Treatment of disease Prevention

This is caused by Sporothrix deep mycosis, mainly affects the skin, and occasionally also be violations of mucous membrane, lung, meninges, and other internal organs. Prior to the onset, the skin often prior history of trauma, and then contact with contaminated soil or plants, bacteria on the skin enter the body from injury, about 1 ~ 3 weeks after, on the part of the initial invasion produced as boils kind of damage is generally not painful or fever, ulceration, after the formation of ulcers, pus is small; also can papules, verrucous damage, plaque, and vegetables pattern pseudo-tumors. Damage can be fixed in a long time, or along the lymphatic spread upward, resulting in a string of similar damage to a few 10 arranged in a number of strips. Generally a maximum opportunity for upper limb disease, lower extremity followed the face is quite prevalent in recent years. Very few can invade the blood, causing wide spread skin and internal organs. Extrusion injury in sepsis as training can often be isolated from bacteria, you can confirm the diagnosis. Iodide effects of this disease in the general with 10% potassium iodide solution, per 10ml, three times a day, oral, treatment in the 2 ~ 3 months. Local hyperthermia therapy can play a supporting role. Prevention of skin injury is very important in preventing this disease. The dressing should be replaced burned patients to avoid polluting the environment, infecting others. A high incidence of this disease should be good publicity.

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(A) treatment
1. Inside the medication
(1) iodide: 5% ~ 10% potassium iodide 3g / d, can be gradually increased to 6 ~ 8g / d, the damage can be following the suit disappears 2 to 4 weeks, the general course of 2 to 3 months. Potassium iodide saturated solution 10 drops / time, 3 times / d, can be gradually increased to 40 drops, 3 times / d, usually 1 week are effective, 1 ~ 2 months curable. Oral potassium iodide have indigestion or nausea, vomiting, poor appetite and other gastrointestinal reactions, can be used sodium iodide 1g / d intravenous injection. If patients have tuberculosis, potassium iodide should not be applied.
(2) griseofulvin: less effective, generally do not. Those who are allergic to iodine may consider, 0.8g / d, for 1 ~ 3 months.
(3) Flucytosine: According to 100 ~ 200mg/kg body weight, until cured.
(4) Itraconazole: ① lymphatic tube: 100 ~ 200mg / d, for 3 to 6 months; ② fixed: 50 ~ 100mg / d, for 3 to 6 months.
(5) Terbinafine: 2 times / d, each 0.25g, generally serving a ~ 2 months.
(6) Fluconazole: 200 ~ 400mg / d.
(7) of amphotericin B on the skin type and disseminated lymphatic sporotrichosis can be applied. The first dose of 3 ~ 5mg, adults can be added to the 30 ~ 35mg, continuing a ~ 2 months.
2. For external use 2% potassium iodide or 0.2% iodine solution can be topical; 2% dimethyl sulfoxide ball erythromycin penetration agent, 2 times / d; amphotericin B250 ~ 500mg, dimethyl sulfoxide 30ml, glycerol 20ml, water 50m1, formulated into a thoroughly topical agent; thermotherapy local heating heater 45 ℃, 3 times / d, every 60min, for the effective isolation of the damage.
(B) the prognosis
Cutaneous lymphatic type, nodules gradually softening, ulceration of the formation of chronic ulcers, difficult to heal. More after the formation of scar.

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1. There inclusion urethritis or cervicitis should be actively treated patients.

2. Observe good personal hygiene, not sharing towels.

3. There inclusion conjunctivitis are strictly prohibited into the public swimming pool, to prevent transmission to others in popularity.

