Causes of acute pneumonia and its treatment
Pneumonia acute is an inflammation of the lung tissue, leading to the development of respiratory failure and disruption of the gas exchange process. This ailment can manifest itself in two forms: in the form of an independent disease or in the form of complications accompanying other pathologies.
Causes of the disease
Pneumonia of any form is transmitted mainly by airborne droplets. This happens when there are pathogenic bacteria, microorganisms and intracellular parasites in the body: streptococci, viruses, intestinal and hemophilic rods, chlamydia, legionella, fungi Candida and others pathogens. In addition, scientists identify a number of reasons associated with the emergence and development of the presented pathology. To them it is customary to include the following factors:
- Incorrect food.
- General weakening of immunity.
- Abuse of alcoholic beverages.
- Chronic diseases of the respiratory system.
- Pulmonary pathology.
- Chronical bronchitis.
- Defeat of the immune system.
- Infections of a viral nature.
- General hypothermia of the body.
- Chronic fatigue.
- Exhaustion of the body.
- Diseases of the endocrine system.
- Drug use.
- Cardiovascular diseases.
- Postponed severe illness.
- Unfavorable ecological environment.
- Postponed surgical operations.
- Age factor (the youngest children and elderly people are most susceptible to this type of pathology).
- The presence of foci of chronic infection in the body.
Acute pneumonia in children can be triggered by a number of the following reasons:
- Presence of intrauterine infections acquired during embryonic development.
- Congenital heart defect.
- Pulmonary pathology.
- Presence of congenital perinatal pathologies.
- Chronic infectious diseases.
- Propensity to allergic reactions.
- Lymphatic-hypoplastic diathesis.
- Premature birth of the fetus.
- Absence of necessary sanitary and hygienic conditions.
- Congenital defectiveness of the bronchi.
- The presence of herpesvirus in the body of a newborn baby.
Symptoms of the disease
For the early stage of the pathological process, the following symptoms are characteristic:
- Permanent cough with a tendency to build up.
- Increased body temperature.
- General worsening of the patient's condition, resembling colds and lasting more than a week.
- Blanching of the skin.
- Lack of positive results in treatment.
- When taking medications with paracetamol content, the patient's body temperature does not go down.
- Painful sensations in the joints.
- Increased fatigue.
- Constant absence of appetite.
- progressive dry cough;
- attacks of suffocation;
- the appearance of purulent or mucous discharge;
- strong pain in the affected lung;
- general intoxication of the body;
- development of respiratory failure;
- respiratory acidosis;
- a sharp decrease in the level of oxygen in the blood;
- reduction of cellular immunity;
- weakening and obstruction of the respiratory process;
- the appearance of characteristic wheezing during breathing.
Acute pneumonia in young children is characterized by heart rhythm disturbances, swelling of the wings of the nose and retraction of intercostal spaces in the process of breathing.
Possible consequences and complications
Acute pneumonia often leads to the development of concomitant diseases and complications. To those it is customary to include:
- Asthmatic segment.
- Pulmonary edema.
- Infectious-toxic shock.
- Endocarditis is infectious.
- The development of so-called intoxication psychosis.
- Allergic myocarditis.
- Development of the DIC syndrome.
It should be clarified that acute pneumonia is a fairly serious disease, in fourth place in terms of mortality.Therefore, when the first signs of this inflammatory process appear, you should immediately consult a doctor.
Methods of diagnosisThe disease is diagnosed after a general medical examination and a clinical picture. However, the symptomatology of pneumonia is largely similar to the signs of tuberculosis. Therefore, in order to avoid a medical error and to order an extremely accurate diagnosis, the patient is assigned the following types of studies:
- General blood analysis.
- Analysis of urine.
- Magnetic resonance imaging.
- Ultrasound diagnosis.
- Bacteriological analysis of fluids from the patient's body.
- Radiography. It is the main diagnostic procedure necessary for determining acute pneumonia. In the presence of this inflammatory process, X-ray images clearly show darkening of the pulmonary sites, the size of which largely depends on the degree of severity and neglect of the disease.
- CT scan.
Treatment of pulmonary disease should be comprehensive and selected individually in each case. In many respects this depends on the patient's age, the form of the course, the degree of severity of the disease, as well as on the presence or absence of concomitant complications. In most cases, patients are hospitalized, but even with home treatment, the patient needs complete rest and bed rest. To combat the acute form of pneumonia, the following therapies are usually used:
- Antibacterial, intended for the destruction of pathogens with the help of certain types of antibiotics.
