron inclined plane. As a result, the inclined plane and the bottom layer produce acid, and the bottom layer produces gas without generating hydrogen sulfide. (2) The purely cultured bacteria were measured by the ATBExpression automatic bacteria identification analyzer, and the ID32GN biochemical identification strip was used. As a result, the bacteria was a Klebsiella pneumoniae subspecies.

Animal experiment

Five mice of about 15 g were inoculated intraperitoneally with 0.2 ml of broth culture solution of pure culture of the bacteria, all died within 24 hours, and the bacteria were isolated from the blood and internal organs.

drug allergy testing

According to the conventional paper method. High-sensitivity drugs include cephalexin, kanamycin, neomycin, and gentamicin; Chinese-sensitivity drugs include streptomycin, panterin, and doxycycline; insensitive drugs include sulfadiazine, acetylspiramycin, and ampicillin And amoxicillin. ?

Treatment of Eliminate foxes with particularly serious illness and no therapeutic significance; use cephalexin infusion and neomycin dressing to reduce the illness; treat symptomatic treatment of sick animals with low food, fever, and dyspnea; strengthen the environmental hygiene of the fox house, and use Peracetic acid is used for disinfection of the environment and animals. Strengthen feed management. The fox house must be sunny, ventilated and warm to prevent cold and thief wind. After 10 days of treatment, the condition was brought under control and the fox population returned to normal. ?

Summary and discussion (1) According to the incidence, clinical symptoms, and post-mortem changes, combined with the isolation and identification of bacteria and animal experiments, it was confirmed that the disease was caused by Klebsiella pneumoniae infection.

(2) Klebsiella pneumoniae is widely distributed in nature such as soil, water, agricultural products and forest products. It is also common in the intestines and respiratory tracts of humans and animals. It is a typical condition pathogen and is often found in animal resistance. A fulminant epidemic when falling. The outbreak of Klebsiella pneumoniae fox pneumonia in this farm was caused by the fox being stressed during transportation, the resistance decreased, and the bacteria in the body multiplying. In addition, the lack of animal farming experience and the lack of introduction of The fox has strengthened feeding management and drug prevention, thereby aggravating the fox's condition.

(3) Although China s aquaculture industry, especially the economic animal breeding industry, has developed rapidly in recent years, the management level of farmers has not been improved accordingly. Regardless of the hardware or software aspects of the farm, there is no standardized management. It is usually disease-free and immunized. If there is any disease, it is necessary to seek medical treatment and treatment. In recent years, due to changes in infection factors, the bacterial spectrum of human and animal infections has also changed greatly. The general trend is that Gram-positive cocci infections are gradually decreasing, while Gram-negative bacteria infections are increasing. In particular, some of the less virulent opportunities cause a greater increase in pathogenic bacteria. In particular, reports of human and animal diseases caused by Klebsiella are increasing rapidly, such as enteritis in rabbits, pneumonia, diarrhea in chickens, and infectivity in sheep. Stomatitis, diarrhea and hepatitis from pandas, swine diarrhea, mink pneumonia and guinea pig pneumonia. In human medicine, the infection caused by Klebsiella has risen to second only to Pseudomonas aeruginosa, ranking second in the infection of Gram-negative bacteria, with a mortality rate of up to 60%. People with Klebsiella pneumonia are more severe than general pneumonia, and are ineffective against penicillin, the preferred drug commonly used for general pneumonia. Therefore, with the changes of the environment in recent years, Klebsiella, as a pathogen of zoonotic diseases, should be paid enough attention by relevant departments.