(A) treatment
Chlamydia infection may spread to the respiratory tract, gastrointestinal tract, so oral medication is necessary. Infants and young children can be taken orally erythromycin 40mg / (kg · d) sub-four second dose of at least drugs for 14 days. If there is recurrence, the need to revisit entire administration. Adult oral tetracycline (1 ~ 1.5g / d) or more sticky Doxycycline (100mg, 2 times / d) or erythromycin (1g / d), treatment of 3 weeks. Topical antibiotic eye drops and eye ointment, such as sodium acetate, 15% sulfanilamide, 0.1% rifampin.
Local and systemic tetracyclines, macrolides and quinolones were significant effects of this disease.Locally drip with O.25% chloramphenicol, 0.1% rifampicin, 0.3% ofloxacin, or 0.05% ~ 0.1% eye drops, etc. Phthiobuzone. Antibiotic eye ointment before going to bed can be painted, such as 0.5% tetracycline, erythromycin 0.5% or 0.3% ofloxacin eye ointment. Necessary, to add with systemic treatment, oral ofloxacin 200 ~ 300mg / d, 1 ~ 3 times / d, orally; or azithromycin 250mg, 2 times / d orally. Can also be oral erythromycin, adult 250mg / times, 4 times / d, for 7 days; baby 25mg / (kg · d), sub-4 second oral, continuous for 14 days.
(B) the prognosis
Inclusion conjunctivitis is not treated for 3 to 9 months, an average of 5 months. A standard program to shorten duration of treatment, the recurrence rate low.
Should be strengthened young people’s health knowledge, especially sex education. High-quality prenatal care, including reproductive tract infections chlamydia testing and treatment is the key to successful prevention of neonatal infections. Effective prevention drugs, including 1% silver nitrate, 0.5% erythromycin and 2.5% poly-selenium PVP iodine. Of which 2.5% poly-selenium PVP iodine eye-best, minimal toxicity.

【Prevention】
Echinococcosis Weiren Zoonosis, intermediate hosts, including domestic and wild animals and its prevention is not only the biological context of a complex issue, but also a serious social problem and should adopt comprehensive measures, including:
(A) Strengthening the endemic areas of treatment and control of cattle dogs to prevent infection of human hydatid critical link. In hydatid endemic areas should all be extinct wild dogs, dogs strict restrictions on use must shepherd, dogs, or dogs etc. must be listed on the registration. On a regular basis taeniafuge and drug monitoring should be classified as conventional systems, according to the report of severe endemic areas of New Zealand provides dosage every 6 weeks once a drive cord. Mild endemic areas into three dosage once a month.
(B) the strict sanitary inspection of meat meat processing factory or abattoir must earnestly implement the meat of the health and quarantine, infected animals liver, lungs and other organs infected with hydatid must be the proper conduct of non-activation treatment, using concentrated burning, digging deep, medicine liquid drugs, and other law, should not feed the dog.
(C) vigorously carry out missionary missionary health approach can be diverse, the content should be simple and user-friendly, pragmatic. And to fully mobilize the masses, so that well-known and well known.

