Untreated pneumonia

Chronic pneumonia

Chronic pneumonia is a chronic inflammatory localized process in the lung tissue, the morphological substrate of which is pneumosclerosis and (or) the cuffing of the pulmonary tissue, as well as irreversible changes in the bronchial tree as a type of local chronic bronchitis, clinically manifested by relapses of inflammation in the same affected part lung. From the concept of chronic pneumonia, asymptomatic localized pneumosclerosis is eliminated in the absence of relapses of inflammation in the affected area.

Currently, the relationship to chronic pneumonia is ambiguous. In modern foreign medical literature such a nosological unit is not recognized and not covered. In ICD-10, this disease is also not called. However, a number of clinicians continue to identify chronic pneumonia as an independent nosological unit.

In addition, in clinical practice, patients are often observed who, after a history of pneumonia, develops symptomatology corresponding to the diagnostic criteria of chronic pneumonia, and previously (prior to acute pneumonia) the patient was absolutely healthy.

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

Causes of Chronic Pneumonia

The main etiological and predisposing factors of chronic pneumonia are the same as acute.

Pathogenesis of chronic pneumonia

Chronic pneumonia is a consequence of unresolved acute pneumonia. Consequently, the development of chronic pneumonia can be represented in the form of the following stages: acute pneumonia - prolonged pneumonia - chronic pneumonia. Therefore, we can assume that pathogenetic factors of chronic pneumonia are the same as protracted, and the main ones are, of course, violations of the function of the local bronchopulmonary protection (decreased alveolar macrophage and leukocyte activity, decreased phagocytosis, deficiency of secretory IgA, decreased concentration in bronchial contents bacteriolyzines and others. - for details, see "Chronic bronchitis") and the weakness of the immune response of the macroorganism. All this creates favorable conditions for the persistence of an infectious inflammatory process in a certain area of ​​the lung tissue, which in further leads to the formation of the pathomorphological substrate of chronic pneumonia - focal pneumosclerosis and local deforming bronchitis.

Pathogens

Pneumococci

Symptoms of Chronic Pneumonia

Chronic pneumonia is always the outcome of unresolved acute pneumonia. It should be emphasized that there is no strict time criterion that allows one to state that in a given patient acute pneumonia has been transformed into a chronic inflammatory process. Previous views on the timing of 3 months, 1 year were untenable. It should be assumed that the determining role in the diagnosis of chronic pneumonia is not the timing of the onset of the disease, but the absence of a positive radiologic dynamics and repeated exacerbations of the inflammatory process in the same part of the lung during a long dynamic observation and intensive treatment.

In the period of exacerbation of chronic pneumonia, the main clinical symptoms are:

• complaints of general weakness, sweating, especially at night, fever, loss of appetite, cough with separation of mucopurulent sputum; sometimes pain in the chest in the projection of the pathological hearth;
• weight loss (not an obligatory sign);
• symptoms of a local infiltrative inflammatory process in the lung tissue (dullness of percussion sound, humid finely bubbling rales, crepitation over the lesion), with pleural involvement, a friction noise is heard pleura.

Instrumental research

1. X-ray examination of the lungs is of decisive importance in the diagnosis of chronic pneumonia. Radiography of the lungs in 2 projections reveals the following characteristic features:
   • decrease in the volume of the corresponding pulmonary department, the severity and deformation of the lung pattern of the small- and medium-cell type;
   • focal blackouts of the lungs (they can be quite clear with pronounced alveolar carnialization);
   • peribronchial infiltration in the affected area of ​​the lung tissue;
   • manifestations of regional adhesive pleurisy (interlobar, paramediastalnye adhesions, obliteration rib-diaphragmatic sinus).
2. Bronchography - is currently considered as an obligatory method of diagnosis and differential diagnosis of chronic pneumonia. The convergence of bronchial branches in the lesion area, the unevenness of their filling with contrast, unevenness, deformation of the contours (deforming bronchitis) are revealed. With bronchoectatic form of chronic pneumonia, bronchiectasis is found.
3. Bronchoscopy - detects in the period of exacerbation purulent (in the period of remission catarrhal) bronchitis, most pronounced in the corresponding lobe or segment.
4. Examination of the function of external respiration (spirography) is mandatory in chronic pneumonia, as patients often suffer from chronic bronchitis, emphysema of the lungs. In the uncomplicated form of chronic pneumonia (with a non-extensive lesion), significant changes As a rule, there are no spirographic indices (in rare cases, restrictive disorders are possible-a decrease Wished). With concomitant obstructive chronic bronchitis there is a decrease in FVC, Tiffno), with pulmonary emphysema - the magnitude of the ZHEL significantly decreases.