- Drug treatment, consisting in the reception of antiseptics, spasmalgics, sedatives, antihistamines, vascular and analgesic drugs.
- Vitaminotherapy (especially important is the intake of drugs with a high content of vitamins B and C).
To the process of recovery was the fastest and most successful, the patient should to limit physical and mental loads, to get enough sleep, to avoid hypothermia and stressful situations.
In addition, it is necessary to organize a full-fledged rational diet with a predominance of foods rich in fiber, carbohydrates and proteins. There is also an abundant drink. During treatment, the patient is recommended to drink at least, l of liquid per day.
Treatment of an acute form of pneumonia is a fairly complex and long-term process. However, with timely diagnosis and strict adherence to all medical recommendations of a significant improvement of the condition with a partial restoration of the patient's working capacity can be achieved in 3 to 4 of the week.
Prevention of inflammation of the lungs is mainly due to the following recommendations:
- Balanced diet.
- Rejection of bad habits.
- Compliance with personal hygiene.
- Total hardening of the body.
- The use of drugs designed to strengthen the immune system.
- Prompt elimination of respiratory infections in acute form.
- Vaccination against influenza, as well as against some varieties of streptococci.
The general prognosis of pneumonia with the necessary surgical treatment is quite favorable, and in most cases there is an absolute recovery of the patient. If you do not take the necessary measures and allow the development of concomitant pathological processes, the consequences can be serious, even to a lethal outcome.
Acute pneumonia in children
Acute pneumonia in children - acute inflammatory disease of the lungs with the reaction of the vascular system in the interstitial tissue and disorders in the microcirculatory bed, with local physical symptoms, with focal or infiltrative changes on the roentgenogram, having a bacterial etiology, characterized by infiltration and filling of alveoli with exudate containing predominantly polynucleated neutrophils, and manifested by a common response to infection.
The incidence of pneumonia is about 15-20 per 1000 children of the first year of life and about 5-6 - per 1000 children over 3 years of age per year.
Pneumonia can occur as a primary disease or secondary, complicating other diseases.
According to the accepted classification (1995), according to morphological forms distinguish focal, segmental, focal, drainage, croup and interstitial pneumonia. Interstitial pneumonia is a rare form in pneumocystis, sepsis and some other diseases. Isolation of morphological forms has a certain prognostic significance and can influence the choice of starting therapy.
The nature of the pathogen and its drug sensitivity largely depend on the conditions in which infection occurred. This makes it expedient to isolate the following major groups of pneumonia. In each group the most likely pathogens are indicated:
- community-acquiredpneumonia: pneumococcus, hemophilic rod, staphylococcus, streptococcus, mycoplasma, chlamydia, legionella, viruses;
- interliningpneumonia: staphylococcus, E. coli, Klebsiella, Proteus, pseudomonas, viruses;
- with perinatal infection: chlamydia, ureaplasma, cytomegalovirus, viruses;
- in patients with immunodeficiency: various bacteria, pneumocysts, fungi, cytomegalovirus, mycobacteria, viruses.
Causes of acute pneumonia in children
Typical bacterial pathogens of community-acquired pneumonia in children are Streptococcus pneumoniae, Haemophilus influenzae, less often - Staphylococcus aureus; so-called atypical pathogens - Mycoplasma pneumoniae, Legionella pneumophila - play a certain role. In children in the first months of life, pneumonia is caused more often by Haemophilus influenzae, Staphylococcus, Proteus and less often by Streptococcus pneumoniae. Viral pneumonia is much less common, respiratory syncytial viruses, influenza and adenoviruses can play a role from viruses in the etiology. The respiratory virus causes the destruction of cilia and ciliated epithelium, a violation of mucociliary clearance, edema of interstitium and interalveolar septa, alveoli, hemodynamic disorders and lymphocirculation, impaired vascular permeability, that is, it has a "dressing" effect on the mucous membranes of the lower respiratory ways. It is also known immunosuppressive effect of viruses.
Risk factors for pneumonia
Intrauterine infections and ZVUR, perinatal pathology, congenital malformations of the lungs and heart, prematurity, immunodeficiency, rickets and dystrophy, polyhypovitaminosis, the presence of chronic foci infections, allergic and lymphatic-hypoplastic diathesis, unfavorable social conditions, contacts when visiting preschool institutions, especially in children under 3 years old age.
