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Pseudomonas aeruginosa Tonglv Se aeruginosa (P. aeruginosa) is a common condition in the Pseudomonas pathogen, resistance drops when the body into the corresponding parts of the body can cause systemic infections, such as burn face, respiratory, urinary tract, central nervous system, cornea and other infections, and sepsis, due to the natural resistance of Pseudomonas aeruginosa, so the treatment more difficult, can be used in clinical Pseudomonas aeruginosa resistant synthetic penicillin class of third-generation cephalosporins, and treatment of horses Burkholderia Pseudomonas (Burkholderia pseudomallei), and Pseudomonas melioidosis (Burkholderia pseudomallei) occasionally cause human disease, Burkholderia pseudomallei wound through the skin, conjunctival or respiratory tract invasion, Burkholderia pseudomallei through direct , respiratory, digestive tract or insect bites and other means of infection in the body, similar to the two clinical manifestations, may be an acute lung infection, and systemic limitations of multi-site multi-organ infection, lack of effective treatment of glanders, melioidosis can try tetracycline, chloramphenicol factors such as the treatment, both after the illness may be more lasting immunity. Clinical manifestations of sepsis 1
Sepsis secondary to Pseudomonas aeruginosa sepsis, and more extensive burns, leukemia, lymphoma cancer, tracheotomy, intravenous catheters, heart valve replacement and a variety of serious chronic diseases i


n the process. Sepsis caused by bacteria Gram-negative bacilli sepsis accounts for about 7% to 18% ranking 3 or 4 fatality is the first place. The clinical process and other similar gram-negative bacilli sepsis, in addition to preterm children and child care may fever, the patient may have missed relaxation or heat, often accompanied by shock, adult respiratory distress syndrome (ARDS) or disseminated intravascular coagulation (DIC ) and so on. Characteristic skin gangrene may occur and deep pustules, around the ring with erythema, rash appears 48 ~ 72h, central gray or black necrotic ulcers, bacteria within the small blood vessels tied to exudate smear Gram stain or culture is easy to find Bacterial skin rash can occur in any part of the body, but mainly in the buttocks or perineum occasionally in the oral arm, limb movement can occur with advanced disease, respiratory infections abscess
Primary Pseudomonas aeruginosa Pseudomonas aeruginosa pneumonia rare, usually secondary to host immune function is impaired, the lungs are particularly vulnerable to chronic changes made to the original basis, such as chronic bronchitis, bronchiectasis, tracheotomy the application of artificial respiration after the X-ray machine with bilateral bronchopneumonia with scattered nodular shadows effusion, empyema are rare. Secondary to sepsis in critical condition, showing that small muscular pulmonary artery or vein necrosis of the type of damage caused by gangrene, erythema similar to high mortality rate. Pseudomonas aeruginosa chronic lung infections occur in patients with cystic fibrosis, often accompanied by chronic cough, sputum, and progressive lung dysfunction. Endocarditis often occurs in heart surgery on the basis of the original heart disease, valve replacement surgery often inoculated bacteria or prosthesis suture the wound, but also can occur in patients with burns or drug addiction on the normal heart valves. Heart disease can affect all valves, but the tricuspid valve is more common, involving the left heart valve vegetations were, the prognosis is more serious. Relative to Streptococcus viridans endocarditis caused by the disease of drug cure rate is low, even in sensitive antibiotic therapy the cure rate is still less than 30% under, it should be an early replacement surgery vegetation and valvular disease. Urinary Tract Infection