Surgery is the preferred method of cure of this disease, should seek to pressure operating before symptoms or complications. When patients first with a thin needle to take away the cyst fluid (beware of cystic fluid leak), and then excision of internal capsule. Internal capsule and external capsule with only mild adhesion, easy to peel, often can be removed complete. Lung, brain, bone and other parts of the surgical removal of hydatid disease should be OK.
In the surgical removal of hydatid cyst within the prior to the injection of hydatid cysts 10% formalin solution to help kill the former head larva, as the product of the lung tissue, stimulating and occasionally with side-effects of poisoning, it is not particularly apply to ruptured pulmonary or hepatic hydatid cyst.Abroad there have been using Xiqu bromide (cetrimide) to kill the former head larva, and considered to be of low toxicity with good effects to kill the former head larva ideal agent for human hydatid cyst excision before the injection capsule 2 times, an appropriate amount of 0.1 % Cetrimide, each lasting five minutes, a group of 10-year period 378 cases of surgery through the application and post-operative observation report shows that non-one cases of hydatid recurrence, without using Cetrimide ago, after hydatid recurrence rate was 10% .
Benzimidazoles at home and abroad in recent years, focus on the anti-hydatid drugs in animal experiments on the basis of clinical trial and achieved a certain effect. In accordance with WHO advice, albendazole and mebendazole are classified as drug of first choice of anti-hydatid. There authors believe that the indications are as follows: ① secondary abdominal or thoracic hydatid disease, mostly occurs in the primary liver or lung hydatid concurrent breakdown can also be a result of lax protection of hydatid surgery, or because mistaken for diagnostic puncture, resulting in hydatid cyst fluid leak, secondary cultivation spread of disease throughout the whole abdominal or thoracic surgery difficult to eradicate. ② multiple or multi-organ hydatid, or recurrent hydatid disease, the patient is unwilling or can not accept re-(multi) surgeries. ③ patients and the coexistence of old and infirm, or vital organs of the organic diseases, poor tolerance to surgery. ④ by surgical exploration or no cure for advanced liver alveolar hydatid disease, or secondary lung, brain metastasis, drug treatment can relieve symptoms and prolong survival. ⑤ either cystic or alveolar echinococcosis, chemotherapy as an adjuvant before and after surgery can reduce the recurrence rate and improve efficacy.
Zole can be reached after the advent of benzene in the treatment of echinococcosis have to replace the trend of mebendazole, albendazole absorption is better, its serum concentration 100 times higher than that mebendazole. Hydatid cyst fluid concentrations 60 times higher than that mebendazole. For the treatment of cystic echinococcosis, its daily dose of 10 ~ 40mg/kg, 2 times, serve 30 days for a course of treatment, visual condition for several consecutive treatments, which course of treatment is superior to mebendazole, especially in lung hydatid disease better. Alveolar echinococcosis of the country it was suggested that the long-term large doses of albendazole treatment, their daily dose of 20mg/kg, treatment from 17 months to 66 months (mean 36 months) range, after a long-term follow-up and found that CT scans showed significant progress, most of all cases of calcification of the original lesions were cured, the effective rate was 91.7%. Most patients can tolerate for long-term treatment, no serious side effects, but the governance process should follow in the liver, kidney function and bone marrow.Pregnant women hanged.
Mebendazole dose and treatment with different foreign countries. Doses ranging from 20 ~ 200mg/kg per day, usually 40 ~ 50mg/kg per day is appropriate, sub-3 second oral course of treatment in January, rest and a half months and then served another course of treatment, general treatment for 3 months.Also expressed that the treatment of cystic echinococcosis are required to drug 1 in June, while the treatment of alveolar echinococcosis Zexu extended course of treatment, a long time are up to 3 ~ 5 years. Reported mixed effects, some patients with cystic echinococcosis is expected to cure, the efficacy is superior to pulmonary hydatid disease of liver hydatid disease. Mebendazole absorption is poor, usually taking only a 1% absorption of fasting for the sake of improving efficacy, medication should be with the fat meal, absorption of drugs easier and fat together, reportedly associated with fatty meals can be served when the absorption rate of 5% ~ 20%.

From the management source of infection, cut off the transmission proceed to carry out extensive health education and patriotic activities, and vigorously carry out eradication of lice lice prevention, anti-rodent flea activity, enhance the people’s awareness of health and disease control. Epidemic typhus in endemic areas residents can be inactivated vaccine. Endemic typhus polyphyletic distribution, it is only by some in the rodent pathogens operators and personnel to carry out preventive vaccination. For healthcare workers and engaged in rodent control, flea and destroying lice officers, and required to wear protective clothing at work, his neck and wrist openings tightly enclosed, the operation is completed the protective clothing and boil, in order to achieve kill fleas, kill lice and eliminate pathogens purpose.