Laboratory data

1. General and biochemical blood tests reveal the following changes in the phase of exacerbation: an increase in ESR, leukocytosis with a shift of the leukocyte formula to the left, an increase in the blood levels of fibrinogen, alpha2 and gamma globulins, haptoglobin, seromucoid. However, it should be noted that these changes are expressed, as a rule, only with a significant exacerbation of the disease.
2. Sputum microscopy - in the period of exacerbation of the disease, a large number of neutrophilic leukocytes are detected.
3. Bacteriological study of sputum - allows you to determine the nature of microflora. The number of microbial bodies more than 10 in 1 μl of sputum indicates the pathogenicity of the detected microflora.

In the phase of remission of chronic pneumonia, the patients feel well, patients practically do not complain, or these complaints are very insignificant. Typical is only a low-productivity cough mainly in the morning due to the presence of local bronchitis. In the physical examination of the lungs, blunting of percussion sound and finely bubbling rales are determined, crepitation in but the auscultatory data in the remission period are much less vivid in comparison with the phase exacerbation. In the phase of remission, there are also no laboratory manifestations of the inflammatory process.

Bronchoectatic form

The bronchoectatic form of chronic pneumonia has the following manifestations:

• cough with the release of a large amount of purulent sputum (for a day 200-300 ml or even more) with an unpleasant odor, most pronounced in a certain position of the patient;
• frequently observed episodes of hemoptysis;
• frequent exacerbations and even a continuous course of the active inflammatory process, periodic sputum separation delay, accompanied by a significant increase in body temperature; sweating on nights;
• decreased appetite and severe weight loss;
• changes in nails (they take the form of watch glass) and thickening of the end phalanx in the form of "drumsticks";
• listening to the focus of the lesion of not only small bubbles, but also medium bubbling rales, they are abundant and consonant;
• more frequent occurrence in comparison with the form without bronchiectasis of such complications as empyema of the pleura, spontaneous pneumothorax, amyloidosis of the kidneys;
• low efficiency of conservative therapy;
• detection of bronchiectasis in bronchographic and tomographic examination (in the form of cylindrical, spindle-shaped, saccular extensions).

Where does it hurt?

Pain in the chest Pain in the chest in children

What's bothering you?

Cough Chrumples in the lungs Shortness of breath Body temperature High fever in the child

Classification of chronic pneumonia

Currently, there is no generally accepted classification of chronic pneumonia. This is due to the fact that not everyone recognizes the nosological independence of this disease. For purely practical purposes, the following classification can be used.

1. Prevalence of chronic inflammatory process in the lung:
   • focal
   • segmented
   • shared
2. Phase of the process:
   • exacerbation
   • remission
3. Clinical form:
   • bronchoectatic
   • without bronchiectasis

Diagnostic criteria of chronic pneumonia

1. A clear connection of the development of the disease with the transferred acute pneumonia, which took a prolonged course, but was not resolved.
2. Recurrent inflammation within the same segment or lobe of the lung.
3. Focal character of pathological process.
4. Presence in the period of exacerbation of clinical symptoms: cough with mucopurulent sputum, pain in the chest, increased body temperature, weakness.
5. Detection of stethoacustic symptoms of the focal pathological process - small-bubble (and with bronchoectatic form of the disease - and medium-bubbly) rales and crepitations.
6. X-ray, bronchographic and tomographic signs of focal infiltration and pneumosclerosis, deforming bronchitis (and bronchiectasis - bronchiectasis), pleural joints.
7. Bronchoscopic picture of local purulent or catarrhal bronchitis.
8. The absence of tuberculosis, sarcoidosis, pneumoconiosis, congenital lung anomalies, tumors and other pathological processes, term survival of the syndrome of focal compaction of pulmonary tissue and laboratory manifestations of inflammation.