Causes of acute pneumonia in summer
Symptoms of acute pneumonia in children
The main way of penetration of the infection into the lungs is bronchogenic with the spread of the infection along the course of the respiratory tract to the respiratory department. The hematogenous pathway is possible with septic (metastatic) and intrauterine pneumonia. The lymphogenous path is a rarity, but on the lymphatic pathways the process passes from the pulmonary focus to the pleura.
SARS play an important role in the pathogenesis of bacterial pneumonia. Viral infection increases the production of mucus in the upper respiratory tract and reduces its bactericidal activity; violates the mucociliary apparatus, destroys epithelial cells, reduces local immunological protection, which facilitates the penetration of bacterial flora into the lower respiratory tract and promotes the development of inflammatory changes in the lungs.
Symptoms of pneumoniadepend on the age, morphological form, causative agent and premorbid background of the child.
In young children, focal community-acquired pneumonia is more common, caused by Streptococcus pneumoniae or Haemophilus influenzae. Pneumonia in young children is more likely to develop during ARVI and in most cases during the first week of a viral illness.
Symptoms of pneumonia are characterized by the appearance and growth of phenomenaintoxication:lethargy, adynamia, tachycardia, not corresponding to a fever, pallor of the skin, restless sleep, anorexia, may be vomiting. Appears febrile temperature more than 3-4 days (after 1-2 days of decline in the background of acute respiratory viral infection), cyanosis in the nasolabial triangle (early symptom), cough becomes deep and wet. An important diagnostic symptom of pneumonia in young children is the change in the ratio of the respiratory rate to the pulse (from 5 to 5 at the norm:), while in the act respiratory involvement involved auxiliary muscles - swelling of the wings of the nose, the retraction of intercostal spaces of the jugular fossa in the absence of bronchial obstruction syndrome. In severe condition, breathing becomes moaning, groaning.
Symptoms of acute pneumonia
Where does it hurt?Pain in the chest Pain in the chest in children Pain in the chest in children
What's bothering you?Coughing Cramps in the lungs High fever in the baby Shortness of breath
What it is necessary to survey?Lungs
How to inspect?X-ray of lungs Examination of respiratory (lung) organs Computed tomography of thorax
What tests are needed?Sputum analysis Complete blood count
Who to contact?Pulmonologist Pediatrician
Treatment of acute pneumonia in children
Basic principlesantibiotic therapythe following:
- etiotropic therapy with an established diagnosis or with a serious condition of the patient begin immediately, when doubting the diagnosis of a non-severe patient, the decision is made after radiography;
- indications for the transition to alternative drugs is the lack of clinical effect of the drug of the first choice in during 36-48 hours with mild and 72 hours with severe pneumonia; development of undesirable side effects from the drug of the first choice;
- pneumococci are resistant to gentamicin and other aminoglycosides; therefore, community-acquired pneumonia therapy with antibiotics of this group is unacceptable;
- in uncomplicated, light pneumonia, preference should be given to prescribing drugs per os, replacing them with parenteral introduction with inefficiency; if therapy was started parenterally, after a drop in temperature, you should switch to taking an antibiotic per os;
- after a course of antibiotic therapy, it is advisable to prescribe biological products.
Other types of pneumonia treatment
Bed rest is indicated for the entire febrile period. Food should be age appropriate and must be full.
- The volume of fluid per day for children up to a year, including breast milk or milk mixtures, is 140-150 ml / kg of body weight. It is advisable to give 1/3 of the daily volume of liquid in the form of glucose-salt solutions (rehydron, oralite), which in 80-90% of patients allows to refuse from infusion therapy.
- If necessary (exsicosis, collapse, disturbance of microcirculation, threat of DIC syndrome), a third of the daily volume is injected into the vein. With excessive infusion of crystalloids, it is possible to develop pulmonary edema.
- In the room where the child is, there must be a cool (18-19 ° C), moistened air, which helps to reduce and deepen breathing, and also reduces the loss of water.
- Antipyretics are not prescribed, as this can make it difficult to evaluate the effectiveness of antibiotic therapy. The exception is children who have premorbid indications for lowering body temperature.
- The appointment of microwave in the acute period (10-12 sessions), inductothermy; electrophoresis with 3% potassium iodide solution.
- Massage and exercise therapy are necessary immediately after the temperature is normalized.
