Is Caused Risk Of Infection?
Diagnosis and treatment of bacterial infections
I. DIAGNOSTIC PRESENTATION
1. Microbiological diagnosis
Specimens: phlegm, bronchial lavage, blood, bone marrow, lymph nodes, cerebrospinal fluid, biopsy tissue ..
Wet smear is not valid for diagnosis of Histoplasma capsulatum. The specimen will be spread or pressed on a slide, after drying it will be fixed with methanol and dyed Wrightt or Giemsa. For histological specimens, it is difficult to distinguish the fungus from surrounding tissue organization when Hematoxylin & Eosin staining, it is better to dye PAS (periodic-acid Schiff) or Gomori's methamine silver (GMS)
Microscopic examination of specimen samples will reveal intracellular fungal cell cells in macrophages or tissue cells, sometimes they are present outside freely These are round or oval enamel cells, small, 2 - 4 đườngm in diameter, bouncing, surrounded by a light ring due to the cytoplasm shrinking, separating from the cell wall during dyeing. A white blood cell can be parasitized by 100 fungal cells.
Samples after collection must be transplanted within a few hours because the fungus easily dies after leaving the host. Two types of cultures that need to be used for fungal isolation are Sabouraud dextrose agar medium, incubated at room temperature to observe the filamentous filament of the fungus and Brain heart infusion (BHI) medium at 370C for granular yeast. Both media are C for enamel form. Both media contain chloramphenicol, can be added with cyclohexime, containing chloramphenicol, can be added with cycloheximide to BHI culture.
After 3 -5 days, sometimes longer, maybe several weeks, on the Saouraud culture, the fungus slowly grows into a white, gradually turning brownish, smooth, cotton-like surface
On BHI agar, the fungus grows into a granular form of yeast, smooth or small surface, cream color gradually turns light brown. Take t.
. Taking a few cultures to observe LPCB under the microscope will see many round or oval enamel cells, diameter 2 - 4 µm, can see short, baffled hyphae in the first isolation but the hyphae will disappear, leaving only yeast seed cells after a few subcultures.
Silk filaments and yeast granular cells can be exchanged with each other when changing the corresponding culture medium for each type.
2. Diagnosis of fungal immunity
Antigen detection techniques circulating in the blood and biological fluids are very effective in the diagnosis
The techniques for detecting antigen circulating in blood and biological fluids are very effective in diagnosing Hcapsulatum var. capsulatum in AIDS patients.
There is no diagnostic value because the positive reaction allows to conclude that there is Histoplasma sp. but it is not distinguishable from past or past infection. Conversely when negative, the disease cannot be ruled out. On the other hand, the test is cross-capable with blastomycin and coccidioidin.
. The response is only valid for community epidemiological investigations in order to assess the community's exposure to fungi. In addition, it can be used to monitor the progress of the disease If the result changes from positive to negative, it shows that the patient's resistance is reduced, the disease is at risk of severe progression, and the prognosis is bad. When switching from yin to yang allows good prognosis, the patient's immune function begins to respond to the fungus.
Ouchterlony diffusion immunity technique (ID): The patient's antibodies will diffuse and combine with histoplasmin antigen to form M precipitate near the antigen well or H line near the serum well. The M line appears to indicate that the patient is newly infected or has recovered. The H line indicates that the disease is progressing.
Complementary fixation test (CFT): begins positive after infection 2 to 4 weeks. The titer of antibody titer decreases and stabilizes at low level in the ninth month, if it continues to be high, it is a sign of bad prognosis. The CF response is more sensitive than ID.
II. TREATMENT OF MUSHROOM DISEASE
1. Acute form
Most cases are self-limiting, requiring no treatment. But if the disease continues to progress, with hypertrophy of mediastinal pulmonary lymphadenopathy, treatment is necessary to prevent pulmonary collapse and mediastinal fibrosis. The main drug used is Amphotericin B 0.5 - 1 mg / kg / day x 2-4 weeks.
When the mediastinum is fibrosis, only surgical removal can reduce the obstruction but face many difficulties.
2 Chronic lung form: The following regimens may be hung:
Itraconazole 400 mg / day x 6 months.
Ketoconazole 400 mg / day x 6 - 12 months but not as effective as itraconazole.
If patients are unable to follow this long-term regimen or use antagonists or drugs that reduce the absorption of the two drugs, amphotericin can be replaced with 0.4 - 0.5 mg / kg / day x 10 weeks.
After stopping the drug must monitor patients for at least 12 months.
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