Differential diagnosis of chronic pneumonia

The diagnosis of chronic pneumonia is rare and very responsible, requires careful exclusion of others diseases manifested by focal seals of lung tissue, primarily pulmonary tuberculosis and cancer lung.

In differential diagnosis with lung cancer, it should be noted that chronic pneumonia is a rare disease, lung cancer is very common. Therefore, as N. rightly writes AT. Putov (1984), "in any cases of prolonged or recurrent inflammatory process in the lung, especially in middle-aged men and smokers, it is necessary to exclude the tumor, the stenosing bronchus and causing the phenomenon of the so-called paracancer pneumonia. " To exclude lung cancer, you need to apply special methods of research - bronchoscopy with biopsy, transbronchial or transthoracic biopsy of the pathological focus, regional lymph nodes, bronchography, computer tomography. The absence of positive X-ray dynamics in patients with lung cancer is also taken into account. active anti-inflammatory and antibacterial treatment, including endoscopic bronchial sanitation. Along with this, it should be borne in mind that if you suspect a cancer, you can not waste precious time on a long dynamic observation.

When conducting a differential diagnosis of chronic pneumonia and pulmonary tuberculosis, the following circumstances should be taken into account:

• with pulmonary tuberculosis there is no acute nonspecific inflammatory process at the onset of the disease;
• for tuberculosis is characterized mainly by the upper lobe localization of the pathological process; petrification in lung tissue and radical lymph nodes;
• tuberculosis is often found in the sputum of tuberculosis bacteria and positive tuberculin samples.

Chronic pneumonia must be differentiated from congenital lung anomalies, most often with simple and cystic hypoplasia and lung sequestration.

Simple hypoplasia of the lung - underdevelopment of the lung without the formation of cysts. This anomaly is accompanied by the development of the suppuration in the lung, which leads to the development of intoxication syndrome, body temperature, the appearance of physical symptoms of inflammation of the lung tissue - a clinical picture similar to exacerbation of chronic pneumonia. Simple lung hypoplasia is diagnosed on the basis of the results of the following research methods:

• radiography of the lungs - signs of a decrease in lung volume are revealed;
• bronchography - only bronchuses of the third-sixth order are contrasted, then the bronchogram as it is broken off (symptom of the "scorched wood");
• bronchoscopy - catarrhal endobronchitis, narrowing and atypical location of the lobes of the lobar and segmental bronchi are determined.

Cystic lung hypoplasia is a hypoplasia of the lung or part of it with the formation of a set of thin-walled cysts. The disease is complicated by the development of a secondary infectious-inflammatory process and chronic bronchitis. The diagnosis of cystic hypoplasia is based on the results of the following studies:

• radiography of the lungs - in the projection of the hypoplastic lobe or segment of the lung, deformity or intensification of the pulmonary the pattern is cellular; Tomographic examination reveals multiple thin-walled cavities with a diameter from 1 to 5 cm;
• bronchography - reveals the lung's hypoplasia and a multitude of flanks partially or completely filled with contrast and having a spherical shape. Sometimes spindle-shaped expansions of segmental bronchi are determined;
• Angiopulmonography - shows the underdevelopment of the vessels of the small circle of circulation in the hypoplastic lung or its lobe. Arteries and veins (subsegmental prelobular and lobular) envelop air cavities.

Sequestration of the lung is a developmental disorder in which part of the cystically altered pulmonary tissue is separated (sequestered) from the bronchi and vessels of the small circle and is supplied with blood by arteries of a large circle, outgoing from the aorta.

There are intra-and extra-casual sequestration of the lung. With intra-lateral sequestration, the abnormal lung tissue is located inside the lobe, but does not communicate with its bronchi and is supplied with blood from arteries that drain directly from the aorta.