- In the hospital children are placed in a separate box. A child can be discharged from the hospital immediately after reaching a clinical effect in order to avoid a cross infection. Preservation of increased ESR, wheezing in the lungs or residual radiographic changes is not a contraindication to discharge.
Treatment of acute pneumonia
- Pneumonia - Treatment regimen and nutrition
- Antibacterial drugs for the treatment of pneumonia
- Pathogenetic treatment of pneumonia
- Symptomatic treatment of pneumonia
- Fighting complications of acute pneumonia
- Physiotherapy, exercise therapy, respiratory gymnastics with pneumonia
- Sanatorium treatment and rehabilitation for pneumonia
Treatment of complications of pneumonia in children
Whenrespiratory insufficiencyoxygenate through the nasal cannula. The optimal method of oxygen therapy is spontaneous ventilation of an oxygen-enriched gas mixture with a positive end-expiratory pressure. An obligatory condition for successful oxygen therapy is cleansing of the airways after application of mucolytic agents, stimulation of cough and / or removal of sputum by sucking.
Pulmonary edemausually develops with excessive infusion of crystalloids, so stopping the infusion is a prerequisite for its treatment. In severe condition, the ventilator is operated in the positive exhalation pressure mode.
Intra-pulmonary cavities and abscessesafter self-emptying or surgery, are usually well suited to conservative treatment. The strained cavities are drained or the bronchoscopic occlusion of the leading bronchus is performed.
Heart failure.Of cardiac agents in emergency cases, intravenously administered strophanthin (ml, 5% solution per year of life) or korglikon (5 ml, 6 ml, 6% solution per year of life). When energetically-dynamic heart failure is shown, the inclusion in the therapy of panangin, corticosteroids use as a means to combat shock, cerebral edema, cardiopathy, pulmonary edema and impaired microcirculation. Immunotherapy of directed action is performed with severe pneumonia of a certain etiology (for example, staphylococcal).
DIC-Syndromeis an indication for the appointment of freshly frozen plasma, heparin (100-250 units / kg / day. depending on the stage).
Preparations of ironwith a decrease in hemoglobin in the acute period is not prescribed, because infectious anemia is adaptive and is usually resolved spontaneously at the 3-4th week of the disease.
Blood transfusionspend only on vital indications at purulent destructive process at children with hemoglobin below 65 g / l, and also at the septic patients.
Rehabilitation of children who have had pneumonia, it is better to spend in a sanatorium. The gradual increase in physical activity, exercise therapy in combination with respiratory gymnastics is shown.
- a complex of social and hygienic measures;
- rational nutrition, hardening, improving the ecology of the dwelling;
- prevention of ARVI, vaccine prophylaxis of pneumonia (conjugated vaccine againstN. influenzae,pneumococcus, vaccine prophylaxis of influenza);
- prevention of nosocomial pneumonia (hospitalization in boxes).
In addition to treatmentPhysiotherapy for pneumonia What to do with pneumonia? Antibiotics for pneumonia
Pneumonia in adults
Pneumonia is an acute inflammation of the lungs caused by an 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
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 treatmentPhysiotherapy 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
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.
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%.
The first signs of pneumonia in children and adults
Pneumonia is a disease that has an infectious origin and is characterized by inflammation of the lung tissue in the event of provoking physical or chemical factors such as:
- Complications after viral diseases (influenza, ARVI), atypical bacteria (chlamydia, mycoplasma, legionella)
- Effects on the respiratory system of various chemical agents - poisonous fumes and gases (see. chlorine in household chemicals is hazardous to health)
- Radioactive radiation, to which infection is attached
- Allergic processes in the lungs - allergic cough, COPD, bronchial asthma
- Thermal factors - hypothermia or burns of the respiratory tract
- Inhalation of liquids, food or foreign bodies can cause aspiration pneumonia.
The cause of the development of pneumonia is the emergence of favorable conditions for the multiplication of various pathogenic bacteria in the lower respiratory tract. The original causative agent of pneumonia is the aspergillus mushroom, which was the culprit of the sudden and mysterious deaths of researchers of the Egyptian pyramids. Owners of domestic birds or lovers of urban pigeons can get chlamydial pneumonia.
For today, all pneumonia is divided into:
- out-of-hospital, arising under the influence of various infectious and non-infectious agents outside the walls of hospitals
- hospital, which cause hospital-acquired microbes, often very resistant to traditional antibiotic treatment.