(A) treatment
Treatment with Q fever pneumonia treated the same, chloramphenicol, tetracycline and doxycycline are special effects. Tetracycline dosage of 2g / d, min 4 times orally. Doxycycline can also be an alternative for adults the amount of chloramphenicol or tetracycline 200mg / d, 2 sub-sub-services. There are tons of domestic 200mg per serving with good curative effect were reported. Treatment is generally 1 week, or the normal body temperature 1 to 2 days after the withdrawal. Associated with bacterial infection should be based on sputum culture and sensitivity results of use of effective antibiotics. For patients with severe nervous system disorders of the coma, swallowing and breathing difficulties, incontinence should strengthen the care, to be tube feeding, oxygen, if necessary, endotracheal intubation, mechanical ventilation, and to ensure airway patency. Complicated by heart failure, shock, heart failure should be actively corrected, anti-shock, accompanied by the necessary oxygen inhalation.
(B) the prognosis
Epidemic typhus in recent years, mostly light, combined with the application of broad-spectrum antibiotics, mortality dropped significantly. As long as the early diagnosis and timely treatment, results were satisfactory prognosis is good.

Pairs of high-risk patients prone to sepsis condition should be closely observed changes in the event of sepsis or suspected signs of illness and decisive when dealing with an active check. On the boil, carbuncle and other skin infections hanged squeeze treatment. Indwelling catheter, if infected with a variety of body need for the timely removal. Burn ward and blood of patients undergoing chemotherapy or bone marrow transplant should be taken strict isolation; infectious diseases, there is room to live or have lived in the ward in patients with sepsis, disinfection and isolation measures should be strengthened to prevent resistant Staphylococcus aureus, Pseudomonas aeruginosa, and fungi, etc. spread. The medical supplies (especially medical devices) and should be thoroughly disinfected, conditional best to use disposable medical supplies. Staff with chronic S. aureus carriers should be temporarily removed from the wards and given medical treatment in order to protect against infection in patients with low resistance. For some patients may consider the application of immunostimulants.

