What is the history of pneumonia in adults?

Pneumonia in adults

Pneumonia is an acute inflammation of the lungs caused by infection. The initial diagnosis is usually based on the chest x-ray.

Causes, symptoms, treatment, prevention and prognosis depend on whether the infection is bacterial, viral, fungal or parasitic; hospital, or hospitalized in a nursing home; develops in an immunocompetent patient or against a background weakened immunity.

Code for the ICD-10 J18 Pneumonia without specifying the pathogen

Epidemiology

Pneumonia is one of the most common infectious diseases. In Europe, the annual number of patients with this diagnosis is between 2 and 15 per 1000 population. In Russia, the incidence of community-acquired pneumonia reaches 10-15 per 1000 population, and in older age groups (over 60 years) - 25-44 cases per 1000 people per year. Approximately 2-3 million people in the US are ill with pneumonia every year, about 4, 00 of them die. This is the most common hospital-acquired infection that has a lethal outcome, and is the most common of the common causes of death in developing countries.

Despite significant progress in diagnosis and treatment, mortality in this disease is increasing. Community-acquired pneumonia is the most common cause of death among all infectious diseases. In the general structure of causes of death, this disease ranks fifth after cardiovascular, oncological, cerebrovascular diseases and COPD, and in the older age group, lethality reaches 10-33%, and among children under 5 years - 25%. Even more high mortality (up to 50%) is characterized by the so-called hospital (hospital or nosocomial) and some "atypical" and aspiration pneumonia, which is due to the highly virulent flora that causes the listed forms of the disease, as well as the rapidly developing resistance to traditional antibacterial medicinal drugs.

The presence of a large number of patients with severe concomitant diseases and certain risk factors, including number of primary and secondary immunodeficiency, has a significant effect on the course and prognosis pneumonia.

Causes of pneumonia

In adults over 30 years, the most frequent pathogens of pneumonia are bacteria, and in all age groups, under all socio-economic conditions and in all geographic areas, Streptococcus pneumoniae. However, pneumonia can cause any pathogens, from viruses to parasites.

The respiratory tract and lungs are constantly exposed to the pathogenic organisms of the environment; upper respiratory tract and the oropharynx are especially colonized by the so-called normal flora, which is safe due to immune defense organism. If pathogens overcome numerous protective barriers, an infection develops.

See also: Inflammation of the lungs

The protective factors of the upper respiratory tract include IgA saliva, proteolytic enzymes and lysozyme, and growth inhibitors produced by normal flora and fibronectin that covers the mucosa and inhibits adhesion. Nonspecific protection of the lower respiratory tract includes cough, clearance of the ciliated epithelium and angular structure of the respiratory tract, which prevents infection of air spaces. Specific protection of the lower respiratory tract is provided by pathogen-specific immune mechanisms, including opsonization of IgA and IgG, anti-inflammatory effects of surfactant, phagocytosis by alveolar macrophages and T-cell immune reactions. These mechanisms protect most people from infection. But in many conditions (for example, in systemic diseases, malnutrition, hospitalization or stay in a nursing home, antibiotic therapy), normal flora changes, its virulence increases (for example, when exposed to antibiotics), or protective mechanisms are broken (for example, when smoking cigarettes, nasogastric or endotracheal intubation). Disease-causing organisms, which in these cases reach the alveolar spaces inhalation, due to contact or hematogenous spreading or aspiration, can multiply and cause inflammation of the pulmonary tissue.

Specific pathogens that cause inflammation of the lung tissue are not excreted in more than half the patients, even with a comprehensive diagnostic study. But, since under similar conditions and risk factors there are certain trends in the nature of the pathogen and the outcome of the disease, pneumonia are classified into out-of-hospital (acquired outside the health facility), hospital (including postoperative and associated with artificial ventilation of the lungs), acquired in nursing homes, and in immunocompromised individuals; this allows you to assign empirical treatment.

The term "interstitial pneumonia" refers to a variety of unrelated states with unknown etiology, characterized by inflammation and fibrosis of pulmonary interstitium.

Community-acquired pneumonia develops in people with limited contact or without contact at all with medical institutions. Streptococcus pneumoniae, Haemophilus influenzae and atypical microorganisms are commonly identified (i.e. e. Chlamydia pneumoniae, Mycoplasma pneumoniae Legionella sp). Symptoms - fever, cough, shortness of breath, tachypnea and tachycardia. The diagnosis is based on clinical manifestations and chest X-ray. Treatment is carried out empirically selected antibiotics. The prognosis is favorable for relatively young and / or healthy patients, but many pneumonia, especially those caused by S. pneumoniae and the influenza virus, are fatal in the elderly and weakened patients.

Many microorganisms cause out-of-hospital pneumonia, including bacteria, viruses and fungi. In the etiologic structure different pathogens prevail depending on the patient's age and other factors, but the relative importance of each as a cause of the out-of-hospital inflammation of the lungs is questionable, since most patients do not undergo a complete examination, but even with a survey, specific agents are detected in less than 50% of cases.