Pseudomonas urinary tract infection in a hospital cross-infection within the urinary tract of the common bacteria, accounting for nosocomial urinary tract infection isolates from the second, indwelling catheter infection is to obtain the incentive for paraplegics. Others such as neuron bladder, urinary tract obstruction, chronic long-term antimicrobial treatment of urinary tract infections also predispose Pseudomonas infection. Pseudomonas aeruginosa sepsis in 40% of the original disease was urinary tract infection. Central nervous system infection caused mainly by Pseudomonas aeruginosa. Manifested as meningitis or brain abscess, often secondary to trauma, head and neck cancer surgery, and lumbar puncture or ventricular drainage after surgery, or by the ear, mastoid sinus infection sping agranulocytosis, severe burns are Pseudomonas aeruginosa sepsis in the process of migrating to the brain of the risk factors. Clinical manifestations of infection with other bacterial same hub, but the prognosis is poor in more than 60% mortality. Bone and joint infection is mainly due to migration of sepsis or blood infection from the adjacent tissue lesions, the elderly complicated urinary tract infections and genitourinary surgery or instrumentation, can be caused by multiple vertebral osteomyelitis. Injection of heroin are often caused by cervical osteomyelitis. Clinical course without even a special, less pain, poor prognosis. Pseudomonas aeruginosa infection in the eye or keratitis is a corneal ulcer is one of the common pathogens, often secondary to ocular trauma or corneal abrasion when the rural rice after threshing. Pseudomonas aeruginosa contamination of lens or lens solution is a bacteria infection in another important way the eye, infection developed rapidly, 48h can be spto all within the eye, can quickly lead to corneal melting, should be urgently addressed, could easily lead to blindness . Ear, mastoid and sinus infection
Sinus infection after swimming because the water into the ear canal of the pH and alkaline, is conducive to the growth of P. aeruginosa, resulting in otitis externa. Diabetic patients with vascular lesions, can occur even due to Pseudomonas aeruginosa chronic pain of malignant otitis externa, if not treated, the consequences of poor. Otitis media and mastoiditis caused by bacteria often secondary to malignant otitis externa or acute otitis media, have diabetes or other diseases of vascular sheath of P. aeruginosa can be caused by intracranial infection. Skin and soft tissue infections in patients with sepsis may be secondary to gangrenous rash erythematous, subcutaneous nodules, deep abscess, cellulitis and other skin lesions. Burn pressure ulcers, trauma wounds and varicose ulcers surface, often they can nurture the Pseudomonas aeruginosa Pseudomonas aeruginosa infection in the digestive tract can be produced in any part of the digestive tract disease, common in infants and young children and low tumor chemotherapy induced neutropenia immune defect, can cause diarrhea in infants and adults appendicitis or rectal abscess. Pseudomonas aeruginosa infection in the digestive tract is also one of sepsis, a major invasion of the portal. Symptoms and signs of Pseudomonas aeruginosa infections in a primary disease or the body resistance on the basis of falls and traumatic process of examination and treatment appears, showing the original condition worsened, the general antibiotic treatment fails, there parts of the system and infection symptoms, blood, cerebrospinal fluid and other secretions, feces positive for pathogenic examination, can be confirmed. 2, sensory disturbance of feeling is different receptors to stimulate the body directly reflects in the human brain. Sensory dysfunction is a common neurological disease in one of the symptoms. 1, peripheral infection disorders common in the ulnar nerve, median nerve, radial nerve damage, peripheral neuropathy, toxic neuropathy, metabolic neuropathy, lateral femoral cutaneous neuritis, multiple neuritis. 2, after the root is common in disc prolapse, spinal cord outside the tumor, syringomyelia, trauma. 3, spinal cord common in transverse myelitis, spinal cord tumors, extramedullary tumors, trauma, spinal cord disease, spinal cord compression. Subacute combined degeneration, syringomyelia, spinal nerve go far. 4, the type commonly found in brain stem disease brain stem, brain stem tumor, brain stem inflammation, birth trauma, congenital malformations, cerebellar pontine angle lesions, brain stem hollow psychosis. 5, thalamus type common in cerebral vascular disease, cancer, epilepsy and so on. 6, capsule type is common in cerebral vascular disease, cancer and so on. 7, is common in cerebral cortical lesions, tumors, epilepsy seizure type feeling, inflammation, trauma. 