What Is an Immunization Record Card?

Although ICH has increased susceptibility to various pathogenic microorganism infections, there are significant differences in the distribution of pathogens in different types of immunocompromised infections. Pulmonary infections in patients with cellular immune impairment are predominantly intracellular parasites, such as Listeria, Nocardia, Salmonella other than typhoid, Mycobacterium, Legionella, and fungi, viruses (mainly herpes viruses including cytomegalovirus) ), Parasites (pneumocystis carinii, toxoplasma, trichomes).

Immune damage

In the past one or two decades, with the increase in the incidence of tumors and the advancement of treatment, the improvement of the diagnosis and treatment of autoimmune and other immune-related diseases, the breakthrough and development of organ transplantation, especially the HIV / AIDS epidemic, and immunocompromised host. (ICH) continues to increase and accumulate, becoming a huge global challenge. Infection is the most important factor affecting the course and prognosis of ICH, and the lung is the main target organ for infection. There are still many problems in the diagnosis and treatment of ICH pulmonary infections, which require in-depth research. On the other hand, if the existing research results and technologies can be promoted and fully utilized, it is still possible to make clear diagnosis and effective treatment for most patients in the clinic and improve the prognosis.

Affected area: whole body
Related diseases: Pneumonia Bacterial Pneumonia Leukemia Typhoid Fever Renal Transplantation Lymphoma Septicemia Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome Digestive System Acquired Acquired Immunodeficiency Syndrome Cardiovascular Damage Acquired Immunodeficiency Syndrome Related Lymphoma Carcinoma Human immunodeficiency virus infectious kidney damage caused by sporeworm pneumonia human immunodeficiency virus

Related symptoms: Atelectasis lung infection dry cough high fever respiratory failure cough sputum lymphadenopathy immune damage chest pain
Affiliated Department: Rheumatology and Immunology
Related inspections: Mixed lymphocyte culture test cyclic guanosine phosphate lung perfusion imaging lung ventilation imaging lung biopsy

Humoral immunodeficiency includes immunoglobulin (Ig) deficiency or deficiency, decreased complement, and post-splenectomy. The main pathogens of lung infection are Streptococcus pneumoniae and Haemophilus influenzae. Neutrophil deficiency. Especially when it is below 500 / mm3, Pseudomonas aeruginosa is the most common pathogen, followed by E. coli, Klebsiella, Serratia, Aeromonas and other G-bacteria. Fungi also More common. If the barrier is damaged and the defense mechanism is damaged, the infection is mostly Staphylococcus, Pseudomonas aeruginosa, and colonizing bacteria in adjacent parts.

However, the epidemiology of ICH lung infection is also restricted by many other factors. For example, cellular immunosuppression is also the main cause. The distribution of pathogens for different causes or basic diseases and different stages of immune impairment are also very different. Regarding bacterial pneumonia after solid organ transplantation, the incidence of combined heart-lung transplantation was the highest (22.2%), followed by liver transplantation (16.7%), single heart transplantation was again (5.2%), and kidney transplantation was the lowest (1.5%). Generally speaking, in the early stage of transplantation, bacterial pneumonia is mostly a series of highly virulent pathogenic bacteria, such as G-bacilli, Streptococcus pneumoniae, and Staphylococcus aureus, which account for more than 80%. Pneumonia within 3 to 4 weeks after surgery is rarely an opportunistic pathogen. After 6 months, if no additional risk factors such as rejection require intensive immunosuppressive therapy, fatal pneumonia and other serious infections are relatively rare, and the pathogen is similar to the community infection of the general population. Solid organ transplant recipient cytomegalovirus (CMV) infection is more common in the first 1 to 4 months after operation, and the peak of pneumonia is in the 4th month. Pneumocystis carinii pneumonia (PCP) mostly occurs in the 2 to 6 months after operation. See less than 6 weeks; fungal infections are mostly 2 to 3 weeks after surgery, but liver transplant recipients can be as early as 1 week. Unlike solid organ transplants, bone follows the early stages of transplantation (January = infection is mainly sepsis, and lung infections are relatively rare.

