What Is the Connection Between COPD and Pneumonia?

1. Symptoms The onset of the disease is slow, and the incubation period is generally 2 to 3 weeks. About 1/3 of the patients are asymptomatic. Onset symptoms are similar to those of upper respiratory tract infections. Some cases include trachea, bronchitis, and pneumonia, some of which occur as tympanitis, and pneumonia is the most severe. In family epidemics, about 1/3 of the members develop pneumonia, about 1/2 are bronchitis, and 10% are only pharyngitis. They often have chills and fever, and their temperature is mostly 38-39 ° C, accompanied by cough, sore throat, and headache. , Fatigue, general discomfort, etc., persistent paroxysmal severe cough is its prominent manifestation, no sputum or only a small amount of mucus sputum, no hemoptysis, but occasionally blood in the sputum, pain behind the sternum and two seasons, It lasts for several weeks without shortness of breath and dyspnea; may have gastrointestinal symptoms, loss of appetite, nausea, vomiting, diarrhea, etc .; a small number of patients may have migratory arthralgia, erythema polymorpha, ulcerative stomatitis, conjunctiva Inflammation and sinusitis. Fever can last for 2 to 3 weeks. After the fever returns to normal, a cough can be left for about 6 weeks, with obvious fatigue and burnout. In a few cases, extrapulmonary complications can occur, which can involve any organ, sometimes more severe than pneumonia itself. It is easy to be ignored and misdiagnosed clinically.

Mycoplasma pneumonia in the elderly

Mycoplasma pneumonia is an acute respiratory infection associated with pneumonia caused by Mycoplasma pneumoniae. Mycoplasma pneumoniae is between virus and bacteria, can grow on cell-free medium, has no cell wall, contains RNA and DNA, generates energy through metabolism, and is often confused with the L-type of bacteria. The two colonies are similar. Mycoplasma is the pathogen of various diseases in animals. Currently, there are 8 types of human mycoplasma. Only Mycoplasma pneumoniae can cause respiratory infections. It can ferment glucose and produce hemolysin. It can completely dissolve sheep and guinea pigs within 24 to 48 hours. The red blood cells can be distinguished from other mycoplasmas. Other mycoplasmas can cause urogenital infections and generally do not invade the respiratory tract. Mycoplasma pneumoniae often causes upper respiratory tract infections without pneumonia and can also cause asymptomatic infections. Reports at home and abroad have shown that the incidence of mycoplasma pneumonia has increased significantly in recent years.

Mycoplasma pneumoniae signs in the elderly

2. Signs: nasal congestion, runny nose, pharyngeal congestion, eardrum congestion, and edema, about 15% of which is tympanitis, neck lymph nodes can be enlarged, polymorphic rash can be seen, and few cases have maculopapular rash, erythema, or cold sores. There may be no chest signs or only a few wet rales, especially in elderly patients, the signs are particularly atypical. A small amount of pleural effusion or pleural friction sounds occurred in 10% to 15% of cases.

Mycoplasma pneumonia treatment in the elderly

1. Routine treatment After the diagnosis of Mycoplasma pneumoniae pneumonia, the drug of choice is macrolide antibiotics. In the past, erythromycin was administered by multiple intravenous drips. However, due to the stimulation of the gastrointestinal tract by this drug and phlebitis that may easily cause the infusion site, it has been rarely used clinically. Many new-generation macrolide drugs are now used, which have the advantages of high tissue concentration, long half-life, stronger antibacterial effect, and less gastrointestinal reactions, such as roxithromycin 150 mg, 2 times a day, orally; clarithromycin 250 mg, 2 times / d, orally; Azithromycin 250 mg, 2 times / d, orally, or 500 mg, 1 time / d, intravenously. The course of treatment is relatively long, preferably 10 to 14 days; in severe cases, the drug dose can be increased to extend the course of disease to 21 days. The general treatment effect is good, and occasionally relapses, the treatment is still effective. For severe cough, appropriate antitussives should be given. If other bacterial infections occur, targeted antibiotic treatment should be selected based on the pathogenic examination. In some cases, when mycoplasma pneumoniae pneumonia is suspected, and it is difficult to distinguish between Legionella pneumonia or Streptococcus pneumoniae, macrolide antibacterial and treatment should be preferred.

2. Optimal plan 250ml of 5% glucose + 0.5g of azithromycin, once per day, intravenous infusion, the course of treatment is 1 to 2 weeks. Or azithromycin (Hisme) 0.2 g, once a day, orally for 3 days.

