What Is the Connection Between Pneumonia and Sepsis?

Streptococcus pneumoniae is a normal flora of the human nasopharynx, which can cause invasive disease when the body's immunity is reduced or a new serotype is obtained. Streptococcus pneumoniae sepsis can be secondary to Streptococcus pneumoniae pneumonia, otitis media, mastoiditis, and pharyngitis. Most of the bacteria enter the blood through the chest through the drainage lymphatic path through the thoracic duct. In otitis media and mastoiditis, Streptococcus pneumoniae can be passed through the vein Sinus into the blood, 20% to 30% of patients with Streptococcus pneumoniae pneumonia were positive for blood culture, the positive rate increased with age. Splenectomy is more common in patients, which may be related to the powerful phagocytosis of the spleen monocyte-phagocytic system and its ability to kill capsulated pneumococcus. Patients with other severe diseases (such as sickle cell anemia and immunodeficiency) are prone to streptococcus pneumoniae sepsis.

Basic Information

Visiting department

Respiratory Medicine

Common locations

blood

Common causes

Secondary to Streptococcus pneumoniae pneumonia, otitis media, mastoiditis, pharyngitis, etc.

Common symptoms

Chills, high fever, headache, general pain, nausea, vomiting, irritability, delirium, lethargy, coma, fast heart rate, weak pulse, cyanosis of lips, blood pressure, etc.

Causes of Streptococcus pneumoniae sepsis

The bacterium is Diplococcus pneumoniae. Although the nasopharynx of normal people is infected with bacteria, it usually does not cause disease, because the cilia of the tracheal mucosa and macrophages in the alveoli can remove the invading bacteria. However, when the body's defense function is reduced, the bacteria cause colonic inflammation in the local tissues through colonization and reproduction, leading to the degeneration of the lungs. If the bacteria enter the bloodstream, they cause sepsis.

Clinical manifestations of pneumococcal sepsis

The main manifestation is sepsis. Only when the whole body's immune function is severely damaged can the bacteria cause sepsis. Examples include lymphoid malignancies, liver and kidney failure, splenectomy, and human immunodeficiency virus (HIV) infection. All organs in the body can be invaded and inflamed, and pneumonia, meningitis, pericarditis, osteomyelitis, and peritonitis can occur. Patients may experience chills, high fever, headache, general pain, nausea, vomiting, irritability, delirium, lethargy, coma, and symptoms of circulatory failure, such as fast heart rate, weak pulses, cyanosis, decreased blood pressure, decreased urine output . If there are migrating lesions, such as meningitis, osteomyelitis, etc., corresponding clinical manifestations can appear.

Streptococcus pneumoniae sepsis examination

Blood image

During systemic infection, the white blood cells can increase significantly (20 ~ 30) × 10 ⁹ / L, with neutrophils accounting for 0.9. In the elderly and those with low immune function, the number of white blood cells did not increase significantly, but the classified neutrality still accounted for more than 0.8.

2. Bacteriological examination

The patient's purulent lesions (such as sputum, pus, cerebrospinal fluid) smear Gram stain to find bacteria, and bacterial culture, fever patients should still be blood culture. Obtaining the diagnosis of Streptococcus pneumoniae.

3. Cerebrospinal fluid examination

The meningitis patients' CSF showed purulent changes, the appearance was rice soup-like, the protein was usually above 1g / L, the number of white blood cells was above 500 × 10 ⁶ / L, the majority was multi-nucleus, and sugar and chloride were reduced.

4. Immunological examination

Detection of capsular polysaccharide antigen in serum and CSF by latex agglutination test or convection electrophoresis is helpful for the diagnosis of those with negative bacterial culture.

5.X-ray inspection

A chest X-ray should be performed on people with lung infections. At the beginning, only the thickening of the lung texture and local thin infiltration images were found, and the perspective was easy to be ignored. Large leaves or segmental dense patches can be seen after consolidation of the lung lobes. Transparency increases during the dissipation period. It takes 2 to 3 weeks for the shadow to completely dissipate.

Diagnosis of pneumococcal sepsis

The clinical manifestations and hemogram changes of pneumonia, meningitis, and sepsis caused by Streptococcus pneumoniae infection, the results of routine examination of cerebrospinal fluid (CSF), and chest radiographs of patients with pneumonia are not specifically different from those caused by other pyogenic bacteria. The diagnosis must be based on the results of bacteriological examination, especially the results of bacterial culture. When possible, perform bacterial cultures before antibiotic treatment.

Streptococcus pneumoniae sepsis treatment

Symptomatic treatment

For severe cough, expectorants and antitussives can be used, such as expectorant, Chuanbeilulu, compound licorice mixture, etc .; hypoxia should be used for oxygen inhalation; those with high fever can be appropriately cooled physically; meningitis patients should pay attention to the prevention and treatment of cerebral edema, available 20% mannitol solution drips intravenously; those with septic shock should actively replenish blood volume and correct acidosis.

2. Antibiotic treatment

Penicillin is still the drug of choice in China. Inpatients with pneumonia can be injected with penicillin, and the drug can be discontinued after 3 days of fever. If the effect is not good, you can use cephalosporin antibiotics. People who are allergic to penicillin can use erythromycin drugs. Meningitis requires intravenous infusion of high-dose penicillin. In severe cases, intravenous infusion of chloramphenicol can be used in combination. If the effect is not good, third-generation cephalosporins, such as ceftriaxone sodium and cefotaxime sodium, can be injected intravenously. Sepsis patients should be treated with a combination of two antibiotics, such as penicillin and cefotaxime sodium. -lactam drugs combined with macrolides can reduce the mortality rate of Streptococcus pneumoniae sepsis.