Staphylococcal infections

Description:

Now as a result of broad use of antibiotics, and sometimes and abuses the dysbacteriosis problem - the major pathogenetic factor in activation of staphylococcus, salmonellas, colibacillus and other opportunistic flora arose them.

Symptoms of Staphylococcal infections:

The clinical course of a staphylococcal infection is characterized by variety - from the hardest, generalized forms to lungs: sepsis, pneumonia, meningitis, abscesses of internals, a coloenteritis, an endocarditis, gynecologic diseases, a staphylococcal infection with a scarlatiniform syndrome, pyoinflammatory diseases of skin and soft tissues, etc. Quite often in such cases the disease happens the mixed etiology. Except staphylococcus, salmonellas, intestinal, pyocyanic sticks or a streptococcus, a pneumococcus, etc. are sowed. At microbic associations the course of a disease is characterized by special weight. Feature of a course of a staphylococcal infection at children is tendency to process generalization. Incidence of sepsis among newborns is most big (see). It is established that staphylococcus in 48-78% of cases are the reason of acute damages of airways. Staphylococcal pneumonia meets or as the independent form of a disease (seldom) or as one of syndromes of a staphylococcal infection, or are combined with other infectious diseases, is more often than a virus etiology. Regarding cases at staphylococcal pneumonia staphylococcus is sowed in associations with an intestinal, pyocyanic stick, with vulgar Proteus, with sort mushrooms Candida, a streptococcus. At staphylococcal pneumonia as well as at other forms of a staphylococcal infection, it is quite often possible to establish epidemiological connection with a pyoderma, other small forms of a staphylococcal infection; infection is quite often connected with family contact (mastitis, quinsy), intrahospital infection in maternity homes, children's hospitals. First of all the polysegmented nature of defeat with bystry, quite often fulminant development of destruction of the pulmonary fabric complicated by pheumothorax is characteristic of a pulmonary form of a staphylococcal infection. Destruction of lungs staphylococcal. Now it is quite widespread in connection with increase of value of staphylococcus in pathology of children's age. In development of staphylococcal pneumonia attach significance as to a bronchogenic way of infection (during epidemics and sporadic cases of a SARS), and to a hematogenous way of damage of lungs when the infection arrives from other centers, however the bronchogenic way does not exclude at the same time and hematogenous.

Biological specifics of staphylococcus are defined by the toxins emitted to them to the environment (lethal toxin, leukocidin, hemotoxin or staphylolysin, necrotoxin, энтертоксин, etc.) and enzymes (a coagualase, hyaluronidase, a penicillinase, etc.). In development of staphylococcal destruction the leading value belongs nekrotoksinu to hyaluronidase under the influence of which in pulmonary fabric very quickly there are necrosis centers (in some sites easy small atelectases are formed), disintegration cavities - "staphylococcal bulls" form (from 0,5 to 2-3 cm in the diameter) and conditions for spread of an infection on a pleura (fibrinopurulent imposings) are created. On the one hand, it puts in the forefront "pleural" symptomatology (a pyopneumothorax, a total empyema), and with another - causes heavy intoxication of an organism, causes the deep functional disorders of breath and blood circulation connected also about acute development of "tension syndrome" in a chest cavity.