3. Rehabilitation of elderly patients, especially those with other heart, cerebrovascular diseases and other basic diseases, such as COPD, coronary heart disease, cerebrovascular disease, diabetes, etc., should pay attention to the emergence of other comorbidities while treating this disease. Such as heart failure, arrhythmia, respiratory failure, water and electrolyte disorders, malnutrition, etc., should be shot back to promote sputum. For those with thick sputum, phlegm sputum drugs and ultrasound atomization inhalation can be given. For those who are unresponsive or unconscious, a catheter can be used for suction. Pay attention to fluid replacement and electrolyte supplementation, strengthen nutrition support treatment, and also give drugs to enhance immunity, such as thymosin and other static spots. During the treatment, pay attention to observe the adverse reactions of the drugs, and also pay attention to the drug-related diarrhea, colitis, and other drug interactions. For example, the combination of macrolide drugs and aminophylline drugs should be monitored for drug concentration.

Mycoplasma pneumonia diet care for the elderly

1. Pear: Pear has the functions of nourishing lungs and clearing heat, reducing phlegm and reducing fire, clearing stomach and reducing heat, nourishing yin and promoting body fluid, nourishing kidney and invigorating deficiency, and nourishing bowel and purging. Treatment of cough and expectoration caused by lung diseases has a unique and obvious effect. The famous "pear cream" is a cough medicine made from sweet pears.

2. Litchi: Litchi has the effects of rejuvenating and quenching thirst, moistening lungs and phlegm, strengthening spleen and stomach, relieving liver and qi, and nourishing kidney yin.

3. Sugarcane: Sugarcane has the effects of nourishing the lungs, nourishing the stomach, and nourishing the kidney and regenerating fluids. It can relieve the symptoms of dry cough, night sweats and hot flashes caused by pneumonia.

4. Walnuts: Walnuts have the functions of nourishing lungs and asthma, nourishing the stomach and helping to support the stomach, moisturizing the bowels, regulating liver and blood, and nourishing the kidney and brain.

5. Apples: Apples are also good for the lungs. Eating 5 or more apples a week can improve the respiratory system and lung function. And eating an apple every day can make you less susceptible to illness. Apples contain a large number of flavonoid antioxidants called quercetin, which protect the lungs from the harmful effects of pollution and smoking. Quercetin is also found in onions, tea and red wine.

6. Honey: Modern medicine has proven that honey is effective for neurasthenia, hypertension, coronary arteriosclerosis, lung disease, etc. Taking honey regularly in the fall will not only help the recovery of pneumonia, but also prevent Qiuzao from harming the human body and play a role in moisturizing and nourishing the lungs.

Mycoplasma pneumonia preventive care in the elderly

With the aging, the physical structure and function of the human body have changed. The elderly tend to be prone to pneumonia and cause death. These changes include reduced cough reflexes, curvilinear kyphotic processes, etc., and other factors such as severe hypoxemia, Pulmonary edema, acidosis, and azotemia all increase the susceptibility to pneumonia. Changes in the defense function of the elderly include increased secretion of mucus in lung tissue, weakened ciliary movement, reduced phagocytic activity of polymorphonuclear leukocytes, and a significant lack of aging-related T cell functions, which have created opportunities for microbial invasion. In recent years, mycoplasma pneumoniae infection in the elderly has a rising trend. For the elderly with the above-mentioned risk factors, especially elderly patients with chronic heart, lung, liver, kidney and other diseases, and long-term application of hormones, immunosuppressants, advanced tumors, and patients with diabetes Health education and avoidance of contact with pneumonia patients can reduce the chance of infection. During the epidemic of Mycoplasma pneumoniae, keep indoor air circulation, regularly boil vinegar for room air disinfection, go to public places less, insist on exercising, improve immunity, and pay attention to the seasonal changes of pneumonia, especially elderly COPD patients. in this way. Once you suspect that you have mycoplasma pneumonia, you should go to the hospital for further examination in time to confirm the diagnosis early.