8, adenosis type sensory disturbance common in trauma, mental stimulation of the over-sensitive people. Mechanism (a) of the sensory pathway from the peripheral sensory receptors specific to the beginning, were transmitted to the hub, and its pathway formed by the three sensory neurons, the general cross in the second stage, so the relationship between central and peripheral motor system with the same is dominated by the opposite sex. 1, pain and temperature sensation in the first order neurons within the spinal nerve; around the branches to the skin, due to membrane receptors (free nerve endings, I feel the final ball, etc.), constitute the central branch of the posterior root of spinal cord rose l ~ 2 spinal After the horn section of backward people, after the substitution for the second order neurons, their axons through white matter, anterior commissure to the contralateral lateral cross-claim to form the upward termination of the spinal cord lateral hypothalamus lateral nucleus of the hypothalamus, the first formed after the substitution three neurons, the axons of cortical bundles composed of the hypothalamus, the internal capsule to the central limb after the last projection back in the back of the upper and paracentral lobule. 2, touch the first level neurons in the spinal ganglion, spinal nerves around the branch composed of sensory fibers to the skin touch receptors (tactile corpuscles, the ring bodies, etc.). Central support section into the spinal cord cord in the thin beam, wedge within the uplink transmission fine tactile (recognition of touch), and deep sensory conduction identical; conduction rough tactile fibers in the posterior funiculus up 1 to 2 spinal segment entered the posterior horn and ends at the posterior horn cells after substitution constitutes the second order neurons cross to the contralateral side the formation of the spinal cord hypothalamic tract upstream, lateral nucleus of the thalamus after substitution constitute the third order neurons by the limb of the internal capsule to the cerebral cortex sensory area. 3, deep feeling of the first dorsal root ganglia neurons are located within the branch formed around the spinal nerve distribution of sensory fibers in the muscle, the team periosteum, joint receptors, etc. in deep and fine touch receptors, composed of the central branch of the medial dorsal root into the spinal cord tract divided into long and short ascending branch of descending branch, all the way up and down in the issue of collateral, either directly or indirectly through intermediate neurons in anterior horn cells and the formation of synapses, constitute the spinal reflex. Ramus fibers up to the medulla oblongata, in which the lower trunk and lower limbs from the fiber cable of the medial part in the arrangement after the formation of a thin beam, upper torso and upper limbs from the fiber cable in the lateral part of the arrangement after the formation of wedge. Thin beam and wedge in the posterior funiculus in the uplink to the medullary nucleus, and finally a thin wedge nucleus. Here for the second stage without the formation of nerve fibers around the central gray ventral to move left and right cross to cross the lemniscus contralateral medial lemniscus to form upstream and ends at the lateral hypothalamic nucleus, and then the third from here order neurons send fibers by the internal capsule, the central limb after the termination of the cerebral cortex in the upper back, near the rear of the central lobule and the central gyrus. Part of the sense of touch also through wedge, thin beam transmission. (B) of the segmental sensory dominance of each dorsal root of the input fiber dominated certain areas, this phenomenon is dominated segmental thoracic obvious. Flat surface for the chest logo is the nipple 4, 8, chest plane for the costal arch, chest plane for the 10 umbilical, groin, chest plane for a dominant 12 waist. Other parts of the complex nerve distribution in the neck from the ear to the collarbone and breastbone on the front cause cervical distribution of 2 to 4, upper chest to the neck 5 to 2, the lower limb in front of the sacral spinal 1 to 5, the perianal area is to saddle 4 5 sacral distribution. Each sensory nerve root or spinal segment dominated the feeling of a piece of skin called dermatomes. Most skin sections from 2 to 3 overlapping segments of the dorsal root or disposable, so when the spinal cord injury to determine the true upper bound, spinal cord injury level must be higher than 1 to 2 segments to calculate. "C) enough for the arrangement of the sensory level of spinal tracts with hypothalamus arranged from outside to inside the fiber bundles were sacral, waist, chest, neck fiber. Conduction from the lower part of the lateral segments (lumbar to above) feeling, but the medial part of the conduction from the upper segments (cervical thoracic) feeling that