Cov menyuam yaus lub cev tiv thaiv kab mob tsis muaj zog thiab lub cev feem ntau raug tua los ntawm cov kab mob pathogenic. Cov kev kuaj sim tso cai rau txheeb xyuas lawv thiab sau ntawv kho kom txaus. Cov kab mob feem ntau pom hauv cov neeg mob hluas yog ntau hom cocci. Qee zaum qhov kev tshuaj ntsuam qhia Klebsiella hauv cov menyuam yaus. Cov kab mob no yog dab tsi thiab yog vim li cas thiaj txaus ntshai rau menyuam yaus, cia peb sim ua kom paub.
Klebsiella yog dab tsi?
Klebsiella yog cov kab mob prokaryotic uas tsim nyog. Lawv yog ib feem ntawm ib tsev neeg loj ntawm enterobacteria xws li Escherichia coli, Salmonella thiab lwm tus. Cov kab mob yog gram-negative ib capsular rods. Lawv muaj cov duab ntawm qhov tsis sib xws oval nrog qhov loj ntawm 0.3-1.25 microns.
Klebsiella decompose yuav luag tag nrho cov carbohydrates, loj hlob hauv nruab nrab nrog potassium cyanide. Lawv nyob twj ywm siv tau tom qab kev kho mob nrog bactericidal xab npum thiab kev npaj.tshuaj tua kab mob. Vim tsis kam mus rau ntau cov tshuaj tua kab mob, cov kab mob enterobacteria yog nyob rau ntawm qhov txaus ntshai tshaj plaws. Lawv tuag thaum rhuab rau ib teev mus rau qhov kub ntawm 65 degrees. rhiab heev rau qhov kev txiav txim ntawm kev daws teeb meem ntawm chloramine, phenol.
Cov kab mob kis tau dav. Lawv muaj nyob rau hauv tib neeg cov quav, tawv nqaij, mucous daim nyias nyias ntawm lub ntsws. Lawv tuaj yeem pom hauv av, dej, khoom cog.
Nyob rau hauv cov neeg laus thiab cov menyuam yaus, cov kab mob Klebsiella ua rau mob ntsws, rhinoscleroma, pas dej, qhov txhab ntawm cov kab mob genitourinary, thiab kab mob hauv plab. Cov kab mob feem ntau raug cais tawm hauv microflora ntawm cov me nyuam mos tam sim tom qab yug me nyuam. Kev kis kab mob ntawm cov menyuam mos tuaj yeem ua rau muaj qhov mob hnyav ntawm lub ntsws cov ntaub so ntswg, kab mob hauv plab, mob toxic thiab septic nrog rau qhov ua rau tuag taus.
Kev faib tawm
Lub Klebsiella capsular genus tau muab faib ua hom biochemical. Cov kab mob tau muab faib ua peb lub ntsiab thiab ob peb hom ntxiv. Cov tseem ceeb yog:
- Klebsiella pneumonia lossis Friedlander's stick. Ib tug me me coccobacillus uas tsis tsim spores. Nws tuaj yeem nyob ib leeg, ua khub lossis tsim tag nrho cov cheeb tsam (ntawm agar nutrient media). Nws feem ntau cuam tshuam rau cov mucous daim nyias nyias ntawm cov kab mob hauv nruab nrog cev, yog ib qho ntawm cov kab mob tseem ceeb ntawm kev mob ntsws. Nws kuj ua rau cov kab mob urinary, purulent o ntawm daim siab parenchyma, spleen. Muaj tshwm sim hauv cov kab mob sib xyaw. Nrog rau kev mob plab hnyuv hauv cov menyuam yaus, staphylococcus aureus thiab Klebsiella feem ntau pom. Tab sis feem ntau cov kab mobua rau bronchitis thiab bronchiopneumonia.
- Klebsiella ozena (Abel-Levenberg stick). Ua rau cov kab mob ntawm txoj hlab pa sab saud. Cov kab mob yog nrog los ntawm qhuav, nplaum secretions uas emit ib tug fetid tsw, atrophy ntawm lub qhov ntswg mucosa thiab skeleton. Ozena feem ntau kuaj pom thaum muaj hnub nyoog 8-16 xyoo. Cov txheej txheem pathological tuaj yeem kis mus rau lub ntsws, trachea. Feem ntau ua rau tsis hnov tsw.