Pathogenic causes of mycoplasma pneumonia in the elderly

Mycoplasma pneumoniae is the smallest microorganism that is facultative anaerobic and can live independently, with a size of 200 nm. Sterile cell wall, which can grow and divide on cell-free medium, contains RNA and DNA, generates energy through metabolism, and is sensitive to antibiotics. Mycoplasma is the causative agent of various diseases in animals. At present, 8 types have been found, of which only Mycoplasma pneumoniae is definitely pathogenic to humans, mainly respiratory diseases. It grows well on agar medium with 20% horse serum and yeast. Typical dome-shaped mulberry-shaped colonies can be seen under the microscope for the first time. After several passages, it turns into a fried egg shape. Mycoplasma ferments glucose and has a hemadsorption effect, solubilizes red blood cells of guinea pigs and sheep, and has resistance to methylene blue, osmium acetate, penicillin, and the like. Finally, serum identification is required. It is transmitted by mouth and nasal secretions through the air, causing sporadic and pandemic respiratory infections, mainly in winter. Respiratory tract infections include pharyngitis and bronchitis, with a few involving the lungs. Mycoplasma pneumonia accounts for more than 1/3 of nonbacterial pneumonia, or 10% of various pneumonia.

Diagnosis of Mycoplasma pneumonia in the elderly

The disease should be distinguished from viral pneumonia and Legionella pneumonia. Peripheral blood eosinophils are slightly normal and can be distinguished from eosinophilia.

Mycoplasma pneumonia examination method in the elderly

Laboratory inspection:

Examination of blood during the acute phase showed that the total number of white blood cells was normal or slightly elevated, mainly lymphocytes; occasional leukemia-like reactions or leukocytopenia. About 2/3 of the cases the erythrocyte sedimentation rate increased (> 40mm / h); urine tests were normal or there was a small amount of proteinuria; liver function tests may also have elevated aminotransferases; pleural effusion was serous or serous blood, protein 32 49g / L. Mycoplasma was isolated in the cytosol.

1. Etiological examination can be used for the isolation and culture of Mycoplasma pneumoniae specimens from pharyngeal secretions (laryngeal swabs, pharyngeal eluates), sputum bronchoalveolar lavage fluid, etc., after the antibody appears, the culture can still be positive. Meningoencephalitis, pericarditis, and bullous tympanitis can be cultured with cerebrospinal fluid, pericardial effusion, or middle ear secretions, respectively. Mycoplasma can also be isolated. Etiological examination is reliable and specific, but it is time-consuming, labor-intensive, difficult to promote and apply, and does not help early diagnosis of the disease.

2. Serological examination is the most commonly used method for the diagnosis of Mycoplasma infection. Two weeks after the onset, about two-thirds of the patients have a positive cold set test, and the titer titer is greater than 1:32, especially when the titer gradually increases. Diagnostic value. This method has been used in clinical practice for many years. Since the condensation antibody (IgM antibody against red blood cell I antigen) appears earlier (the first weekend of onset), the positive rate is high (50% to 75%), and the decline is rapid ( Rapid decline after 4 weeks), so it is still a simple, fast and practical early diagnosis method, but it must be judged in conjunction with clinical and other serological tests, such as complement binding test, indirect hemagglutination test, indirect fluorescence Antibody determination, enzyme-linked immunosorbent assay, and growth inhibition test, etc., because all antigens are prepared from lipid extracts of Mycoplasma pneumoniae, so it has specific diagnostic value, of which the enzyme-linked immunosorbent assay is the most sensitive, which is helpful to determine the recent infection ; Indirect fluorescent antibody determination IgG antibody appears late and lasts a long time, suitable for epidemiological investigation; indirect hemagglutination IgM antibody appears early, disappears quickly, and is more practical; growth inhibition test The specificity of the test is strong, but the test period is long, and the judgment of the effect after treatment with effective drugs such as erythromycin and azithromycin; about half of the patients are positive for the streptococcus MG agglutination test, which is a traditional method for the diagnosis of Mycoplasma pneumoniae infection, but its The sensitivity and specificity are not ideal; the complement binding test is not as sensitive and specific as other serological tests, but it is widely used because of the simplicity of the method.

3. Antigen detection is used for early diagnosis. Common methods are: solid phase enzyme immunoassay technique Elisa method, polyclonal antibody intermittent immunofluorescence assay, monoclonal antibody immunoblot method, nucleic acid hybridization technology and polymerase chain reaction technology, etc., which can be directly The diagnosis is established by detecting Mycoplasma pneumoniae antigen from patients' nasopharyngeal secretions or sputum specimens. This method is fast and simple, and meets clinical requirements, but its sensitivity, specificity and stability need to be further improved. Nucleic acid hybridization technology has been made into a kit, which has the advantages of high efficiency, specificity and sensitivity, and is easy to popularize.