With out-of-lobe sequestration of the lung, the aberrant portion of the lung tissue is outside the normal lung (in the pleural cavity, in the thicker than the diaphragm, in the abdominal cavity, on the neck and elsewhere) and is supplied with blood only by arteries of a large circle blood circulation.

The non-sequential sequestration of the lung is not complicated by the suppuration process and, as a rule, does not manifest itself clinically.

Intra-lateral sequestration of the lung is complicated by a suppuration and requires a differential diagnosis with chronic pneumonia.

The diagnosis of lung sequestration is based on the results of the following studies:

• X-ray of the lungs reveals a deformation of the pulmonary pattern and even a cyst or a group of cysts, sometimes darkening irregularly; often peribronchial infiltration is detected;
• The tomography of the lungs detects cysts, cavities in the sequestered lung and often a large vessel that goes from the aorta to the pathological formation in the lung;
• bronchography - in the zone of sequestration deformation or expansion of the bronchi;
• selective aortography - reveals the presence of an abnormal artery, which is a branch of the aorta and supplies the blood with a sequestered part of the lung.

Most often, these x-ray changes are detected in the posterior basal areas of the lower lobes of the lungs.

Chronic pneumonia should also be differentiated with cystic fibrosis, bronchiectasis, chronic lung abscess. Diagnosis of these diseases is described in the relevant chapters.

Survey program

1. Common blood tests, urine tests.
2. Biochemical blood test: content of total protein, protein fractions, sialic acids, fibrin, seromucoid, haptoglobin.
3. Radiography of the lungs in 3 projections.
4. Tomography of the lungs.
5. Fibrobronchoscopy, bronchography.
6. Spirography.
7. Sputum examination: cytology, flora, sensitivity to antibiotics, detection of mycobacterium tuberculosis, atypical cells.

Example of the formulation of the diagnosis

Chronic pneumonia in the lower lobe of the right lung (in 9-10 segments), bronchiectatic form, exacerbation phase.

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 Complete blood count

Who to contact?

Pulmonologist

Treatment of chronic pneumonia

Chronic pneumonia is a chronic inflammatory localized process in the lung tissue, the morphological substrate of which is pneumosclerosis and (or) the cuff of the lung tissue, and also irreversible changes in the bronchial tree by the type of local chronic deforming bronchitis, clinically manifested by relapses of inflammation in the same affected part lung.

When treating a patient with chronic pneumonia, one should proceed from the premise that chronic pneumonia is the result of unsolved acute pneumonia. Stages of the disease: acute pneumonia → protracted pneumonia → chronic pneumonia.

With the help of modern examination methods (lung radiography in 3 projections, X-ray tomography, computed tomography, bronchoscopy with cytological study of bronchial secretion, bronchography), it is necessary to make sure that the diagnosis is "chronic pneumonia "does not hide tuberculosis or malignant disease of the bronchopulmonary system, congenital lung disease (anomaly development, cyst, etc.).

The curative program for chronic pneumonia fully corresponds to the program for acute pneumonia. However, when organizing the treatment of a patient with chronic pneumonia, the following features should be considered.

1. In the period of exacerbation of chronic pneumonia, antibiotic therapy is performed similarly to that for acute pneumonia. It should be remembered that chronic pneumonia is characterized by a constant presence in the focus of inflammation potentially active microflora, and in recent decades the composition of pathogens of pneumonia has expanded. In addition to the bacterial flora, pneumotrophic viruses that cause severe viral and viral-bacterial pneumonia have acquired great importance, especially during periods of flu epidemics. The spectrum of bacterial flora has also changed. According to A. N. Kokosova (1986), with exacerbation of chronic pneumonia from sputum and bronchial contents of patients, hemolytic streptococcus, Staphylococcus aureus, pneumococcus, microbial associations of 2-3 microorganisms are frequent, staphylococcus with pneumococcus, with hemolytic streptococcus, with Friedlander's stick, intestinal and pseudomonas aeruginosa chopsticks. In 15% of patients with exacerbation of chronic pneumonia, the role of mycoplasmas has been proven.