- Klebsiella rhinoscleroma (Frisch-Volkovich stick). Nws cuam tshuam rau mucous daim nyias nyias ntawm lub ntsws. Hard dawb nodules nrog viscous hnoos qeev tshwm nyob rau hauv lub qhov ntswg thiab lub ntsws. Infiltrates tshwm nyob rau hauv lub bronchi, uas tom qab caws pliav.
- Klebsiella oxytoca. Nws cuam tshuam rau cov pob qij txha, qhov muag, daim nyias nyias ntawm lub hlwb, cov kab mob ntawm lub genitourinary system. Sticks ua rau septicopyemia thiab ua rau ntshav lom.
Hauv cov neeg mob hluas, Friedlander's wand feem ntau kuaj pom. Tab sis Klebsiella oxytoca tsis tshua pom hauv cov menyuam yaus.
Yuav ua li cas tus kab mob nkag mus rau hauv tus menyuam lub cev
Pathogenic rods suav hais tias yog tus neeg sawv cev ntawm tus kab mob nosocomial. Cov kab mob tuaj yeem kis tau los ntawm txhais tes ntawm cov neeg ua haujlwm muaj kab mob, cov catheters kho tsis zoo. Nyob rau hauv tsev kho mob, Klebsiella muaj nyob rau saum npoo ntawm cov zaub, cov ntses khov, thiab hauv cov khoom siv mis nyuj. Enterobacteria muaj sia nyob thiab txawm ntau hauv lub tub yees.
Qhov laj thawj ntawm qhov pom ntawm Klebsiella hauv cov quav ntawm tus menyuam tsis yog ib txwm muaj kab mob sib kis. Enterobacteria tuaj yeem nyob hauv lub cev ntawm tus menyuam mus ntev yam tsis muaj kev hloov pauv pathological. Cov kab mob tuaj yeem ua rau lub cev ua haujlwm tau los ntawm kev siv tshuaj tua kab mob ntev, kev noj zaub mov tsis zoo, thiab teeb meem digestive.
Tab sis tseem ntau dua Klebsiella hauv cov menyuam yaus tshwm sim vim yog cov haujlwm hauv qab no:
- siv dej tsis huv;
- me nyuam noj nyoos, feem ntau tsis ntxuav txiv hmab txiv ntoo thiab zaub;
- me nyuam tsis ua raws li cov cai yooj yim huv: tsis ntxuav tes tom qab mus rau chav dej, ua ntej noj mov, tom qab taug kev;
- Kev tu niam tsis txaus: tsis ntxuav nws lub mis ua ntej thiab tom qab pub mis, tsis ntxuav nws txhais tes kom zoo txaus;
- kam nrog tus neeg mob: Klebsiella kis tau los ntawm cov tee dej, thaum txham, thaum hnoos;
- Siv cov khoom ntawm tus neeg mob: cov menyuam yaus muab cov khoom ua si los ntawm tus menyuam mob rau hauv lub qhov ncauj.
Txawm hais tias cov kab mob capsular muaj sia nyob tau zoo, qee qhov xwm txheej tsim nyog rau lawv txoj kev loj hlob. Pawg pheej hmoo suav nrog:
- menyuam mos;
- premature;
- muaj caj ces los yog qhov tsis xws luag;
- cov me nyuam los ntawm cov tsev neeg koom nrog: leej niam raug kev quav dej caw lossis kev quav yeeb tshuaj, saib xyuas tus menyuam tsis zoo;
- HIV-positive;
- nquag mob thiab mus kho mob hauv tsev kho mob.
Nyob rau hauv qee cov menyuam yaus, qhov pom ntawm kev ua xua dhau los ua ib qho chaw zoo rau kev yug me nyuam ntawm Klebsiella.
daim duab kho mob
Tom qab nkag ntawm cov kab mob capsular rau hauvlub cev nkag mus rau lub sijhawm incubation. Nws lub sijhawm yog nyob ntawm hom kab mob, lub xeev ntawm kev tiv thaiv kab mob thiab lwm tus yam ntxwv ntawm tus kheej. Lub sijhawm txij li lub sijhawm nkag mus rau hauv lub cev mus rau qhov pom ntawm thawj cov tsos mob tuaj yeem yog los ntawm ob peb teev mus rau ob peb hnub.
