Klebsiella pneumoniae - what is it? It is a bacterium that can cause serious inflammatory diseases of the respiratory, digestive and genitourinary systems. Such cases require serious treatment and careful medical care. And the nosocomial infections caused by it are practically not amenable to therapy due to the significant number of pathogen species.
Biological properties
It is difficult for an ordinary person to imagine what Klebsiella pneumoniae looks like, what it is. Morphologically, it is a small motionless sticks that can be located both singly and in groups. This is a gram-negative bacterium, that is, when stained with hematoxylin-eosin, it turns pink (indicates the presence of a capsule).
It prefers to breed in places with limited access to oxygen, but even in its presence does not lose its cultural properties. In laboratory conditions, the bacterium Klebsiella pneumoniae grows on solid and liquid nutrient media, forming beautiful grayish-white colonies. It got its name by the name of the discoverer - pathologist Edwin Klebs.
Types of Klebsiella
Microbiologists since the discovery of the microorganism identified six types of Klebsiella:
- Klebsiella pneumoniae (Friedlander's wand).
- Klebsiella oxytoca.
- Klebsiella rhinoscleromatis (Frisch-Volkovich stick).
- Klebsiella ozaenae (Abel - Lavenberg wand).
- Klebsiella terrigena.
- Klebsiella planticola.
In humans, the first two diseases most often cause diseases, but with a decrease in immunity, other species become pathogenic. In healthy people, Klebsiella pneumoniae is also found in the intestine, its norm should not exceed 105 bacteria per 1 gram of chyme. In addition, these microorganisms are constantly present in the skin and mucous membrane of the bronchial tree. They are able to preserve their properties on food, in water and soil long enough for infection to occur.
Sources of infection
Among many others, anthroponotic infections include Klebsiella pneumoniae. What it is? This means that the source of the disease can be either sick people or carriers of the pathogen that have no symptoms. Inside the body, Klebsiella gets along with dirty food or from dirty hands. If the infection affects the bronchopulmonary system, then the spread of bacteria will be predominantly by airborne droplets (through coughing and sneezing). All people are susceptible to Klebsiella, but small children, the elderly and people with immunodeficiency belong to the high-risk group, since the reproduction of the obligate intestinal microflora is practically not endogenously controlled.
Once in the body, the bacterium produces endotoxin, which is released only after the death of the carrier microbe. It causes fever and intoxication. There are two more exotoxins: enterotoxin and membranotoxin. The first affects the mucosa of the small intestine, and the second damages red blood cells, causing anemia.
Pneumonia
Pneumonia is caused, as you might guess, Klebsiella pneumoniae. A characteristic feature of this type of inflammation is the appearance of many small foci of inflammation, which can merge with each other, over the entire surface of the lungs. Patients have a high temperature (up to thirty-nine degrees), weakness, lethargy, sweating. At the beginning of the disease, the cough is dry, but in the midst it becomes moist, with an admixture of sputum and pus, there may be streaks of blood. Dyspnea is characteristic, and in advanced cases - respiratory failure and pulmonary edema.
During a physical examination, wet rales are audible on the inflammation side, and shortening of percussion sound during palpation. On the x-ray of the chest organs in a direct and lateral projection, focal shadows are visible, prone to association.
If the disease is diagnosed on time and the correct treatment is prescribed, then there is a high probability that the inflammatory process can be interrupted at the very beginning, before it has spread to the entire surface of the lungs. But in case of incorrect treatment or late admission to the hospital, most likely the patient will already have a picture of sepsis (generalized inflammation), and in this case the mortality rate is very high.
Digestive system
This disease is also caused by Klebsiella pneumoniae. Unfortunately, it "disguises itself" as a gastroenterological pathology, making diagnosis and treatment difficult. The patient first turns to a gastroenterologist with complaints of pain in the stomach and navel, heartburn, nausea, loss of appetite, but FGDS (fibrogastroduodenoscopy) shows normal or slightly inflamed gastric mucosa. This in no way can prompt the doctor to think of Klebsiella. Rather, he will deliver gastritis and prescribe appropriate treatment.