S. pneumoniae, H. influenzae, C. pneumoniae and M. pneumoniae - the most frequent bacterial pathogens. Chlamydia and mycoplasma are clinically indistinguishable from other causes. Frequent viral pathogens are the respiratory syncytial virus (RSV), adenovirus, influenza virus, metapneumovirus and parainfluenza virus in children and influenza in the elderly. Bacterial superinfection may make it difficult to differentiate the viral from bacterial infection.

FROM. pneumoniae causes 5-10% of community-acquired pneumonia and is the second most frequent cause of lung infections in healthy people aged 5-35 years. FROM. pneumoniae is usually responsible for outbreaks of respiratory tract infections in families, educational institutions and military training camps. It causes a relatively benign form, rarely requiring hospitalization. Pneumonia caused by Chlamydia psittaci (ornithosis) occurs in patients with birds.

Reproduction of other organisms causes lung infection in immunocompetent patients, although the term community-acquired pneumonia is commonly used for more frequent bacterial and viral etiologies.

Ku fever, tularemia, anthrax and plague are rare bacterial infections in which there may be severe pneumonia; the last three infectious diseases should raise suspicion of bioterrorism.

Adenovirus, Epstein-Barr virus and Coxsackie virus are widespread viruses that rarely cause pneumonia. Chicken pox and gantavirus cause infection of the lung with chickenpox in adults and gantavirus pulmonary syndrome; A new coronavirus causes severe acute respiratory syndrome.

The most frequent fungal pathogens are Histoplasma (histoplasmosis) and Coccidioides immitis (coccidioidomycosis). Less common are Blastomyces dermatitidis (blastomycosis) and Paracoccidioides braziliensis (paracoccidioidomycosis).

Parasites that cause lung damage in patients in developed countries include Plasmodium sp. (malaria) Toxocara canis or catis (migration of larvae to internal organs), Dirofilaria immitis (dirofipyariosis) and Paragonimus westermani (paragonimiasis).

Symptoms of pneumonia

Symptoms of pneumonia include malaise, coughing, shortness of breath, and chest pain.

Cough is usually productive in older children and adults and dry in infants, young children and the elderly. Dyspnoea is usually mild and occurs with physical activity and is rarely present at rest. Pain in the chest is pleural and localized next to the affected area. Inflammation of the lung tissue can be manifested by pain in the upper abdomen, when the infection of the lower lobe irritates the diaphragm. Symptoms vary in extreme age groups; Infection in infants can manifest as vague irritability and restlessness; in the elderly - as a violation of orientation and consciousness.

Manifestations include fever, tachypnea, tachycardia, wheezing, bronchial breathing, euphony and dullness with percussion. Symptoms of pleural effusion may also be present. Inflammation of the nostrils, the use of extra muscles and cyanosis are frequent in infants.

Signs of pneumonia, as previously thought, differ depending on the type of pathogen, but there are a lot of common manifestations. In addition, none of the symptoms or symptoms are sufficiently sensitive or specific to be able to determine the etiology on its basis. Symptoms may even resemble non-infectious lung diseases, such as pulmonary embolism, neoplasms and other inflammatory processes in the lungs.

Where does it hurt?

Chest pain Chest pain after pneumonia Chest pain with inspiration Chest pain when coughing

What's bothering you?

Shortness of breath Body temperature Chrypses in lungs Cough

Diagnosis of pneumonia

The diagnosis is suspected on the basis of the symptoms of the disease and is confirmed by chest radiography. The most serious condition, mistakenly diagnosed as an inflammation of the pulmonary tissue, is pulmonary embolism, which is more is likely in patients with minimal sputum production, absence of concomitant ARVI or systemic symptoms and risk factors thromboembolism.

When chest radiography is almost always found infiltration of a certain degree of severity; rarely infiltration is absent in the first 24-48 hours of the disease. In general, no definite results of the study distinguish one type of infection from another, although multi-dose infiltrates suggest infection of S. pneumoniae or Legionella pneumophila, and interstitial pneumonia involves viral etiology or mycoplasma.

A generalized blood and electrolyte test, urea and creatinine should be performed by a hospitalized person to determine the degree of hydration and risk. Two blood cultures are done to detect pneumococcal bacteremia and sepsis, as approximately 12% of all patients hospitalized with pneumonia have bacteremia; S. pneumoniae accounts for two thirds of these cases.

Studies are continuing to help determine whether the results of blood cultures are so important for treatment to justify the costs of these analyzes. Pulse oximetry or analysis of arterial blood gases should also be performed.

Usually, there is no evidence to conduct research, including the analysis of sputum, identifying a pathogenic microorganism; exceptions can be made for critically ill patients, suspected drug resistant or unusual microorganism (eg, tuberculosis), and patients whose condition worsens or who do not respond to treatment in for 72 hours. The feasibility of Gram staining and bacteriological examination remains questionable, since samples are often contaminated and their overall diagnostic effectiveness is low. In patients who do not produce sputum, samples can be obtained non-invasively by simple cough or after inhalation of hypertonic saline, or the patient may undergo bronchoscopy or endotracheal suction, which can be easily performed through the endotracheal tube in patients on IVL. In patients with a worsening condition and not responding to broad-spectrum antibiotics, the study should include staining for mycobacteria and for fungi and crops.