The frequency of detection of various infectious agents in community-acquired pneumonia is presented in the table.
|Causative agent||Average% detection|
|Streptococcus is the most frequent pathogen. Pneumonia caused by this pathogen is the leader in the frequency of death from pneumonia.||3, %|
|Mycoplasma - affects most children, young people.||1, %|
|Chlamydia - chlamydial pneumonia is typical for people of young and middle age.||1, %|
|Legionellae - a rare pathogen, affects weakened people and is the leader after streptococcus by frequency of deaths (infection in rooms with artificial ventilation - shopping centers, airports)||, %|
|Hemophilus rod - causes pneumonia in patients with chronic bronchial and lung diseases, as well as in smokers.||, %|
|Enterobacteria are rare pathogens, affecting mainly patients with renal / hepatic, cardiac insufficiency, diabetes mellitus.||, %|
|Staphylococcus is a frequent pathogen of pneumonia in the elderly population, and complications in patients after the flu.||, %|
|Other pathogens||, %|
|The causative agent is not installed||3, %|
When the diagnosis is confirmed, depending on the type of pathogen, the patient's age, the presence of concomitant diseases, a corresponding therapy, in severe cases, treatment should be performed in a hospital setting, with mild forms of inflammation, hospitalization of the patient is not is required.
Characteristic first signs of pneumonia, the vastness of the inflammatory process, acute development and danger of serious complications in untimely treatment - are the main reasons for the urgent circulation of the population for medical help. At present, a sufficiently high level of medical development, improved diagnostic methods, and a huge the list of antibacterials of a wide spectrum of action has considerably lowered a death rate from an inflammation of lungs (cm. antibiotics for bronchitis).
Typical first signs of pneumonia in adults
The main symptom of the development of pneumonia is a cough, usually it is first dry, obtrusive and persistent. protivokashlevye, expectorants with a dry cough), but in rare cases cough at the beginning of the disease can be rare and not strong. Then, as the inflammation develops, the cough becomes pneumatic with pneumonia, with a discharge of mucopurulent sputum (yellow-green color).
Any catarrhal virus disease should not last more than 7 days, and a sharp deterioration of the condition later 4-7 days after the onset of an acute respiratory viral infection or influenza indicates the onset of an inflammatory process in the lower respiratory ways.
Body temperature can be very high up to 39-40C, and can remain subfebrile 3, -3, C (with atypical pneumonia). Therefore, even with a low body temperature, coughing, weakness and other signs of malaise, you should definitely consult a doctor. Caution should be a repeated temperature jump after a light gap during the course of a viral infection.
If the patient has a very high temperature, one of the signs of inflammation in the lungs is the inefficiency of antipyretic drugs.
Pain with deep breath and cough. The lung itself does not hurt, as it is devoid of pain receptors, but involvement in the pleura process gives a pronounced pain syndrome.
In addition to cold symptoms, the patient has dyspnea and pale skin.
General weakness, increased sweating, chills, decreased appetite are also characteristic for intoxication and the onset of the inflammatory process in the lungs.
If such symptoms appear either in the midst of a cold, or a few days after the improvement, these may be the first signs of pneumonia. The patient should immediately consult a doctor to undergo a complete examination:
- To pass blood tests - general and biochemical
- To make a roentgenography of a thorax, if necessary and a computer tomography
- Sputum for culture and sensitivity of the pathogen to antibiotics
- Sputum for culture and microscopic determination of mycobacterium tuberculosis
The main first signs of pneumonia in children
Symptoms of pneumonia in children have several characteristics. Attentive parents may suspect the development of pneumonia with the following discomforts in the child:
Body temperature above 38C, lasting for more than three days, not knocked down by antipyretics, there may also be a high temperature of up to 3, especially in young children. At the same time, all signs of intoxication are manifested - weakness, increased sweating, lack of appetite. Small children (as well as elderly people), can not give high temperature fluctuations with pneumonia. This is due to imperfect thermoregulation and immaturity of the immune system.
There is frequent shortness of breath: in children up to 2 months of age, 60 breaths per minute, up to 1 year, 50 breaths, after a year, 40 breaths per minute. Often the child spontaneously tries to lie down on one side. Parents may notice another sign of pneumonia in the child, if you undress the baby, then when breathing from the patient lung can be noticed the retraction of the skin in between the ribs and the lag in the process of breathing one side of the chest. There may be irregular breathing rhythm, with periodic stops of breathing, changes in the depth and frequency of breathing. In infants, shortness of breath is characterized by the fact that the child begins to nod his head in time with the breath, the baby can stretch his lips and inflate his cheeks, foamy discharge from the nose and mouth can appear.