But most often, Klebsiella manifests itself in the gastrointestinal tract (gastrointestinal tract) in the form of enteritis or enterocolitis. The patient goes to the infectious diseases hospital with complaints of fever, weakness, nausea, cramping abdominal pain and stool disorder (profuse diarrhea with blood, mucus and unpleasant odor). This condition can last from two to five days.
Diseases of the genitourinary system
Most often, Klebsiella pneumoniae in the genitourinary system manifests itself in the form of pyelonephritis, cystitis and prostatitis. Depending on the level of damage, patients complain of pain in the lumbar region, difficulty urinating and with erectile function.
If the immune system works well, then the disease is acute, and with proper treatment, the person is completely cured. But in case of inferiority of the body's defenses (elderly or childhood, immunodeficiency), the disease takes a chronic or recurrent course.
Complications
During the severe course of Klebsiella, the following complications are not excluded:
- pulmonary edema;
- ITSH (infectious toxic shock);
- hemorrhagic syndrome;
- cerebral edema.
These are life-threatening conditions, each of which can end fatally. And if they are combined, then the likelihood of death increases. After the infection, the patient develops a specific unstable immunity, that is, speaking in the usual language, after a while a person can get sick again.
Features of the disease in children and pregnant women
Klebsiella pneumoniae during pregnancy is not so rare. The body experiences a double load, immunity decreases, and the likelihood of an increase in obligate microflora increases. Since the situation is delicate, whether or not to take antibiotics, the doctor decides. It all depends on the gestational age, the amount of Klebsiella pneumoniae in a swab from the genital tract and the level of white blood cells. The dose is also selected individually. In no case should not be treated at home.
Often there is a situation when a pregnant woman asks questions not to the doctor, but to her friends about the bacteria Klebsiella pneumoniae. What is this, she still can not figure out. And then errors in treatment are inevitable, in addition, it can harm the child.
Due to the weakened immunity, newborns and young children also often suffer from conditionally pathogenic microflora. Klebsiella pneumoniae in infants causes severe intoxication, generalization of the inflammatory process and sepsis. Most often it is a dysbiosis with characteristic symptoms (belching, refusal of the breast, weight loss and violation of the stool).
Diagnostics
Clinically diagnosing that the infection is caused specifically by Klebsiella pneumoniae is rather difficult, since there are no specific symptoms that indicate this. Therefore, the diagnosis is made syndromically and only then confirmed bacteriologically. As a material, blood, urine, sputum, cerebrospinal fluid, bile and sectional material are suitable.
Klebsiella pneumoniae in the urine is detected by bacteriological or bacterioscopic examination. To do this, the material is sown on a nutrient medium or dripped onto a glass slide and examined under a microscope.
Using the same methods, Klebsiella pneumoniae can be found in the feces, but only the sampling of the material is slightly different. For a quality study, you need to deliver the material to the laboratory within half an hour after its collection.
Two weeks after the onset of the disease, you can send blood for a serological examination. It allows you to evaluate the severity of the process and the functioning of the immune system.
Treatment
The doctor chooses the treatment tactics for each specific case. It depends on the form of the disease, its severity and the characteristics of the patient's body. Most often, patients receive outpatient treatment.
Specific bacteriophages are primarily prescribed. They must be taken three times a day before meals. In addition to the oral option, it is possible to administer the drug to the body through an enema. The course of treatment can vary from five to ten days. The next step is the probiotics necessary to restore normal intestinal flora. You need to drink them for at least ten days, and preferably two or three weeks.
From antibiotics, cephalosporins and fluoroquinolones of the third or fourth generation, aminoglycosides and tetracyclines are selected.
Patients are hospitalized in the hospital for the following reasons: worsening, high fever, sepsis. Symptomatic and pathogenetic therapy is necessarily carried out, aimed at eliminating the symptoms of the disease and alleviating the patient's condition.
Nonspecific prophylaxis for Klebsiella is not carried out, since there is no vaccine. Therefore, it comes down to the hygienic education of children and adults, hardening and timely and complete treatment of infectious diseases.