Additional studies are appointed under certain circumstances. People with a risk of legionellosis pneumonia (for example, patients who smoke have chronic lung diseases, the age is older 40 years old, receive chemotherapy or take immunosuppressants for organ transplantation) should carry out a urine test for Legionella antigens, which remains positive for a long time after the initiation of treatment, but allows the identification of only L pneumophila serogroup 1 (70% of cases).

A fourfold increase in antibody titers up to>: 28 (or in a single serum upon recovery>: 56) is also considered diagnostic. These tests are specific (95-100%), but not very sensitive (40-60%); Thus, a positive test indicates an infection, but a negative test does not exclude it.

Babies and small children with a possible RSV infection should be promptly examined for antigens in swabs from the nose or throat. There are no other tests for viral pneumonia; Viral culture and serological tests are rarely available at the clinic.

The PCR test (for mycoplasma and chlamydia) is not yet available, but it has good prospects due to its high sensitivity and specificity, as well as speed of execution.

The SARS-associated coronavirus test exists, but its role in clinical practice is unknown, and its use is limited beyond known outbreaks. In rare situations it is necessary to consider the possibility of anthrax.

What it is necessary to survey?

Lungs

How to inspect?

X-ray of the lungs Examination of the respiratory (lung) organs Computed tomography of the chest Study of bronchi and trachea

What tests are needed?

Sputum analysis General blood analysis Antibodies to pneumococcus in serum Antistreptolysin O in serum Antibodies to streptococcus A, B, C, D, F, G in the blood Staphylococcal infections: antibodies to staphylococci in the blood serum Respiratory mycoplasmosis: detection of the Mycoplasma pneumoniae antigen in the direct immunofluorescence Mycoplasma infection: detection of mycoplasmas Chlamydia: detection of Chlamydia trachomatis Influenza A: antibodies to the influenza A and B virus in the blood Antibodies to cytomegalovirus class IgM and IgG in the blood Cytomegalovirus infection: detection of cytomegalovirus HIV / AIDS test HIV infection: detection of the immunodeficiency virus human (PCR vich)

Who to contact?

Pulmonologist

Treatment of pneumonia

Risk assessment is carried out to identify those patients who can safely be treated on an outpatient basis and those who require hospitalization because of a high risk of complications. Prediction should reinforce, not replace, clinical data, as the choice of location of treatment is affected a host of invaluable factors - compliance, ability to self-service and the desire to avoid hospitalization. Hospitalization in OITR is required for patients who need artificial ventilation, and patients with arterial hypotension (systolic blood pressure <90 mm Hg. st.). Other hospitalization criteria in PIT include a respiratory rate of more than 30 / min, PaO2 / on inhaled O2 (PO2) less than 250, multi-lobe inflammation of the lung tissue, diastolic blood pressure less than 60 mm gt; st., confusion and urea of ​​blood more than 1, mg / dl. Adequate treatment includes the fastest possible initiation of antibiotic therapy, preferably no later than 8 hours after the onset of the disease. Supportive treatment of pneumonia includes fluids, antipyretic and analgesic drugs and O2 for patients with hypoxemia.

Because microorganisms are difficult to identify, antibiotics are selected taking into account the likely pathogens and severity of the disease. Agreed recommendations have been developed by many professional organizations. Recommendations should be adapted to the local characteristics of the sensitivity of pathogens, the available drugs and the individual characteristics of the patient. It is important that none of the guidelines have recommendations for the treatment of viral pneumonia.

In bronchiolitis in children caused by RSV, ribavirin and specific immunoglobulin are used in monotherapy and in combination, but data on their effectiveness are inconsistent. Ribavirin is not used in adults with RSV infection. Amantadine or rimantadine orally at a dose of 200 mg once a day, taken within 48 hours of the onset of the disease, reduce the duration and severity symptoms in patients with suspected influenza during the epidemic, but effectiveness in terms of preventing unwanted outcomes of influenza pneumonia is unknown. Zanamivir (10 mg in the form of inhalation twice a day) and oseltamivir (orally 2 times a day for 75 mg, with an extremely severe flow of 2 times 150 mg) are equally effective in reducing duration of symptoms caused by influenza A or B if the reception is started within 48 hours of the onset of symptoms, although zanamivir may be contraindicated in patients with bronchial asthma. Acyclovir 5-10 mg / kg intravenously every 8 hours for adults or 250-500 mg / m2 body surface intravenously every 8 hours for children protects against infection of the lung caused by the varicella virus. If the patient does not begin treatment with antiviral drugs in the first 48 hours from the onset of the disease, then they should be used and to patients with the flu 48 hours after the onset of the disease. Some patients with viral inflammation of the lung tissue, especially those with influenza, develop additional bacterial infections and require antibiotics directed against S. pneumoniae, N. influenzae and Staphylococcus aureus. With empirical therapy, the condition of 90% of patients with bacterial pneumonia improves, which is manifested by a decrease coughing and shortness of breath, normalizing the temperature, reducing pain in the chest and reducing the number of white blood cells. The lack of improvement should cause suspicion of an atypical microorganism, resistance to an antibiotic with an inadequate spectrum action, co-infection or superinfection with a second pathogen, obstructive endobronchial lesion, immunosuppression, distant foci of infection with repeated infection (in the case of pneumococcal infection) or insufficient adherence to treatment (in the case of outpatients). If none of these causes is confirmed, failure of treatment is likely to result from inadequate immune protection.