G + and G-bacteria and Candida albicans are the main pathogens. In recent years, coagulase-negative staphylococci have increased. In the middle period (January to March), although bacterial and fungal infections still occur, CMV pneumonia is the most common, followed by PCP. In the later period (March), herpes viruses other than CMV are the most common, but rarely invade the internal organs; the lungs Infection is still mainly bacterial, especially Streptococcus pneumoniae and Staphylococcus aureus. It is believed that humoral immunodeficiency in the later stage of transplantation is mostly systemic due to malignant tumors such as leukemia and lymphoma, and lung infections are also common. But in leukemia patients, it is inferior to perineal infection. Leukemias and lymphomas that have not been treated with chemotherapy have a certain correlation with the type of immune damage. For example, granulocytic leukemia is prone to pyogenic infection, while lymphoma is susceptible to tuberculosis and fungal infection. However, this correlation has mostly disappeared in patients receiving chemotherapy. More than 1/3 of patients with granulocytopenia before chemotherapy are local infections of sensitive bacteria; if they have received multiple antibiotics, they may be resistant to Pseudomonas aeruginosa, Klebsiella pneumoniae, and fungi. The underlying disease is very serious. Even if antibiotics have not been used, most of them are resistant to bacteria. Sensitive bacteria, such as staphylococcus and E. coli, are more common in patients receiving chemotherapy in the initial induction stage; due to repeated application of antibiotics, subsequent infections are mostly resistant to G-bacteria and fungi. The good effect of hormones on lymphocytic leukemia and lymphoma will reduce the risk of infection, but long-term application of hormones in the intensive phase can cause PCP, fungi and other opportunistic infections. Failure to achieve remission or disease recurrence, continued chemotherapy under low white blood cell count conditions can easily lead to drug-resistant G-bacteria and fungal sepsis and pneumonia.

In general, bacteria are predominant in both systemic and local infections, but the proportion of special pathogens such as fungi is increasing in lung infections. In autoimmune diseases such as systemic lupus erythematosus, G + bacteria are more common if infection occurs in inactive patients, and G + bacillus infection is more common in active patients that involve more than 2 organs; when hormones and cyclophosphamide treatment further aggravate immunity When inhibited, infections by opportunistic pathogens such as Aspergillus, Nocardia, Cryptococcus neoformans, Pneumocystis carinii, and CMV increase. It should be emphasized that in China, the infection rate of tuberculosis is high, and it is quite common for patients with immunosuppressed TB to cause and re-ignite for any reason.

The onset is mostly hidden and difficult to detect. However, some patients have a sudden onset of illness, which has an violent course, rapidly progressing to the extreme, and even respiratory failure.

Fever is very common, and sometimes patients continue to receive hormone therapy, which is not enough to calm down. Although G-bacillus pneumonia has high fever, it rarely trembles. This is considered a rather characteristic symptom in immunocompetent G-bacillus pneumonia.

Cough and sputum are relatively rare. According to the observation of G-bacteria pneumonia in tumor patients receiving intensive chemotherapy, the incidence of cough symptoms is only 41%, mostly dry cough, and less than 1/5 of sputum. Chest pain is also uncommon.

The lesions are mostly bilateral. Signs and signs of consolidation on X-rays are rare, only about 50%. Especially in patients with agranulocytosis, the pulmonary inflammation is mild, and atelectasis can be an early or only sign of infection. With the recovery of granulocytes, the inflammatory response intensified, and only X-ray lesions increased.

Even in the same cell immune damage, the PCP performance in AIDS and non-AIDS immunocompromised patients can be very different. Compared with the latter, the former has an onset of latent disease and a slow response to treatment, and has a large number of worms. The diagnosis of sputum guidance is easier to find. The clinical treatment effect is not related to the extermination of worms, and the recurrence rate is high. The incidence of allergic reactions is high in the application of SMZco, while the side effects of pentamidine are relatively small.

The inflammatory response of fungal infection is usually more than that of bacterial infection.

As weak, especially in ICH. If the pulmonary symptoms of invasive pulmonary aspergillosis are very mild, the first manifestation is usually the migration of brain or other organs. ICH complicating pulmonary tuberculosis is also significantly different from non-ICH, such as more dissemination, no significant difference in leaf segments in the distribution of lung focus, accompanied by mediastinal / hilar lymphadenopathy and more pleurisy, and a high probability of complication with other infections.