this same arrangement with the pyramidal tract. This is so because from the upper segment of the spinothalamic tract fibers after another will come from the lower part of the lateral segment of the fiber into the cause. Beam after the fiber array were sacral from the inside out, waist, chest, neck, fiber, just the opposite with the spinothalamic tract, from the upper segment of the posterior bundle fibers (wedge) in succession to the post from the lower segment bundle (thin beam) into the inner of it. Law of this arrangement, especially in pain, temperature sense obstacles, identifying intramedullary and external swelling. Tumors are of particular importance. Such as cervical intramedullary tumor, superficial sensory disturbances since the beginning level of top-down development of lesions, ie neck, chest, waist, and the order of development; cervical extramedullary tumors. Superficial sensory disturbance of the barrier opposite the order of development. And the former is more bilateral symmetry, which in the early stage lesions contralateral to the lesion. 3 fever fever (feVer, pyrexie) is the pathological increase in body temperature, the body of the role of pyrogen body temperature regulation center of the set point on the shift caused by, is the most common clinical symptoms, is in the process of disease progression Important clinical manifestations. Can be found in a variety of infectious diseases and non-infectious diseases. Typical type and duration of heat, specific clinical features, diagnosis generally easier; but some patients with fever, heat path length, non-specific signs, the lack of information with the diagnosis, often referred to as fever of unknown origin or unexplained fever (fever of unknown origin, FUO). These patients are potentially more lesions in vivo, but not to identify the short term, through clinical observation and special inspection, most of the last available diagnosis, about 10% of patients, despite not been able to confirm the diagnosis of various examination, duration of delay months, indicating long-term causes of fever of unknown clinical diagnosis is indeed facing an important issue. 1, normal human body temperature regulation has the perfect body temperature regulation system (including temperature information transmission, body temperature regulation center and the effector of three parts), the general volatility in the temperature range to maintain relatively constant body temperature. Play a key role in this system is the body temperature regulation center, the main part of a hill before the preoptic hypothalamus (precptic anterior hepothalamus, POAH), followed by the medulla, pons, midbrain and spinal cord. The hypothalamus are temperature sensitive neurons, the temperature of blood flowing through there is very sensitive, can quickly lead to thermoregulatory responses. Body temperature regulation center on various aspects of the information from comprehensive, the issue of regulating the impulse to control the heat and the heat sink official activities to maintain the balance of heat and cooling to maintain a relatively constant body temperature. Body temperature are not necessarily caused by disease, in some cases can be Yousheng rational body temperature, such as strenuous exercise, pre-menstrual and pregnancy. High temperature or hot water into the bath is slightly higher than usual body temperature Dengjun can, through self-regulation of these return to normal. 2, normal adult body temperature to determine heat to maintain a certain constant level, there are differences between individuals. Generally believed that the sublingual temperature 37 , axillary temperature of 36.5 , the rectal temperature higher than the sublingual temperature of 0.3-0.5 , day temperature difference between the normal value of not more than 1 . When the sublingual temperature is higher than 37.5 T, axillary temperature higher than 37 , or the temperature difference between day or more in the l , known as fever. General body surface temperature is low, susceptible to external factors. Therefore, the three methods to measure body temperature rectal temperature more accurately. Usually measured to facilitate more use of axillary temperature, should pay attention to the thermometer placed in the center of clamping the upper arm close to the armpit of the armpit sweat armpit should be dry retest. Temperature measurement in children with coma patients should not leave. Patients should not be too thin temperature measuring method has been applied. Oral temperature measurement, will be put toward the tongue body, closed 3 ~ 5min. This method should not be used for psychiatric disorders, coma, difficulty breathing, nose and mouth diseases and children. 20 minutes after eating drinking retest. Rectal temperature measurement, the thermometer first coated with oil, insert the rectum 3-cm ,3-5min, should not be used for diarrhea and rectal surgery. Thermometer temperature prior to rejection to below 35 . 4 pustule pustules (pustule) is a limitation of epidermal cavity bulge, containing turbid pus. Department of primary in the skin blisters from the rash evolved. Pus