Treatment for pneumonia of the viral origin is not carried out, since most viral pneumonia is resolved without it.

Patients older than 35 years after 6 weeks after treatment should undergo a second X-ray study; Preservation of an infiltrate causes suspicion of a possible malignant endobronchial formation or tuberculosis.

In addition to treatment

Physiotherapy for pneumonia What to do with pneumonia? Antibiotics for pneumonia Than to treat? Zaxter Paxeladine R-Cynex Saironem Tavanik Fagotsef Fazizhin Hailefloqs Cebopim Zedex Thyme Herb Galavit

Prevention

Some forms of community-acquired inflammation of the pulmonary tissue can be prevented by the use of pneumococcal conjugate vaccine (for patients <2 years), N. influenzae B (HIB) vaccine (for patients <2 years) and influenza vaccine (for patients> 65 years of age). Pneumococcal, HIB and influenza vaccine are also recommended for high-risk patients. High risk patients not vaccinated against influenza can be prescribed amantadine, rimantadine or oseltamivir during flu epidemics.

Forecast

The status of candidates for outpatient treatment usually improves within 24-72 hours. The state of hospitalized patients may improve or worsen, depending on the concomitant pathology. Aspiration is the main risk factor for death, as well as the elderly age, the amount and nature of concomitant pathology and certain pathogens. Death can be caused by pneumonia itself, by progression to a septic syndrome that damages other organs, or by aggravation of underlying co-morbidities.

Pneumococcal infection still causes approximately 66% of all fatal cases of community-acquired pneumonia with a known pathogen. The total mortality in hospitalized patients is approximately 12%. Adverse prognostic factors include age less than 1 year or older than 60 years; involving more than one share; the content of leukocytes in peripheral blood is less than 5000 / μL; concomitant pathology (heart failure, chronic alcoholism, hepatic and renal insufficiency), immunosuppression (agammaglobulinemia, anatomical or functional asplenism), infection with serotypes 3 and 8, and hematogenous spread with positive blood cultures or with extrapulmonary complications (arthritis, meningitis or endocarditis). Infants and children are in a group of special risk for pneumococcal otitis media, bacteremia and meningitis.

Lethality in legionella infection is 10-20% among patients with community-acquired pneumonia and is higher among immunosuppressive or hospitalized patients. Patients who respond to treatment recover very slowly, radiologic changes usually persist for more than 1 month. Most patients require hospitalization, many require respiratory ventilation support and 10-20% die, despite adequate antibiotic therapy.

Mycoplasma pneumonia has a favorable prognosis; almost all patients recover. Chlamydia pneumoniae responds slower to treatment than mycoplasma, and tends to recur after premature discontinuation of treatment. People of young age usually recover, but mortality among the elderly reaches 5-10%.

ilive.com.ua

Symptoms and signs of pneumonia in adults

Is pneumonia dangerous for adults?

Pneumonia is an acute infectious disease that occurs with inflammation of the lung tissue. Inflammation of the lungs remains one of the leading causes of death from respiratory diseases, despite a giant leap in the development of medicine. Symptoms of pneumonia in adults, children and the elderly, as before, make doctors worry about the fate of patients.

In 2006, 591493 cases of pneumonia were detected in Russia, which amounted to 4 ‰ among adults & 8 years. But these figures from official reports do not fully reflect the true picture. The calculations of scientists show that the real incidence of pneumonia in Russia reaches 15 ‰. The absolute number of cases of pneumonia is 1500000 people every year. According to statistics in 2006, pneumonia and its complications claimed the lives of 3, 70 Russian adults.

If elderly patients & g; 0 years there is a chronic concomitant pathology (chronic obstructive pulmonary disease, cancer; alcoholism; diseases of the liver, kidneys, heart and blood vessels; diabetes), then with severe pneumonia, mortality increases to 30%. The highest mortality from pneumonia in Russia is registered in adult men of working age. Typical for Russians, the risk factor for the fatal outcome of pneumonia is later seeking medical help.

Signs that increase the risk of death from pneumonia in adults:

• Male.
• Severe hypothermia before the disease.
• Dyspnea with respiratory rate & g; 8 in 1 min.
• Violation of the mental state of the patient.
• Concomitant diseases - chronic heart failure, decreased immunity, diabetes, atherosclerosis of the heart vessels, oncological processes, chronic renal failure.
• Low blood pressure
• Low body temperature

If patients who died of pneumonia knew the first signs of a dangerous illness and turned to the doctor on time, their lives could be saved.