(A) treatment
1. The basis of therapy and symptomatic treatment of sepsis in patients with poor health, symptoms weight, condition must persist for some time, so antibiotic therapy in the application of effects at the same time, need to pay attention to add a variety of vitamins, energy mixture, and even a small amount of blood given to people on many occasions albumin (albumin), plasma or fresh whole blood to supplement the body’s consumption, the supply of energy, better nutrition, to support organ function, and promptly correct water and electrolyte disturbance, maintaining acid-base balance, maintaining a stable internal environment. There is shock, toxemia, toxic myocarditis, and other serious performance, can be step-up drugs, cardiac drugs and (or) short-term adrenal cortex hormones. Severe headache, high fever, irritability can be antipyretic and sedative. Need to strengthen care, attention to the prevention of secondary stomatitis, pneumonia, urinary tract infections and pressure sores and so on.
2. Antimicrobial therapy
(1) The application of the principles of antimicrobial agents:
① timely application of targeted antibacterial drugs is the key to treating sepsis. In the absence of access to the results of bacteriology and drug sensitivity of the situation, to gain time, the first choice medication virtue of clinical experience. After the return to be the result, and then combined with the clinical manifestations and pre-treatment response to be adjusted.
② right in critical condition who wish to select the two kinds of antimicrobial agents in combination (triple or quadruple the need for the application is not).
③ pathogens should be a right to kill, rather than temporary suppression, so antibiotics should be used in sufficient quantities, starting dose should be relatively large, sub-second intravenous drip to vote for, efficacy should long, usually more than 3 weeks, or in the normal body temperature , the symptoms disappeared, and then continue medication for several days. There migratory lesions, in addition to local treatment, systemic agents should also be extended in appropriate circumstances.
(2) the choice of antimicrobial agents:
① staphylococcal septicemia: Due to Staphylococcus aureus can produce β-lactamase strains reached about 90% of penicillin G and therefore their efficacy is poor, while the first third-generation cephalosporins inhibited to varying degrees of β-lactam The role of the enzyme to its sensitive strains of up to 90%, it is often used in Cephalothin, cefazolin, cefotaxime, cefoperazone / sulbactam and so on, can also be combined with Amikacin, Gentamicin Su, the first choice for methicillin-resistant Staphylococcus aureus Vancomycin.
② Gram-negative bacilli sepsis: chloramphenicol, ampicillin. Is now widely resistant. Third-generation cephalosporins such bacteria has a strong antibacterial activity, sensitivity rate is normally greater than 90%, second-generation cephalosporins against Escherichia coli and Klebsiella pneumoniae have antibacterial activity. Therefore, this type of sepsis from the second and third generation cephalosporins to choose one, can be combined with gentamicin or amikacin can also be combined with piperacillin.Application of Pseudomonas aeruginosa sepsis Cefixime ineffective in order to use cefoperazone, cefoperazone / sulbactam better. Or the use of drugs and aminoglycoside antibiotics Wu, efficacy Yehao. Ofloxacin, ciprofloxacin and other quinolones, including Pseudomonas aeruginosa, including G-bacteria have strong antibacterial activity, and are subject to outside influence is small, with other types of antimicrobial agents was no cross-resistance, side effects light, are often clinical use.
③ anaerobic sepsis: Changcheng complex mixed bacterial infection, drug selection should be both facultative anaerobes or aerobes. The drugs are often used chloramphenicol, vancomycin, lincomycin, clindamycin, Carbenicillin, Ampicillin, pull oxygen cephalosporins, ceftizoxime, ceftriaxone, metronidazole, tinidazole, cyclopropane gatifloxacin and ofloxacin, etc..
④ fungal septicemia: 50 years of this century, with amphotericin B treatment of the disease, the drug’s anti-fungal effect is quite strong, but toxic side effects limit the use of. The antifungal drugs have emerged since the ball erythromycin, fluorocytosine, clotrimazole, or for narrow-spectrum anti-fungal, or because of renal toxicity and gastrointestinal reaction to apparent Guchang to two drugs in combination, natural effect is still not ideal, the patient adhere to a long course of treatment has also proved difficult. 80 years have occurred since the miconazole (Daktarin) is a synthetic 1 – phenylethyl imidazole derivatives, against Candida, Aspergillus, Cryptococcus is a new powerful antimicrobial, etc., do not have with other anti-fungal Wu drug use, intravenous, but also capsule, sheath, wound multi-channel delivery. Fluconazole (Diflucan) is a new triazole antifungal agent that can specifically and efficiently inhibit fungal sterol synthesis, and plasma protein binding rate of low-energy penetration to the body fluids, there are two kinds of intravenous and oral dosage forms. Although the two drugs on certain side effects, patients still capable to endure, in the custody of an important organ function under the conditions of application, is now wider. When the fungi and bacterial infections exist, the selection is extremely difficult drug to kill bacteria, fungi proliferation, inhibit the fungi, bacteria will disaster, garlic injection can simultaneously control the growth of fungi and bacteria, should use of, the only role of the more weak, severe infection usually does not work.
3. Other treatments
(1) To use antagonistic inflammatory mediators and oxygen free radical clearance of drugs such as anti-endotoxin monoclonal antibody, IL-1 receptor antagonist, de-glycosides deaminase inhibitors.
(2) topical treatment: The primary or migratory purulent lesions, when mature should be timely and incision and drainage. Purulent pericarditis, arthritis, liver abscess in the drainage of empyema after local injection of antimicrobial agents can be. To have obstruction of the biliary tract, urinary tract infection, you should consider blocking the lifting operation.
(3) the treatment of underlying diseases can not be ignored.
(B) the prognosis
Recent mortality of sepsis is about 30% ~ 40%. Prognostic factors: ① age: the elderly, infants and young children than the case fatality rate of children, youth, middle-aged patients with high. ② Does the hospital infection, nosocomial infection case-fatality rate 75% ~ 85%, infections outside the hospital case-fatality rate 43% ~ 56%, P <0.01, with hospital-acquired infections of multi-resistant strains of the department. ③ the types of pathogens. Pseudomonas aeruginosa and fungal septicemia in a high fatality rate. ④ the amount and severity of complications. ⑤ the basis of severity of the disease and so on.