Pustular blisters the size of the depth range can be around the Yan Xing Hongyun, light turned to pus scab pustules dry up without leaving scars after healing, pustules may form deep ulcers may leave scars after healing. 5, the mechanism of pustule differences due to different causes. Some diseases cause pustules performance is still not clear. But the pustules are large number of white blood cell cavity exists. Pox virus-like pustules by different viruses transmitted by droplets or feeling of the human body, through a series of immune responses, occur under the epidermis, or skin pustules. The typical skin changes can occur degeneration reticular degeneration and gas sphere, may have a different virus inclusion bodies. Bacterial infection of the pustules are usually done by staphylococcus, streptococcus infections. Routes of infection for the primary infection and secondary infection. Primary infection is caused by bacteria directly onto the skin pustules. Such as infectious impetigo, the bacteria play a major role in pathogenesis. Secondary infection occurs on the basis of the original lesions. General for a variety of mixed infection of bacteria, such as infectious eczematous dermatitis. Bacterial pustule caused by pathogenic factors, the large population of bacteria on the skin or with foreign virulent strains, the bacteria easily invade skin damaged. Resistance of a thin tender skin, poor children vulnerable to infection. Metabolic disorders, malnutrition, fatigue or a lack of susceptibility to immune function. Non-infected cells as aseptic pustular rash. General cause is not yet clear, such as impetigo herpetiformis, pustular psoriasis and so on. Are considered to focal infection, endocrine disorders, immune dysfunction and other factors. (A) of the infectious pus cell 1. Pox virus-like pus cells, Kaposi varicella-like rash, vaccination reactions, vaccinia-like eczema, smallpox, sheep pox, vaccinia, milking nodules. 2. Pustular inflammatory bacterial infectious impetigo, bullous impetigo, deep wound pus cells, neonatal impetigo, follicular impetigo, necrotizing acne, to be blistering, alopecia folliculitis hand (foot) superficial bullous pyoderma, pustular rash of bacteria, infectious eczematous dermatitis. 3. Fungi, spirochetes, mites and infectious pustular psoriasis seen in yellow, pus psoriasis, pustular rash syphilis, scabies, dermatitis, insect follicles. (B) non-infectious diseases in this group of aseptic pustules of small pustules, most of them not very clear cause, such as pustular psoriasis, herpes-like blisters on disease, impetigo under Corner, palmoplantar pustulosis , continuous acrodermatitis, baby extremities impetigo, folliculitis eosinophilic pus cells, miliary pustular rash, drug agents such as bromine, iodine induced pustules. 6, skin cyst is a cyst cavity structure, outside wall, or other components within the liquid can be derived from the skin, also comes from the mesenchymal tissue. First, congenital hereditary 1. Trichilemmal cyst cyst sebaceous glands over the past 114 degrees, which is autosomal dominant. 2. Multiple lipid cysts as an autosomal dominant inheritance. 3. Dermoid cyst is congenital, after students there. 4. Bronchogenic cyst catheter hyoid bone and thyroid hypoplasia congenital abnormality. 5. Midline cyst of the penis due to congenital dysplasia. 6. Eruptive hair cysts cause carbon unclear, some reports that an autosomal dominant inheritance. Second, 1 of unknown etiology. The new liquid cyst. 2. Milia: those unexplained primary, secondary scar were more common in the epidermis of a large release, congenital ectodermal defect, Ye Lin delayed skin disease, skin abrasion surgery. 3. Epidermal cysts: cause unknown. 7 secondary infection of secondary infection is the blood disease patients decreased immunity due to illness leaving; eating poor resistance to drop caused by malnutrition, leaving the body; more importantly, mature white blood cells due to decreased volume and quality of lead can not resist bacterial invasion and infection, leukemia patients one of the most common cause of death. 