The first signs and symptoms, indicating an inflammation of the lungs:

• Suddenness of onset of the disease;
• fever (a sharp increase in body temperature & 8 ° C);
• chills (muscle trembling);
• chest pain when coughing and deep breathing;
• dry or unproductive cough with sputum rusty;
• shortness of breath - a feeling of lack of air;
• general weakness and fatigue;
• heavy sweats at night and at the slightest load.

These signs in a person who has fallen ill with a "cold" should alert his relatives, as he is quite likely to diagnose pneumonia. If you suspect an inflammation of the lungs, consult a doctor.

Objective signs of the disease

The doctor, examining the patient, reveals the objective symptoms of pneumonia:

• Dullness of sound when tapping over the affected places of the lungs;
• hard breathing over the inflamed part of the lung tissue;
• listening to wheezing over the site of inflammation.

The main rule that confirms pneumonia is the asymmetry of objective findings, that is, the presence of pneumonia symptoms in only one lung. After the examination, the doctor will prescribe an X-ray of the chest.

X-ray symptoms of pneumonia

The main radiographic evidence of pneumonia is local dimming of the lung in a patient who has symptoms of inflammation of the lower respiratory tract.

X-rays for suspected pneumonia are performed by all patients: children and adults. This mandatory rule is associated with the risk of complications of pneumonia with a delay in the appointment of antibiotics. The consequences of procrastination can be fatal.

Treatment of inflammation of the lungs

The main component of treatment, determining the prognosis, is the correct choice of antimicrobial agent - antibiotic. Treatment of mild cases of inflammation of the lungs in adults can be carried out at home. In addition to antimicrobial drugs, the patient needs a bed rest for the time of fever, abundant warm drink and adequate nutrition. If the patient coughs up phlegm, then cough can be alleviated with the help of expectorants and compresses on the chest.

Diet for a patient with pneumonia is in frequent fractional nutrition, the food should be easily assimilated and fully-fledged in composition.

In case of a serious condition, the patient is treated in a hospital (hospital).

After recovering from pneumonia, the patient is observed at the clinic therapist for 1 year.

Prevention of disease

To prevent the disease will help vaccinate against pneumococcus - the main culprit of the disease. If the vaccine is contraindicated to a patient at risk, you can use drugs such as "vaccine-tablets." Such drugs contain surface proteins of microbial pathogens that enhance immunity. The action of such immunomodulators is regarded as "grafting only without injection. For a competent choice of treatment and prevention of pneumonia, a doctor's consultation is necessary.

ingalin.ru

Is there pneumonia without fever? Pneumonia without fever and cough

Pneumonia is a very dangerous disease, which can lead to complications and disruptions in the work, in the first place, the cardiovascular system. In the presence of such signs as cough, shortness of breath, weakness and high fever, it is not difficult to suspect the presence of such a disease in your presence and to consult a doctor in time.

Does it happen without a fever? It turns out that in some cases this is quite possible. This pneumonia is also called quiet or hidden.

Than the disease is dangerous

To detect this pathology, it is necessary to conduct a thorough diagnosis, the usual listening to the lungs does not reveal latent pneumonia. In addition, even an experienced doctor can not always put the right diagnosis in a disease that is not accompanied by fever and cough, which often leads to disastrous consequences.

Particularly dangerous is pneumonia in children without temperature, since a young child is not yet able to explain his feelings. Therefore, it is desirable for everyone to know the main symptoms of this disease.

Main Risk Factors

Pneumonia without temperature often occurs in people with reduced immunity. The reason for reducing the protective forces of the body may be the presence of a source of chronic infection, such as, for example, inflamed tonsils or untreated teeth. A person with reduced immunity may not even suspect that he has pneumonia without fever, symptoms may be absent for several days. The main sign in this case is shortness of breath. When you try to take a deep breath, a person feels dizzy.

In elderly people, pneumonia without fever and cough can manifest as pain in the chest, which is not always localized in the lungs. Such pain is sometimes similar to muscle pain, so people sometimes go to the doctor with complaints about stretching the muscles.

The most susceptible to this disease are people with a busy life schedule, who work hard without rest and suffer from diseases on their feet.

A good standard of living and adequate nutrition help the body cope with inflammation on its own, but with This is the replacement of affected lungs with connective tissue, and this can cause respiratory insufficiency.

Another cause of the disease is uncontrolled use of antibiotics. With prolonged use of such drugs, the body becomes accustomed to them, which leads to a decrease in the therapeutic effect.

Due to prolonged use of antitussive drugs, pneumonia can develop without temperature and cough. Such drugs suppress the process of sputum discharge from the lungs, which leads to the accumulation of pathogenic flora in the body.

Features of the course of the disease

Sometimes pneumonia happens without a temperature, but is accompanied by a cough. Most often this happens after a long cold, when the person's condition has improved, wheezing in the lungs is not audible, but a small cough persists.