- Atypical pneumonia
Inflammation of the lungs caused by mycoplasma and chlamydia differ in that first the disease passes like a cold, there is a dry cough, runny nose, swelling in the throat, but the presence of dyspnea and a stably high temperature should alert parents to the development pneumonia.
- Character of cough
Because of the perspiration in the throat, only coughing can appear first, then the cough becomes dry and painful, which is amplified by crying, feeding the baby. Later, the cough becomes wet.
- Behavior of the child
Children with pneumonia become capricious, whiny, sluggish, they are disturbed by sleep, sometimes can completely refuse to eat, and also to appear diarrhea and vomiting, in babies - regurgitation and rejection of breasts.
- Blood test
In the general analysis of blood, changes are detected that indicate an acute inflammatory process - increased ESR, leukocytosis, neutrophilia. Shift of the leukoformula to the left with increasing stab and segmented leukocytes. In viral pneumonia, along with high ESR, there is an increase in leukocytes due to lymphocytes.
With timely access to a doctor, adequate therapy and proper care for a sick child or adult, pneumonia does not lead to serious complications. Therefore, at the slightest suspicion of pneumonia, the patient should be given medical care as soon as possible.
Symptoms of pneumonia of the lungs
Before discussing the symptoms of pneumonia, it is necessary to understand a little the nature of the disease and clarify the meaning of terms describing the inflammatory processes in the lungs.
The nature of the disease and its causesUntil the beginning of the 21st century, Soviet medicine extended the expanded interpretation of the term "pneumonia." It was used to describe any acute focal inflammation of the lung tissue regardless of the cause. In the Russian classification of the disease "acute pneumonia" there were isolated such forms as "pneumonia from exposure chemical and physical factors allergic pneumonia infectious-allergic pneumonia "and others options.
Currently, in accordance with international standards, the term "pneumonia" refers to acute infectious diseases of the pulmonary tissue of predominantly bacterial nature. It is characterized by a local (focal) lesion of the respiratory tissue of the lung with the swelling of the inflammatory fluid into the pulmonary vesicles. Symptoms of inflammation in the lung tissue are revealed when the patient is examined by a doctor and an x-ray examination of the chest organs. For inflammation of the lungs are characterized by: acute febrile reaction (fever) and severe intoxication.
Since this disease by definition is an acute infectious disease, the definition of "acute" before the word "pneumonia" in the diagnosis became redundant and out of use.
Is there a chronic pneumonia?
The term "chronic pneumonia" in modern medicine is also not used, as it lost a real clinical basis. "Chronic pneumonia" of the 20th century was divided into several diseases of different nature. To distinguish them was made possible by improving the methods of examination and the progress of medical science. Chronic inflammatory reaction in the pulmonary ways takes place with all these diseases, which have received separate names and special methods of treatment. The most common of these is chronic obstructive pulmonary disease - a constant companion of tobacco smokers. Chronic bacterial infection is also characteristic of bronchiectasis.
What external signs does pneumonia have?The first symptoms of inflammation of the lungs, which tell patients:
- sudden onset of the disease;
- acute fever (body temperature increase 8 8 ° C);
- tremendous chills;
- acute chest pain, worse with coughing and breathing;
- cough dry or unproductive;
- expectoration of a rusty color in a small amount;
- pronounced general weakness, fatigue;
- sweating at night and with minimal physical exertion.
The thought of pneumonia should occur when a combination of body temperature increases with complaints of coughing, sputum separation, dyspnea, chest pain. Also, patients with pneumonia, complain of unmotivated weakness, fatigue, increased sweating at night.
How to recognize the latent form of the disease?
Almost in all age categories - in children, adolescents and adults, inflammation of the lungs has a similar clinical picture. But it is possible and hidden, sluggish form of the disease. Symptoms such as chest pain with coughing, fever and other signs may not be present in weakened adolescents or adults.
The latent symptomatology of pneumonia can be observed in the elderly. In 25% of patients aged> 65 there is no increase in body temperature, and the disease can manifest as fatigue, weakness, nausea, lack of appetite, abdominal pain, impaired consciousness.