At present, immunofluorescence method is used to make sputum and pharyngeal secretion smears, which can be used to observe Mycoplasma directly under microscope. The method is simple and fast, and the diagnosis can be made in 1 to 2 hours.

Other auxiliary checks:

Chest X-ray manifestations: The basic pathological manifestations of mycoplasma pneumonia are bronchi and bronchiolitis and interstitial pneumonia. The chest radiographs are diverse and non-characteristic. They may have enhanced lung texture and multiple irregular, low-density, uniform patch-like shadows distributed along the texture. More than half of them are multi-lobed; nearly half of them are violated and large In most cases, the lower lobe is involved; the lesions can be isolated in the surrounding areas in isolation, but most of them spread from the hilum to the lung field and gradually become a fan-shaped shadow; the lungs usually have one or more spots. Lesion absorption is slower, up to 4 weeks in the elderly, and unilateral transient pleural effusion may occur in about 1/3 of the patients.

Mycoplasma pneumonia complications in the elderly

Extrapulmonary complications are as follows: Nervous system: Central and peripheral neuropathy can occur 4 weeks after infection. It manifests aseptic meningitis (usually short-lived), meningoencephalitis, and polyneuritis. In severe cases, there may be transversal myelitis, seizures, and even mental disorders, but rarely cause death. Blood system: Occurred 2 to 3 weeks after the onset of disease, mainly autoimmune hemolytic anemia, thrombocytopenic purpura, and diffuse intravascular coagulation. Cardiovascular system: those with mild symptoms only show abnormal electrocardiograms; those with severe symptoms may have pericardial effusion, cardiac insufficiency, and arrhythmias. Motion system: Specific myalgia and arthralgia can occur within 2 weeks after the onset of disease, mainly large and medium joints, which have the characteristics of multiple joints, mobility, and slow remission, and polymorphic erythema can be seen. Other: gastrointestinal symptoms: loss of appetite, nausea, vomiting, diarrhea, etc .; ulcerative stomatitis; conjunctivitis and sinusitis. For elderly patients, there can be a variety of atypical manifestations. Fever is generally low fever, high fever and chills are rare, and the temperature of a considerable number of cases is not high. The symptoms are mainly weakness, loss of consciousness and loss of appetite, often accompanied by electrolyte disorders. , Especially those with poor diet, common hypokalemia, hyponatremia.

Mycoplasma pneumonia prognosis in the elderly

The condition of the elderly is diverse, and delays in treatment can be life-threatening.

Pathogenesis of Mycoplasma pneumonia in the elderly

Mycoplasma pneumoniae can be found in respiratory secretions 2 to 3 days before the onset of mycoplasmal pneumonia until weeks of healing. After Mycoplasma pneumoniae invades into the alveoli, it usually exists between the ciliated epithelium and does not invade the alveoli. Through the neuraminic acid receptor site on the cell membrane, it is adsorbed on the surface of the host's respiratory epithelial cells. By generating peroxides, it inhibits ciliary activity and destroys epithelium Cell, and submucosal cell infiltration. The pathogenesis of intrapulmonary and extrapulmonary organ lesions caused by Mycoplasma pneumoniae is not fully understood. Some people believe that the pathogenicity of Mycoplasma pneumoniae may be related to patients' allergic reactions to pathogens and their metabolites. It is a host's hyperimmune response to infection. reaction. The occurrence of extrapulmonary organ lesions may be related to the immune response, the production of immune complexes and autoantibodies after infection. However, it has also been reported that mycoplasma pneumoniae can directly invade the central nervous system and heart through lymph and blood flow, thereby causing meningitis and myocardial pericarditis. Pulmonary lesions are flaky or fused bronchitis, interstitial pneumonia, bronchial pneumonia, alveoli can contain a small amount of exudate and focal atelectasis can occur. Alveolar walls and septum are often infiltrated with neutrophils and monocytes, and have mucosal hyperemia, swelling of epithelial cells, and cytoplasmic cavities. The pleura may have fibrin exudative inflammation. In central nervous system, meningitis, encephalitis, and myelitis can be seen. Myocardial and pericardial inflammation can be seen in patients with concurrent heart disease. An autopsy reports embolism after multiple intravascular thrombosis.