Should be alerted, when such signs occur:

• Cough with abundant or poor sputum lasts more than two weeks;
• increased weakness, decreased appetite, a constant sense of thirst;
• a painful blush. Red spots can appear only on one cheek, from the side of the inflamed lung;
• obstructed, wheezing, which is accompanied by pain in the lower part of the chest. When breathing, the asymmetry of the chest movement is noticeable. Rapid breathing is one of the main symptoms of this disease. The fact is that when the disease develops, the area of ​​a healthy lung becomes smaller, the patient lacks oxygen and compensates this lack with frequent breathing;
• with minimal physical exertion, a person sweats profusely and throws it into fever;
• there are painful sensations in the chest when the body turns.

Diagnostics

The identification and diagnosis of such a disease requires vast medical experience and basic knowledge symptomatology, as pneumonia in adults without a temperature with listening to the lungs is often not is revealed.

To diagnose a doctor, the doctor should ask the patient for complaints, perform an examination of the chest, paying special attention to the symmetry of her movement during inspiration and expiration. Then rattling and listening to the lungs are performed (with inflammation dry and wet wheezing, dull sound in problem areas).

To diagnose this form of the disease requires a general analysis of blood, urine, as well as sputum analysis.

In order to clarify which area of ​​the lung is affected, determine the size of the inflammation focus, and identify possible complications, an X-ray examination is performed. The X-ray diffraction pattern is performed in two projections. The presence of a limited darkening of the lung tissue is the main sign of this pathology.

Unfortunately, sometimes radiographic research is not informative. In this situation, resort to a more accurate method of research - computed tomography of the lungs. Use this method in such cases:

• The roentgenogram does not allow to reveal the center of an inflammation at presence at the person of all signs of a pneumonia;
• with recurrence of the disease (more than 3 times), in the event that the focus of inflammation is in the same lobe of the lungs;
• if the results of the X-ray examination do not match the clinical manifestations of the disease.

In some cases, you may need a bronchoscopy. The study is carried out using a flexible tube with a camera at the end. The tube through the nose is inserted into the lumen of the bronchi. Bronchoscopy is necessary for complicated forms of pneumonia.

Signs of latent pneumonia in children

Pneumonia in children without fever is accompanied by slightly different symptoms than in adults. Parents should be alerted by constant drowsiness and sluggishness of the baby, tearfulness without reason, poor appetite, excessive sweating, blueing of the nasolabial triangle, shortness of breath.

In the presence of such signs it is necessary to immediately show the child to the pediatrician, who will conduct the necessary studies and make an accurate diagnosis.

Treatment

After a complete preliminary examination and conducting all the studies, the doctor will prescribe the necessary treatment. If you have pneumonia without temperature, self-medication in this case is unacceptable.

For the treatment of pneumonia, antibiotics of a broad spectrum of action are usually prescribed. Very often a combination of two antibacterial drugs is required. The course of treatment is at least 7-10 days.

If pneumonia without fever is accompanied by a cough, expectorant and thinning medications are prescribed at the "ACE" Lazolvan Bromhexine ". In patients without cough or with a dry cough, there is no need to use such remedies.

If a person suffers from shortness of breath, it is necessary to use bronchodilators. Inhalation with nebulizer is useful.

In severe forms of pneumonia, immunomodulatory therapy is required, the administration of multivitamins.

10 days after the start of treatment, an X-ray examination is repeated. In case of threat of complications or deterioration of a person's condition, pictures can be taken earlier. Since there is a risk of decomposition of the lungs during a prolonged course of the disease, it is necessary to visit the phthisiatrician.

Treatment with folk remedies

Folk methods of treatment can only be an addition to the main treatment, but not a substitute for it. If you have pneumonia without fever, treatment with any folk remedies is possible only if you are not allergic to them.

It is useful to use honey, as well as large doses of garlic or onions.
Instead of the usual hot drinks, it is good to drink infusions from the leaves of mother-and-stepmother, hips, elderberry, linden flowers, raspberry.

At the stage of recovery is useful infusion of leaves of mother-and-stepmother, plantain, calendula flowers, thyme, licorice. A tablespoon of a mixture of plants is poured into a glass of boiling water and insisted for 30 minutes. Then the medicine should be filtered and taken on a tablespoon 3-4 times a day before meals. This remedy strengthens the immune system, regains strength.

Lifestyle during illness

Pneumonia without temperature requires bed rest. No smoking. The volume of liquid used should be no less than -3 liters per day. Food should be rich in proteins, carbohydrates and vitamins, especially A, B and C.

Many will benefit from breathing exercises. The simplest exercise is inflating balloons. Before you start, you should consult your doctor. In some conditions, breathing exercises are contraindicated.

What can not be done

In no case do not self-medicate with antibacterial drugs (you can use them only after the sputum is examined for sensitivity to a particular series of antibiotics).

Do not heat the chest and body as a whole. You can not take hot baths, bathe in a sauna or a sauna. Do not use antitussive and expectorant drugs without the advice of a doctor.