Due to the fact that ICH infections are more severe, the empirical antibacterial treatment should be started immediately on the basis of making an estimation of the pathogenic diagnosis by referring to clinical and pathogenic epidemiological data, and on the premise of retaining various test specimens, especially pathogenic specimens. 48 ~ 72h if no effect is seen, a special diagnostic test is needed. Fiberoptic bronchoscopy is most useful; if the lesion is localized and close to the pleura, percutaneous puncture can also be used; in some cases, a thoracotomy biopsy is also necessary, especially diffuse Lesions. If the exact pathogen diagnosis cannot be determined, after more aggressive antibacterial treatment and comprehensive and careful re-evaluation, treatment with special pathogens (Pneumocystis carinii, fungi, tuberculosis, etc.) can be changed. Empiric treatment should generally target a single pathogen to avoid confusing diagnosis.

As a microbiological phenomenon, pneumonia is not fundamentally different from those with sound immune mechanisms. However, the suppression of the host's immune inflammatory response can significantly change the clinical and X-ray manifestations of lung infections, while hormones and other immunosuppressive drugs can also interfere or mask the symptoms and clinical course of the infection. In summary, ICH pneumonia has the following characteristics: The onset is mostly hidden and difficult to detect. However, some patients have a sudden onset of illness, which has an violent course, rapidly progressing to the extreme, and even respiratory failure. Fever is very common, and sometimes patients continue to receive hormone therapy, which is not enough to calm down. Although G-bacillus pneumonia has high fever, it rarely trembles. This is considered a rather characteristic symptom in immunocompetent G-bacillus pneumonia. Cough and sputum are relatively rare. According to the observation of G-bacteria pneumonia in tumor patients receiving intensive chemotherapy, the incidence of cough symptoms is only 41%, mostly dry cough, and less than 1/5 of sputum. Chest pain is also uncommon. The lesions are mostly bilateral. Signs and signs of consolidation on X-rays are rare, only about 50%. Especially in patients with agranulocytosis, the pulmonary inflammation is mild, and atelectasis can be an early or only sign of infection. With the recovery of granulocytes, the inflammatory response intensified, and only X-ray lesions increased. Even in the same cell immune damage, the PCP performance in AIDS and non-AIDS immunocompromised patients can be very different. Compared with the latter, the former has an onset of latent disease and a slow response to treatment, and has a large number of worms. The clinical treatment effect is not related to the extermination of worms, and the recurrence rate is high. The incidence of allergic reactions is high in the application of SMZco, while the side effects of pentamidine are relatively small. The inflammatory response of fungal infection is usually more than that of bacterial infection.

Avoid the cause of the cause, cleanse yourself. At the same time improve immunity, here are six ways to improve immunity:

First, sleep is closely related to human immunity. Well-known immunologists have found through self-sleep tests that good sleep can significantly increase the number of two lymphocytes in the body. Studies by medical experts have shown that during sleep, the body produces a sleep factor called muramic acid, which promotes the increase of white blood cells, active macrophages, and enhanced liver detoxification functions, thereby eliminating invading bacteria and viruses.

Second, maintaining an optimistic mood An optimistic attitude can maintain the human body in an optimal state, especially in today's society, people face great pressure, and huge psychological pressure will lead to an increase in hormone components that have a suppressive effect on the human immune system, so Vulnerable to colds or other diseases.

3. Limit drinking alcohol. Do not drink less than 100 ml of low-grade white wine, 250 ml of yellow wine, or more than 1 bottle of beer, because alcohol has a negative impact on every part of the human body. Even if drinking wine can lower cholesterol, you should limit one glass a day. Excessive drinking will cause great damage to blood and heart organs.

4. Three studies conducted by sports experts indicate that after 30 to 45 minutes of exercise a day, 5 days a week, for 12 weeks, the number of immune cells will increase and the resistance will also increase. As long as your heart rate is faster for exercise, walking after dinner is ideal.

Fifth, vitamin supplements appropriate daily vitamins and minerals. Experts point out that the body's weapons against external aggression, including interferon and the number and vitality of various types of immune cells, are related to vitamins and minerals.

Six, research and use of micro-ecological preparations to improve immunity in the body have been used for a long time. Studies have shown that beneficial bacteria represented by intestinal bifidobacteria and lactobacillus have broad-spectrum immunogenicity, can stimulate the division and reproduction of lymphocytes responsible for human immunity, and can also mobilize the non-specific immune system. Various pathogenic foreign microorganisms, including viruses, bacteria, chlamydia, etc., produce a variety of antibodies to improve the human immune system. For healthy people, it may be better to eat food and eat more lactic acid bacteria beverages; and healthy marginalized people can use micro-ecological preparations to adjust the micro-ecological balance in the body. Foods that improve immunity.

What Is an Immunization Record Card?

Immune damage

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