Unilateral localization of process with frequent and quite bystry (almost simultaneous), involvement in pathological process of a pleura is more characteristic of primary staphylococcal pneumonia. Development of secondary staphylococcal pneumonia (these forms less than primary) occurs owing to generalization of a purulent infection in an organism (osteomyelitis, otitis, a pyoderma, etc.) more slowly and gradually. Primary staphylococcal pneumonia first differs from an acute pneumonia of other etiology a little, however the course of a disease quite often gains prompt character. The fulminant course of process sometimes gives the grounds to assume emergence of an acute abdomen at patients (intestines invagination, appendicitis, etc.). Quickly intoxication which displays can be a hyperthermia (39-40 гр accrues. With above, a curve of gektichesky type), cardiovascular and respiratory insufficiency (a Crocq's disease even at rest, an asthma, cyanosis of mucous membranes and integuments). Children are uneasy, rush about in a bed, periodically groan, sometimes shout; perspiration, a fever, an injetsirovannost of scleras, puffiness of the person, a hyperemia of cheeks (it is preferential on the party of defeat), occasionally attacks painful dry (is more rare wet) cough are noted. The break of contents of one of intense bulls in a pleural cavity is possible; as a result already serious condition of the child catastrophically worsens, cyanosis sharply develops, there is a cold clammy sweat, an asthma reaches 80 in 1 min., tachycardia - 170-180 in 1 min., pulse becomes threadlike, there is a kollaptoidny state. Less often symptoms of purulent pleurisy accrue gradually. The struck half of a thorax lags behind aspiration, at percussion shortening of percussion tone up to absolute dullness is defined; at auscultation unlike adults ball breath decides, and on a bronchial shade, and the less child, the such options is more often (a thin thorax, the drawn-in lung). Over bulls breath has an amphoric shade, mixed wet rattles are listened. Shift of bodies of a mediastinum in the healthy party, especially at patients with valve pneumo - or a pyopneumothorax is characteristic. A special threat for life is posed by shift and is squeezed the main veins. Big, sometimes crucial importance in diagnosis of staphylococcal destruction of lungs has dynamic X-ray inspection. In the beginning in lungs multiple dense shadows within several segments, one or two lung lobes are found, for the 2-5th days roundish enlightenments of various size with level and without it ("dry bulls") begin to come to light around which infiltration of pulmonary fabric accurately is defined. Also signs of damage of a pleura with accumulation in her cavity of pus or air or that and another together come to light. Therefore one of the major diagnostic testings along with radiological is the puncture of a pleural cavity. At indications carry out a bronchography, a tomography, a plevrografiya, an angiopnevmografiya, a radio isotope research of lungs, diagnostic (it and medical) a bronkhoskopiya, a torakoskopiya. The staphylococcal coloenteritis makes ot4 up to 30% of all cases of acute intestinal infection. This most serious illness among all intestinal infections. The lethality reaches 13%.

Children of the first half of the year of life with an adverse premorbidal background get sick preferential (prematurity, a hypotrophy, early artificial feeding, the postponed diseases, in particular acute respiratory and a pseuofurunculosis, repeated prescription of antibiotics, other medicines, quite often mastitis at mother). In this regard gastrointestinal diseases of this profile quite often consider not only as result of infectious and toxic influence, but also as a result of disturbance of a biocenosis of intestines as a result of decrease in resistance of an organism or action of antibiotics. Staphylococcal meningitis at children differs in the heaviest current. Among all cases of purulent meningitis 2-3% are the share of meningitis of a staphylococcal etiology. Staphylococcus in .sovremenny conditions often is the reason of septic endocarditises (in 67% of cases). It is revealed in 95-100% of cases at purulent diseases of soft tissues and integuments. Staphylococcus burdens the course of burns, various dermatosis, and at some of them is considered as an etiological factor.

Reasons of Staphylococcal infections:

Staphylococcal diseases affect preferential the children of younger age or children weakened by other diseases. This feature is connected with properties of the activator as opportunistic microbe and forces to focus attention on reactivity of children. Disturbance of mechanisms of natural resistance and pathology of local immunity as in formation autoflor play the leading role specific and local immunological reactions of an organism is the main origin of a staphylococcal infection. To 80% of the pathogenic strains allocated from healthy faces are steady against one or more antibiotics. Stafilokokki, allocated at patients and personnel are, as a rule, characterized by multiple resistance, it is frequent to 6-8 antibiotics. Therefore use of antibiotics with the preventive purpose does not protect from is purulent - septic diseases, and these drugs, being an immunodepressantamiya reducing protective forces of an organism, colonizations of hospital strains of microbes which are characterized not only high virulence, but also invasiveness promote. Restriction of use of antibiotics with strict indications can lead to decrease in an antibiotikorezistentnost of stafilokokk. The significant role in spread of a staphylococcal infection is played by carriers of pathogenic staphylococcus. The carriage of stafilokokk is characterized by wide circulation as among healthy, and especially among sick people. The form of a carriage can be various. There is a category of persons in whom constantly are found staphylococcus of the same serotype. These are, apparently, true carriers. Carriers of different types of stafilokokk are less dangerous though the last are found in them also constantly. Distinguish a carriage temporary and non-constant.

