Pseudomonas aeruginosa infection in the diagnosis and treatment

• Author: admin
• Filed under: Virus
• Date: Nov 30,2008

Pseudomonas aeruginosa (P.pseudomallei) for Gram-negative, concentrated at both ends into Brevibacterium, present in the soil, mostly in Southeast Asia and Australia, in the near future in China also reported a number of cases. Human infection due to skin damage caused by contaminated soil, the soil-related diseases (soil-related di-sease) called. Pseudomonas aeruginosa (P.pseudomallei) for Gram-negative, concentrated at both ends into Brevibacterium, present in the soil, mostly in Southeast Asia and Australia, in the near future in China also reported a number of cases. Human infection due to skin damage caused by contaminated soil, the soil-related diseases (soil-related di-sease) called. Clinical infection caused by bacteria is very dynamic and widespread resistance to commonly used antibiotics, cause of misdiagnosis, causing serious consequences. The cases in our hospital the following report.

Clinical data

First, general information

In June 1995 to June 1998, the hospital confirmed a total of 16 cases of melioidosis. 12 cases of male, 4 female, age 33 to 70 years old, of which 33 to 50-year-old in 14 cases (87.5 percent). 14 cases of professional farmers. 8 patients died (50%).

Second, the clinical

16 cases of patients with clinical manifestations of infection for the most part, for systemic infection, can also make use of local infection.

Third, the laboratory

(A) Identification of Pseudomonas aeruginosa 1. Cultivate characteristics: blood in the plate after a 24-hour training was a small colony, 48 hours after the colony to increase the size of the middle, and sallow, like the wheel-like appearance or chrysanthemum-like. Around the colony was semi-state hemolysis. In liquid culture, as the turbidity in the early growth of bacteria after the formation of membrane folds. MacConkey the plate to break down lactose red colony; SS in the flat on the growth of non-performing; with the 2% and 3% NaCl nutrient agar plate is not growing. All of the growth plate colony were strong smell. Bacterial form of gram-negative, at both ends of Brevibacterium concentrated into a single extreme 1 ~ 4 flagella. 2. Biochemical reactions: oxidase, phosphatase, nitrate reductase positive, tryptophan, urea, DNA-, B-lactamase, citrate, H2S, Yang water, salt MDA, seven Ye glycosides, Asia tellurite, VP, lysine, and ornithine, rhamnose and ONPG were negative. 3. Serological tests: the standard strains isolated Pseudomonas aeruginosa serum lectin-positive diagnosis. Strains isolated patients with serum agglutination also positive titer 1:160.

(B) sensitivity test 15 isolates tablet application Scepter system micro-dilution method, to determine the outcome of the United States in the light of the clinical laboratory criteria Committee (NCCLS) standards on 18 kinds of antibiotics susceptibility.

The results showed that the above-mentioned sensitivity Pseudomonas aeruginosa and other gram-negative bacteria, only ticarcillin, and Thailand to amoxicillin (Imipenem) sensitive, and other commonly used antibiotics, most clinical drug resistance.

Discuss

Melioidosis (melioidosis) of clinical volatility, the incubation period of at least 2 to 3 days, while more than a few years, acute onset can be slow, although the most common involving the lungs, but almost every organ in the human body can be violated, so , The extremely high rate of misdiagnosis. Lung disease melioidosis for the most common type of infection, for the performance of the primary source of blood or disseminated pneumonia. The former most often misdiagnosed as tuberculosis, in addition to clinical manifestations similar things, X-ray is the major cause leading to misdiagnosis, the number of attacks on leaves, it was changed or the kind of smoke infiltration, and there are thin-walled empty (2cm ~ 7cm) . A small number of patients with complicated by pleural effusion, pleural adhesions and hilar lymph nodes. As for the melioidosis sepsis and multi-site diagnosis of the abscess, according to the absence of pathogenic, the more difficult. Puthucheary such as [1] review of 50 cases of melioidosis patients, found that 76% of patients on the basis of diseases such as diabetes, leukemia or solid tumors and systemic lupus erythematosus, and so on. Thailand Pseudomonas aeruginosa is a report of the liver abscess one of the main pathogens [2]. For this reason, those living in affected areas (tropical, subtropical), on the basis of the above diseases, suffering from unexplained fever, anti-TB treatment or invalid “TB” disease, or purulent diseases of the disease should be considered, for Pathogen in time Examination, including exudate, pus, and so on for smear, culture and immunology experiments confirmed as soon as possible.

Melioidosis is the key to antimicrobial therapy. Pseudomonas aeruginosa reported on chloramphenicol, piperacillin, the first cell cefotaxime, ceftazidime, West Yan Li, sensitive to cotrimoxazole, and ceftazidime, as recommended in the treatment of severe sepsis, such as the drug of choice [3] objects. According to the sensitivity test in our hospital, ceftazidime sensitive only 13.3 percent, and ticarcillin, amoxicillin and Thailand to be more sensitive and should be treated as a drug of choice.

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