Do not engage in the usual activities, even if you have pneumonia without temperature. Symptoms of the disease may not be pronounced, but even in this case you can not lead an active lifestyle and give your body increased physical activity.

For the prevention of pneumonia, it is necessary to strengthen the body's immunity and defenses, to eat fully and regularly exercise.

At the first signs of the disease, it is necessary to urgently consult a doctor, because the inappropriate treatment of such a disease can be fatal.

syl.ru

Community-acquired pneumonia: diagnosis, treatment. Prevention of community-acquired pneumonia

Community-acquired pneumonia is considered to be the most common infectious diseases of the respiratory tract. Most often, this ailment causes death from various infections. This occurs as a result of a decrease in the immunity of people and the rapid adaptation of pathogens to antibiotics.

What is community acquired pneumonia?

This is an infectious disease of the lower respiratory tract. Community-acquired pneumonia in children and adults develops in most cases as a complication of a viral infection. The name of pneumonia characterizes the conditions of its occurrence. The person is ill at home, without any contact with the medical institution.

Pneumonia in an adult

Adults most often get pneumonia due to ingestion of bacteria, which are the causative agents of the disease. Community-acquired pneumonia in adults does not depend on geographical zones and socio-economic relations.

Throughout life on the airways and lungs of a person are constantly affected by pathogens: viruses and parasites. On the way to the lungs, bacteria encounter protective barriers, which are represented by the upper respiratory tract and the oropharynx. If these barriers are overcome by pathogenic organisms - bacteria, viruses and fungi, infection begins to develop.

What is pneumonia?

This disease is divided into three types:

1. Light pneumonia is the largest group. She is treated out-patiently, at home.
2. The disease is of medium severity. Such pneumonia is treated in the hospital. The peculiarity of this group is that most patients have chronic diseases.
3. Severe form of pneumonia. She is treated only in the hospital, in the intensive care unit.

Community-acquired pneumonia happens:

• Focal. A small area of ​​the lungs is inflamed.
• Segmental. Characteristic is the defeat of one or at once several parts of the organ.
• The equity. Some part of the body is damaged.
• The total. The defeat is all the lungs.

Community-acquired pneumonia is one-sided and two-sided, right-sided and left-sided.

Symptoms

• The body temperature rises.
• There is a chill and weakness.
• Decreased efficiency and appetite.
• Sweating appears, especially at night.
• The head, joints and muscles aches.
• The consciousness gets confused and the orientation is broken, if the disease is in severe form.
• Pain in the chest.
• Herpes can appear.

• Pain in the abdomen, diarrhea and vomiting.
• Shortness of breath, which occurs during exercise. When a person is at rest, this does not happen.

Causes

Community-acquired pneumonia develops when microbes enter the weakened human body and cause inflammation. The causes of the disease are as follows:

• Subcooling the body.
• Viral infections.
• Concomitant diseases: diabetes, heart, lungs and others.
• Weakened immunity.
• Excessive consumption of alcoholic beverages.
• Long stay on bed.
• Postponed operations.
• Elderly age.

Pathogens of the disease

• Pneumococci (most often the cause of the disease).
• Staphylococci.
• Atypical pathogens: mycoplasma and chlamydia.
• Klebsiella.
• Viruses.
• Pneumocystis.
• Intestinal bacillus.
• Haemophilus influenzae.

Diagnostics

During the examination, it is very important to identify and evaluate the clinical symptoms of the disease, such as fever, chest pain, cough with phlegm. Therefore, if a person has community-acquired pneumonia, the history of the disease is mandatory for every patient. In it, the doctor records all the patient's complaints and appointments. To confirm the diagnosis, a radiological examination is carried out: chest x-ray. Clinical manifestations of community-acquired pneumonia are:

• Cough with discharge of muco-purulent sputum, in which veins of blood are present.
• Pain in the chest during breathing and coughing.
• Fever and shortness of breath.
• Trembling of the voice.
• Chryps.

Sometimes the symptoms differ from those typical for this disease, which makes it difficult to establish the correct diagnosis and determine the method of treatment.

Radiation examination

The patient is assigned radiography if he has community-acquired pneumonia. Diagnosis by the radiation method involves the examination of the organs of the chest cavity in the anterior part of it. The image is taken in a straight and a side view. The patient underwent an X-ray examination as soon as he consulted a doctor, and then half a month after the treatment with antibacterial agents began. But this procedure can be carried out earlier, if the treatment has complications or the clinical picture of the disease has changed significantly.

The main sign of community-acquired pneumonia during X-ray examination is the compaction of lung tissue, a darkening is determined in the picture. If there are no signs of densification, then there is no pneumonia.

Lower-lobe right-sided pneumonia

Many patients go to the hospital when they are disturbed by such symptoms as dyspnoea, cough, accompanied by discharge of mucous sputum, an increase in temperature to 39 degrees, pain with a sensation of tingling on the right side under edge. After hearing complaints of the patient, the doctor examines it, listens and probes where necessary. If it is suspected that the patient has a community-acquired right-sided pneumonia, which, as a rule, occurs much more often (why we pay special attention to it), he is assigned a full examination:

• Laboratory tests: general, clinical and biochemical blood analysis, urine and sputum analysis.
• Instrumental studies, including chest radiography, fibroblochoscopy and electrocardiograms. The form of darkening on the radiographic image allows us to clarify the diagnosis, and fibroscopy - to reveal the involvement of bronchi and trachea in the process of inflammation.