Thaum lub sijhawm muaj kev loj hlob ntawm Klebsiella, cov tsos mob ntawm tus menyuam muaj qhov sib txawv me ntsis thiab nyob ntawm qhov chaw ntawm enterobacteria. Yog hais tias tus kab mob tau tsoo lub ntsws, ces daim duab kho mob yuav ua raws li nram no:
- kub nce siab;
- -kub taub hau, ua daus no;
- nyuaj hauv qhov ntswg ua pa, qhov tsos ntawm cov paug tawm nrog cov ntxhiab tsw qab;
- redness, o ntawm lub ntsws;
- hnoos tshwm thawj hnub qhuav qhuav, tom qab ntawd ntub ntau hmo;
- tus me nyuam tsaug zog tsis txaus, quaj thiab tsis zoo;
- ua txhaum ntawm qhov zaus thiab qhov tob ntawm kev ua pa.
Thaum lub plab hnyuv cuam tshuam los ntawm Klebsiella hauv cov menyuam yaus, cov tsos mob hauv qab no tau pom:
- thawj paroxysmal, ces mob plab plab;
- gas tsim nce;
- xeev siab, tsis ib txwm nrog ntuav;
- me nyuam tsis kam noj zaub mov, txawm tias cov zaub mov nyiam;
- cov quav raug cuam tshuam: nws dhau los ua kua, nquag, hnoos qeev pom ntawm qhov muag, cov ntshav tawm hauv cov quav;
- vim cov quav nquag, qhov quav yog khaus, hyperemia tshwm sim, qee zaum pob me me;
- ua npaws tau pom nyob rau hauv cov menyuam yaus uas tsis muaj zog lossis tsis muaj kev kho mob ntev.
Klebsiella hauv caj pasme nyuam
Microflora ntawm lub qhov ncauj suav nrog ntau tus kab mob sib txawv. Cov kab mob kis tsis tau tsuas yog nrog zaub mov, tab sis kuj los ntawm kev nqus pa, sib tham. Feem ntau, Klebsiella hauv tus menyuam hnub nyoog 3 xyoos lossis lwm lub hnub nyoog yuav tsum tsis tuaj. Lub xub ntiag ntawm enterobacteria qhia tias muaj cov txheej txheem inflammatory tshwm sim hauv lub cev.
Ntau zaus hauv pharynx, Klebsiella pneumonia, oxytoca, ozena, rhinosleroma raug kuaj pom hauv tus menyuam. Cov kab mob ua rau mob ua pa hnyav. Raws li kev txheeb cais, 35.7% ntawm lawv yog cov neeg tuag. Ntau hom Klebsiella ua rau qee yam kab mob.
- Klebsiella rhinoscleroma yog tus neeg sawv cev ntawm tus kab mob scleroma. Qhov no yog cov txheej txheem inflammatory uas cuam tshuam rau cov phab ntsa ntawm cov hlab ntsws nrog kev tsim cov ntaub so ntswg nodules (granulomas). Qhov txaus ntshai ntawm tus kab mob yog tias nws pib tsim 2-3 xyoos tom qab Frisch-Volkovich stick nkag mus rau hauv lub cev. Cov tsos mob zoo ib yam li mob khaub thuas. Cov niam txiv pib kho tus menyuam ntawm lawv tus kheej, uas ua rau qhov xwm txheej nyuaj.
- Klebsiella ozena ua rau tus kab mob ntawm tib lub npe. Nws yog tus cwj pwm los ntawm cov txheej txheem atrophic ntawm cov qauv ntawm lub qhov ntswg (mucosa, pob txha mos, thiab lwm yam). Ozena tshwm sim tsis tshua muaj 1-3% ntawm tag nrho cov kab mob qhov ntswg. Feem ntau, cov ntxhais hnub nyoog 7-8 xyoo mob. Pathology tuaj yeem ua rau muaj teeb meem: sinusitis, sphenoiditis, conjunctivitis, keratitis, mob otitis media.