Objective signs of inflammation of the lungs
The next stage of diagnosis of the disease after questioning is examination of the patient, revealing the objective symptoms of pneumonia. These are signs of a disease that the doctor finds in the patient when examining, tapping the chest (percussion) and listening to the lungs (auscultation).
Classical objective symptoms are:
- Stupidity of percussion sound when tapping over inflamed areas of the lungs.
- Listening to hard breathing over a limited area of the lung tissue at the site of inflammation.
- Local listening to sonorous small bubbling rales over the inflamed area of the lung.
The main criterion that confirms pneumonia is the asymmetry of the lesion, that is, the presence of objective signs of inflammation of the lungs only on one side of the chest.
In almost 20% of cases, objective signs of pneumonia in patients may differ from the classical ones or absent. In these cases, latent symptoms can lead to diagnostic errors. Fortunately, in the arsenal of doctors there is a way to detect the inflammation of the lungs with the help of X-rays.
X-ray signs of pneumoniaThe main x-ray symptom of pneumonia is a local compaction (infiltration) of lung tissue found in a patient with external signs of acute inflammation of the respiratory system.
The consolidation of the pulmonary tissue in pneumonia usually has a one-sided nature. Two-sided infiltration is rare. This symptom is more typical for swelling of the lungs, metastases of malignant tumors, systemic connective tissue diseases with respiratory organs.
An x-ray study with suspicion of pneumonia is conducted in all patients without exception: newborns, adolescents, adults, pregnant and lactating women, elderly people. This rule is associated with the danger of a diagnostic error, high mortality when delayed in prescribing antibiotics for patients with pneumonia.
Symptoms of viral pneumonia
Acute viral respiratory infection and pneumonia itself are various diseases. Viral infection, of course, is a leading risk factor for inflammation of the lungs. However, painful changes in the lung tissue caused by respiratory viruses should be clearly delimited from pneumonia. After all, the treatment of these conditions is fundamentally different. True microbial pneumonia is qualitatively different from that of lungs by viruses, which is characterized by bilateral infiltration along the way of the pulmonary vessels.
Viral infection, especially highly pathogenic influenza ("pork "avian"), can occur in the form of bilateral lung damage with inflammation in the course of the pulmonary vessels. At laboratory confirmation of the presence of highly pathogenic influenza virus in the patient's sputum and the absence of other pathogens in it, the diagnosis of viral pneumonia is justified.
The first significant symptoms of viral influenza pneumonia are rapidly increasing dyspnoea, an increase in temperature bodies to very high figures (9 9 ° C), a painful cough with bloody frothy sputum, a sharp general weakness. Influenza pneumonia is a very dangerous condition requiring treatment in the intensive care unit.
What is croupous pneumonia?
The term "croup pneumonia" is a traditional name for pneumococcal pneumonia, which has all the classic symptoms of lung inflammation in its entirety. Croup pneumonia is practically the only of all forms of this disease, in which a preliminary diagnosis corresponds to an aetiological (pneumococcal infection).
Croupous pneumonia develops sharply, beginning with a tremendous chill and a swift rise in body temperature to 39-40 ° C. An early sign is the appearance of chest pain on the side of the lesion, which is sharply aggravated by deep inhalation or coughing. First, the cough is dry, then on the second or third day of the disease, rusty or brown sputum appears. Characteristic signs are reddening of the face, especially on the side of the lesion, frequent shallow breathing to 30 per minute and more. Croup pneumonia usually affects one lung (usually the right one) and can capture 1, 2 or 3 lobes.
Atypical pneumonia in adolescentsThe term "atypical pneumonia" means the belonging of the causative agent to microbes, called "atypical flora". Atypical flora are intracellular infectious agents - mycoplasma, chlamydia, legionella. Inflammation of the lungs, caused by mycoplasmas, most often affects young people in organized collectives - military service personnel, students, children, adolescents (20-30% of all pneumonia). And, on the contrary, at patients of the senior ages atypical pneumonia is diagnosed extremely seldom.
Atypical mycoplasmal or chlamydial infection is accompanied by muscle and headaches, chills, symptoms of ARI. Hemoptysis and chest pain are uncharacteristic of pneumonia caused by atypical flora.
Treat such a disease as atypical pneumonia, special drugs - antibiotics from a group of new macrolides (josamycin, rovamycin, spiramycin, klatsid). These drugs are approved for use in children and adolescents and do not cause intestinal dysbiosis.