If the results of all tests confirm that the patient has a right-side community-acquired pneumonia, the medical history is supplemented. Before starting therapy, the patient's chart records the results of studies on all indicators. This is necessary in order to carry out its adjustment as necessary.

Laboratory and instrumental studies can show inflammation of the lower right lobe of the lung. This is another story of the disease. Community-acquired lower-lobe pneumonia - this will be the diagnosis. When it is accurately established, the doctor prescribes a treatment that is individual for each patient.

How to treat community-acquired pneumonia?

Patients with this diagnosis can be treated both in a hospital and at home. If a patient has community-acquired pneumonia, the history of the disease is mandatory, regardless of the place of treatment. Patients in out-patient treatment are conventionally divided into two groups. The first refers to people under 60 years of age who do not have concomitant diseases. The second - over 60 or people with concomitant diseases (of any age). When a person has community-acquired pneumonia, treatment is performed with antibacterial drugs.

For patients of the first group, the following are appointed:

• "Amoxicillin" with a dosage of -1 g or "Amoxicillin / Clavulanate" 25 grams at a time. Accepted during the day 3 times.
• An alternative to these drugs may be: "Clarithromycin" or "Roxithromycin" in a dosage of, g, and 5 g, respectively. Take twice a day. Can be appointed "Azithromycin which is taken once a day in the amount of, g.
• If there is a suspicion that the disease is caused by an atypical pathogen, the doctor may prescribe "Levofloxacin" or "Moxifloxacin" in g, g, g, respectively. Both drugs are taken once a day.

If patients of the second group have community-acquired pneumonia, the treatment is performed using the following drugs:

• "Amoxicillin / clavulanate" is prescribed three times a day for, 25 g or twice a day for 1 g, "Cefuroxime" should be taken in an amount, g at one time twice a day.
• Alternative drugs may be prescribed: "Levofloxacin" or "Moxifloxacin" in g, g, g, respectively, once a day per day. "Ceftriaxone" is prescribed for 1-2 grams intramuscularly, too, once a day.

Treatment of the disease in children

Community-acquired pneumonia in children with uncomplicated form of the disease, depending on age, is treated with the following drugs:

• Children under 6 months are prescribed: "Josamycin" twice a day for a week in the calculation of 20 mg per one kilogram of body weight. Maybe "Azithromycin" - the daily norm should not exceed 5 mg per kilogram of body weight, the duration of treatment - 5 days.
• Children under the age of 5 years are prescribed "Amoxicillin" inside 25 mg / kg twice a day, the duration of treatment is 5 days. Can appoint "Amoxicillin / clavulanate" in recalculation per kilogram of body weight 40-50 mg or "Cefuroxin aksetil" dosage of 20-40 mg / kg, respectively. Both drugs are taken twice a day, the duration of treatment is 5 days.
• Children older than 5 years are prescribed "Amoxicillin" with a dosage of 25 mg / kg in the morning and in the evening. If there are suspicions of SARS, prescribe "Josamycin" inside, increasing the dosage to 40 mg / kg per day for a week or "Azithromycin" according to the scheme: 1 day - 10 mg / kg, then 5 mg / kg for 5 days. If there is no positive result in treatment, you can replace "Amoxicillin" at a rate of 50 mg / kg once a day.

Preventive measures for the prevention of disease

Preventive maintenance of community-acquired pneumonia is carried out using pneumococcal and influenza vaccines. If necessary, they are injected simultaneously, only in different hands. For this purpose, a 23-valent unconjugated vaccine is used. It is introduced:

• People who are over 50 years old.
• Persons living in nursing homes.
• Adults and children with chronic lung, heart and vascular disease or under constant medical supervision.
• Children and adolescents (from six months to adulthood) who have been taking aspirin for a long time.
• Pregnant women 2-3 rd term.
• Doctors, nurses and the rest of the hospital staff and outpatient clinics.
• Employees of nursing departments.
• To family members of those people who are at risk.
• Medical workers caring for the sick at home.

Prevention of community-acquired pneumonia is:

• The correct way of life, which involves exercise, regular long walks in the fresh air, active rest.
• A balanced healthy diet with a normal content of proteins, vitamins and trace elements.
• Annual vaccination of children and adults against influenza, which is done before the onset of the cold season. Very often, the flu gives a complication. A person gets pneumonia, which is difficult.
• Life without hypothermia and drafts.
• Daily cleaning and airing of the room.
• Frequent washing of hands and rinsing of nasal passages.
• Restriction of contacts with patients with ARI.
• In the period of mass spread of infection, the intake of honey and garlic. They are excellent immunostimulating agents.
• If you become infected with flu yourself or your child, do not self-medicate, but call a doctor.

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