- Klebsiella pneumonia, txawm tias nws lub npe, ua rau mob ntsws ntawm cov ntaub so ntswg hauv 2-4% ntawm tag nrho cov neeg mob uas muaj cov kab mob pulmonary. Tab sis tus kab mob no txaus ntshai heev, tshwj xeeb tshaj yog tias nws tshwm sim hauv menyuam yaus. Cov laj thawj tseem ceeb rau kev loj hlob ntawm Klebsiella pneumoniae hauv cov menyuam yaus yog qhov tsis muaj zog tiv thaiv kab mob thiab nquag pathologies ntawm cov kab mob ua pa. Friedländer's pneumonia feem ntau ua rau mob ntsws thiab mob ntsws ntxiv: exudative pleurisy, abscesses, sepsis.
Klebsiella hauv quav
Klebsiella pneumonia, oxytoca thiab lwm tus yog cov neeg sawv cev ntawm cov hnyuv ib txwm muaj, muab tias lawv cov lej tsawg dua 10⁴. Nyob rau theem siab dua, cov kab mob capsular ua rau cov kab mob gastroenterological.
Nyob rau hauv ib tug me nyuam, Klebsiella nkag mus rau hauv cov quav los ntawm txoj hnyuv. Nyob rau hauv lub plab zom mov, enterobacteria tsim enterotoxins. Cov no yog cov kab mob polypeptide uas cuam tshuam lub peev xwm nqus cov as-ham los ntawm txoj hnyuv lumen. Cov kab mob pathological no ua rau muaj kev pheej hmoo ntawm kev tsis sib haum xeeb ntawm cov hnyuv thiab kev loj hlob ntawm lwm cov kab mob. Cov cim tseem ceeb ntawm kev muaj enterotoxin hauv cov hnyuv yog xoob, cov quav dej hauv tus menyuam.
Ntxiv rau enterotoxin, Klebsiella tsim cov tshuaj membranotoxin. Lawv nce permeability ntawm cell membrane rau hydrogen, potassium, sodium ions. Qhov no ua rau kev puas tsuaj ntawm cov hlwb thiab ua txhaum ntawm pH ntawm cov ntshav.
Dysbacteriosis hauv cov menyuam yaus feem ntau tshwm sim vim qhov tseeb tias Klebsiella pneumonia "tus tswv" cov hnyuv. Lwm cov kab mob pathogenic kuj tseem muaj nyob hauv cov quav ntawm tus menyuam thaum kuaj. Qhov no feem ntau yog vim qhov tseeb tias capsular enterobacteria ua rau lub cev tsis muaj zog, uas ua rau muaj kev sib txuas ntawm cov kab mob thib ob. Cov menyuam yaus feem ntau mob khaub thuas, kab mobkab mob. Lub cev tsis muaj zog yog qhov chaw yug me nyuam zoo tshaj plaws rau Klebsiella.
Klebsiella hauv cov menyuam yug tshiab
Cov keeb kwm zoo tshaj plaws rau kev loj hlob ntawm Klebsiella yog cov kab mob uas tsis muaj zog. Yog li ntawd, feem ntau cov kab mob no cuam tshuam rau cov menyuam yaus, uas nws txoj kev tiv thaiv tsuas yog pib tsim.
Cov me nyuam yug ntxov ntxov yuav kis tau kab mob ntau dua li lwm tus. Qhov txaus ntshai yog tias cov txheej txheem pathological hauv cov menyuam yaus tsis muaj zog nce mus rau qhov nrawm nrawm. Kab mob feem ntau tshwm sim tam sim tom qab tso tawm. Lub sterility ntawm lub tsev kho mob sai hloov mus rau ib txwm tej yam kev mob, nws yog ib qho nyuaj rau lub cev los tiv thaiv xws li ib tug xov tooj ntawm microbes. Hauv cov menyuam mos ntxov ntxov, Klebsiella tuaj yeem ua rau mob plab hnyuv thiab mob ntsws.
Tab sis Klebsiella feem ntau pom nyob rau hauv cov menyuam yaus uas yug los ntawm lub sijhawm. Cov tsos mob ntawm cov kab mob capsular yog tib yam li cov kab mob hauv plab:
- Tus me nyuam pib tso quav ntau zaus, nrog cov quav xoob txhua zaus.
- Cov xim ntawm cov quav hloov, nws dhau los ua xim daj-ntsuab. Mucus, tawg ntawm cov khoom noj uas tsis tau zom (yog tias tus menyuam twb tau noj cov khoom noj ntxiv lawm), pom cov ntshav tawm. Ib qho tsw qab qaub tshwm.