8 differential diagnosis of culture positive, and identified as Pseudomonas by the biochemical diagnosis is confirmed in the selective medium and produce pus green pigment was identified as Pseudomonas aeruginosa can, without pigment, or does not ferment in the differential medium lactose or glucose, Gram-negative bacteria, possible to further identify the following methods. Identification of bacteria in pigment can be inoculated in King A, B slant medium at room temperature 37 24h or home observation for 5 days (1) green pus pigment: the King A slant on the dark green, green liquid medium exposed to air at the obvious. If the pigment is not obvious or mixed with other pigments may be added chloroform in the slope, observed room temperature for 1 ~ 24h, as is still evident in the chloroform solution dropwise diluted hydrochloric acid, green pus in the acid layer of red pigment. (2) The fluorescent pigment aeruginosa: Pseudomonas aeruginosa, Pseudomonas fluorescens, Pseudomonas putida in the King B slant medium yellow-green fluorescence on the show. (3) pigment red pus: the King A medium reddish purple slant, such as red home 37 24h is not obvious, can be further room temperature for 3 to 5 days observation of Pseudomonas aeruginosa toxin produced by red pus rare. (4) Black pussy toxins: Pseudomonas aeruginosa in the growth medium containing peptone often have black pus toxin production. Stenotrophomonas maltophilia has black pus toxin production. Identification of Pseudomonas aeruginosa and other key identifying other oxidative decomposition of glucose, oxidase, arginine double hydrolysis, B lactamase, gluconic acid oxidation of ammonia nitrate test were also positive for P. aeruginosa origin of sepsis patients proteinuria appears Tonglv Se in urine, the urine of patients transferred into acidic, alkaline and neutral, were placed in dark UV radiation, if any, fluorescent light green patina proteinuria occurred. 9 If the infection is located outside the treatment and limitations, the available 1% acetic acid wash or topical application of polymyxin B or polymyxin E, can be effective. To dissection of necrotic tissue, and abscess must be drained. For parenteral administration therapy with tobramycin or gentamicin 5mg / (kg.d) sub-agent to give, cure most of the Pseudomonas aeruginosa urinary tract infection, according to clinical response, dose can be reduced to 3mg / (kg.d) to minimize side effects, renal dysfunction, the dose must be reduced, the enzyme-mediated P. aeruginosa resistance to tobramycin and gentamicin amikacin should be used, many experts advocated the treatment of severe Pseudomonas aeruginosa aminoglycoside plus an anti-free -lactamase of Pseudomonas, several penicillin, including ticarcillin, piperacillin, mezlocillin and azlocillin against Pseudomonas aeruginosa effective. Other good effect of the drug also ceftazidime, cephalosporin levels, aztreonam, imipenem, and ciprofloxacin Metro horses Ning, ticarcillin most commonly used, the dose of 16 ~ 20g / d, intravenous injection. Piperacillin, azlocillin, ceftazidime level, ceftazidime, and imipenem Metro horses rather vitro for some strains resistant to ticarcillin efficiently. Of systemic infection or patients with neutropenia should be effective against P. aeruginosa with an aminoglycoside combined with an anti-Pseudomonas penicillin. Of neutropenia and the marginalized status of renal function in patients with non-aminoglycoside combination therapy can be used, such as double -lactam or -lactam plus a fluoroquinolone, is safe. Urinary tract infection can often be carboxy indane benzylpenicillin or ciprofloxacin or other fluoroquinolone therapy, but fluoroquinolones should not be used for children because the drug has adverse effects on cartilage. In combination of two anti-pseudomonas drugs in the treatment of drug-resistant strains occurred during the opportunity to significantly reduced. 10 Prevention of Pseudomonas aeruginosa are widely found in nature, as can be in the hospital through various channels, thus the need for strict disinfection equipment, dressings, especially for patients with wound secretions should be special treatment, the patient should be isolated to reduce the unit cross infection and reduce hospital infection rate of P. aeruginosa. 11


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