Treatment of Staphylococcal infections:

Efficiency of treatment depends on timely diagnosis and early use of complex specific drugs of anti-staphylococcal action. The correct nursing of the child is of great importance. From antibiotics aminoglycosides (Kanamycinum, gentamycin) in therapeutic concentration in combination with semi-synthetic antibiotics of a penicillinic row (Methicillinum, Oxacillinum, ампиокс, rationally combining properties of ampicillin and Oxacillinum, etc.), Olemorphocyclinum, цепорин, erythromycin phosphate (intravenously), and also Fusidinum, especially in combination with Oleandomycinum are most effective (indications to a combination of antibiotics are considerably narrowed now as at the same time also the negative effect is noted; their combined use is reasonable only in very hard cases). Widely use nitrofurans, in particular фурагин To (intramusculary, intravenously less often vnutrikostno). It is necessary to use germicides extremely carefully and only in combination with the drugs stimulating protective mechanisms and recovering ecological equilibrium. In the acute period of a disease means of passive immunization - direct transfusions of donor blood, administration of anti-staphylococcal plasma, anti-staphylococcal (from donor blood) immunoglobulin intramusculary, immunoglobulin of the directed action intravenously are shown. Use proteolysis inhibitors - Contrykal (Trasylolum), synthetic means - Ambenum and to it similar. Also correction of exchange disturbances, use of symptomatic means are necessary. According to indications (phlegmon, pheumothorax, etc.) make immediate surgical intervention. At improvement of a condition of the patient apply means of active immunization - staphylococcal anatoxin, an autovaccine, a staphylococcal bacteriophage. For stimulation of an immunogenesis recommend Prodigiosanum, a lysozyme, chlorophyllin. All this is used in a complex with such biologically active agents as лактобактерин, бификоп, бифидобактерин, and also methacil, vitamins.

Prevention of staphylococcal diseases at children is developed insufficiently. Strict control of the sanitary and epidemic mode of treatment and prevention facilities, control of pregnant women, women in childbirth, newborns has to play a major role in the prevention of spread of an infection: early detection at them small forms of pyoinflammatory diseases and their immediate transfer at detection of pathology from physiological departments in chambers and even departments with the infectious mode. Centralization of sterilizing divisions as a part of medical institutions is of great importance.

The important action directed to decrease in prevalence of a staphylococcal infection is vaccination of pregnant women the purified adsorbed staphylococcal anatoxin. Considering that the most often antibiotic-resistant cultures of staphylococcus are sowed from excrements, for recovery of a normal biocenosis of intestines it is recommended to appoint widely бифидобактерин: 1) to all premature and small children in maternity homes, and in the subsequent in departments for pathology of newborn and premature children within the 1-2nd month of life; 2) to the children receiving antibiotics in the early neonatal period; to the newborns raised by donor breast milk or children of mothers having лактостаз, the nipple cracks which resumed feeding by a breast after mastitis; 3) to sick newborns and children of the 1st year of life (with sepsis, pneumonia, especially an intestinal syndrome), especially the seriously ill patient. It is necessary to cancel бифидобактерин at sick children not earlier than in 10-15 days after the end of treatment by antibacterial drugs. It is important to strengthen control of use of antibiotics, means of immunosuppressive therapy.