- Ntau regurgitation "kub". Cov tsos mob zoo li no yuav tsum ceeb toom cov niam txiv, nws tshwm sim tsuas yog thaum cov hnyuv cuam tshuam los ntawm cov kab mob pathogenic microbes.
- Nyob siab. Thaum ua tiav kev tsim kho, tus menyuam pib quaj, tsis tu ncua.
- Thaum Klebsiella tshwm sim hauv tus menyuam, qhov kub thiab txias feem ntau pom hauv ib xyoos. nwspov thawj tias twb muaj kev tiv thaiv thiab lub cev sim tawm tsam cov kab mob.
Kev kuaj mob li cas
Nrog cov tsos mob zoo ib yam li kev loj hlob ntawm cov kab mob ua pa lossis kab mob ntawm cov vaj tsev thiab cov kev pabcuam hauv zej zog, nws yog ib qho tsim nyog yuav tsum tau qhia tus menyuam tam sim ntawd rau tus kws kho mob. Kev noj tshuaj rau tus kheej, tshwj xeeb tshaj yog rau cov menyuam mos, tuaj yeem ua rau tuag taus.
Tus kws kho mob ua ntej ntawm tag nrho siv anamnesis. Los ntawm cov tsos mob, koj tuaj yeem nkag siab qhov system twg cuam tshuam los ntawm enterobacteria. Tom qab kuaj lub cev, tus kws kho mob xaj ntau yam kev kuaj sim:
- Kev cog qoob loo ntawm cov khoom noj khoom haus. Hauv cov quav ntawm tus menyuam, Klebsiella rau mob ntsws tau kuaj pom siv kev tshuaj xyuas rau dysbacteriosis. Qhov kev sim no tseem qhia tau tias muaj kev tiv thaiv rau qee yam tshuaj tua kab mob. Cov txiaj ntsig yog lub hauv paus rau kev txiav txim siab cov tshuaj tua kab mob uas yuav tau kho.
- Gram stain. Txoj kev tso cai rau cais cov kab mob nyob ntawm tus qauv thiab phab ntsa ntawm tes rau hauv gram-positive thiab gram-negative. Txoj kev tso cai rau kev sib txawv ntawm Staphylococcus pneumococcus los ntawm Klebsiella pneumonia.
- Serological txoj kev tso cai rau koj los txiav txim seb hom kab mob thiab muaj cov tshuaj tiv thaiv rau nws. Cov khoom siv biomaterial tau tshawb pom yog ntshav los ntawm cov hlab ntsha. Hauv cov menyuam yaus, qhov kev kawm no tsis tshua muaj ua.
- Coprogram. Nrog kev pab los ntawm txoj kev, tus kab mob yog kuaj, cov yam ntxwv ntawm cov txheej txheem kis. Kev tshuaj xyuas yog sau tseg rau txhua lub hnub nyoog.
Thaum lees paub tias muaj Klebsiella hauv lub cev hauv cov menyuam yaus, kev kho mob tau sau rau hauv tus account homkab mob, lub hnub nyoog ntawm tus me nyuam. Antibacterial therapy yog ua raws li kev saib xyuas nruj ntawm tus kws kho mob. Qee zaum, nws tau ua tas mus li.
Klebsiella hauv tus menyuam: yuav kho li cas?
Kev kho mob yog nyob ntawm lub hnub nyoog ntawm tus neeg mob, tus yam ntxwv ntawm chav kawm thiab theem ntawm tus kab mob. Feem ntau, kev kho mob yog ua los ntawm tus neeg mob sab nraud, tshwj tsis yog cov menyuam mos uas muaj kab mob hauv lub cev los yog kev tiv thaiv tsis muaj zog heev.
Kev kho yog ua nrog kev pab ntawm cov tshuaj tua kab mob. Tab sis cov me nyuam mos yuav tsum tsis txhob siv tshuaj tua kab mob vim tias lawv muaj kev phiv ntau. Lawv hloov los ntawm bacteriophages. Nta ntawm Klebsiella kho nrog bacteriophages:
- tshuaj noj peb zaug ib hnub ua ntej noj mov (20-30 feeb), yog tias tus menyuam pub niam mis, koj tuaj yeem haus cov tshuaj ua ntej pub mis;
- ntau tshaj ib koob tshuaj rau cov menyuam yug los txog rau lub hlis yog 5 ml;
- 6-12 lub hlis - 10 milliliters;
- ntawm ib mus rau peb xyoos - 15 ml;
- 3 mus rau xya - 20 ml;
- Rau cov menyuam yaus hnub nyoog tshaj xya xyoo, ib koob tshuaj yog xam raws qhov hnyav.
Klebsiella hauv tus menyuam hnub nyoog 2 xyoos lossis laus dua raug kho nrog tshuaj tua kab mob zoo. Qhov zoo tshaj plaws yog cephalosporins ("Cefazolin", "Cefalexin") thiab fluoroquinolones ("Ciprofloxacin"). Penicillins (Amoxiclav) kuj yuav raug sau tseg, tab sis lawv suav tias tsis zoo.
Probiotics tau pom los kho thiab ntxiv dag zog rau lub ntuj microflora: Bifiform, Bifidumbacterin,"Linex rau menyuam yaus", "Acipol", "Probifor" thiab lwm yam. Probiotics qaug cawv thaum kho tshuaj tua kab mob thiab ob lub lis piam ntxiv tom qab nws xaus.
Kev kho kab mob tau ua tiav:
- NSAIDs (antipyretics): Paracetamol, Nurofen;
- immunomodulators: "Kipferon", "Genferon Teeb";
- tshuaj tiv thaiv kab mob: Zodak, Zyrtec.
kho mob:
- rau ntuav, "Motilium" tau sau tseg hauv kev ncua, cov menyuam yaus hnub nyoog 12 xyoos tuaj yeem ua tau hauv ntsiav tshuaj;
- nrog raws plab noj "Stopdiar", "5-NOC", "Enterofuril";
- thaum lub cev qhuav dej, tus menyuam tau muab dej thiab electrolyte tshuav nyiaj li cas Regidron, Hydrovit.
Txhais tau
Nrog rau kev kho raws sijhawm thiab tsim nyog ntawm Klebsiella hauv cov menyuam yaus, qhov kev cia siab tau zoo. Nrog rau kev nthuav qhia lig lossis tsis muaj kev kho mob, tus kab mob kis tau sai heev thiab ua rau mob sepsis, mob txaus ntshai, tshwj xeeb tshaj yog rau menyuam yaus. Ntxiv nrog rau cov lus teb inflammatory, tej zaum yuav muaj lwm yam tshwm sim loj:
- Ib qho teeb meem ntawm cov kab mob capsular hauv txoj hnyuv yog mob dyspepsia. Tus kab mob no nrog xeev siab, ntuav, mob tas li nyob rau hauv lub epigastrium, los ntshav nyob rau hauv ntau qhov chaw ntawm txoj hnyuv.
- Nyob rau hauv cov menyuam mos uas tsis muaj kev kho Klebsiella, hemorrhagic diathesis tuaj yeem tsim. Tus kab mob no tshwm sim los ntawm ntuav ntawm cov ntshav, tso quav tso, sab hauv hemorrhages.
- Meningitis thiab cerebral edema.
- mob ntsws tsis ua haujlwm.
Txawm tias tom qab kho tau zoo, lawv tsis muaj zog heevtiv thaiv kev ua haujlwm ntawm lub cev. Cov menyuam yaus feem ntau rov kis tau tus mob. Qhov txaus ntshai nyob rau hauv qhov tseeb hais tias cov kab mob yog dav thiab resistant heev. Txhawm rau kom tsis txhob rov tshwm sim dua, nws yuav tsum ua tib zoo saib xyuas kev nyiam huv, ntxuav zaub thiab txiv hmab txiv ntoo, thiab nws yog qhov zoo dua rau kev kho kom sov. Thaum xub thawj, tiv thaiv tus menyuam los ntawm cov neeg coob coob, tiv tauj nrog cov neeg nqa khoom ntawm cov kab mob kis los ntawm cov tee dej.
Txog hnub no, cov tshuaj tiv thaiv tiv thaiv Klebsiella tsis tau tsim. Qhov kev tiv thaiv tseem ceeb yog kev tu cev thiab ntxiv dag zog rau tus menyuam txoj kev tiv thaiv.