Assigning antibacterial therapy in the early days of exacerbation of chronic pneumonia, it is advisable to focus on these data, but then, without fail, it is necessary to make sputum examination, bacteriological, bacterioscopic, on the sensitivity of flora to antibiotics and to make adjustments to antibacterial therapy depending on the results research. It is better to examine sputum obtained from fibrobronchoscopy; if this is not possible, the sputum collected by the patient and processed by the Mulder method is examined.

It should be emphasized the great role of endotracheal and bronchoscopic sanation in the treatment of chronic pneumonia. This is of great importance, especially with frequent and prolonged exacerbations, since chronic pneumonia is a localized inflammatory process with the development of pneumosclerosis in the inflammatory focus. With oral or parenteral antibacterial therapy, medicines do not penetrate sufficiently into the focus of inflammation and only endotracheal and endobronchial administration of antibacterial drugs allows one to obtain the desired concentration of them in the lung tissue in the outbreak inflammation. The most appropriate combination of parenteral and eudrobronchial antibacterial therapy. This is especially important with the bronchoectatic form of chronic pneumonia.

In very severe disease, there is a positive experience with the introduction of antibiotics into the pulmonary hemodynamic system.

In severe recurrence of chronic pneumonia caused by staphylococcal, pseudomonasal and other superinfection, along with antibacterial drugs with success passive specific immunotherapy - the introduction of appropriate antibacterial antibodies in the form of hyperimmune plasma, γ- and immunoglobulin. Anti-staphylococcal-pseudomonas Proteus plasma is administered intravenously on 125-180 ml 2-3 times a week. Treatment with hyperimmune plasma is combined with intramuscular injection of antistaphylococcal γ-globulin. Before starting immunotherapy, one should consult a patient with an allergist and prescribe antihistamines to prevent allergic complications.

1. The most important direction for chronic pneumonia is the restoration of the drainage function of the bronchi (expectorants means, bronchodilators, positional drainage, fibrobronchoscopic sanitation, classical and segmental massage of the thoracic cells). For more information, "Treatment of chronic bronchitis."
2. Immunocorrective therapy is of the greatest importance in the treatment of chronic pneumonia (after studying of the immune status) and increase of the general reactivity and nonspecific protective reactions organism (see "Treatment of acute pneumonia"). It is extremely important to conduct annual sanatorium treatment.
3. Much attention should be paid to sanation of the oral cavity, the fight against nasopharyngeal infection.
4. If there are no contraindications, physiotherapy with directed to the local inflammatory process (CMV-therapy, inductothermy, UHF-therapy and other methods physiotherapy). It should also be widely used ultraviolet and laser irradiation of blood.
5. With frequent relapses of chronic pneumonia in young and middle-aged people and clearly localized The bronchoectatic form of the disease should be addressed by surgical treatment (resection lung).

Prevention of Chronic Pneumonia

• a healthy lifestyle, physical activity;
• early onset and proper treatment of acute pneumonia; effective treatment of acute and chronic bronchitis; timely and effective treatment of nasopharyngeal foci
• chronic infection; thorough sanitation of the oral cavity;
• correct and timely medical examination of patients with acute pneumonia;
• elimination of occupational hazards and factors causing irritation and damage to the respiratory tract;
• cessation of smoking.

These same measures are also the prevention of recurrences of exacerbations of chronic pneumonia. In addition, antiretroviral courses are recommended (so-called anti-relapse prophylaxis during dispensary observation).

L. N. Tsarkova identifies 4 groups of patients with chronic pneumonia, who are subject to dispensary registration, depending on degree of compensation of the inflammatory process in the phase of remission, the patient's ability to work, and the presence of complications.

1. The first group includes patients with chronic pneumonia, which in the phase of remission can be considered almost healthy and whose work capacity is fully preserved. Patients are observed 2 times a year.
2. The second group includes patients who have a rare cough (dry or with a small amount of sputum) and especially a vegetative syndrome while maintaining working capacity. Patients are observed 2 times a year.
3. The third group includes patients with persistent moist cough, marked asthenovegetative syndrome and disability (disabled group III). Patients are observed 4 times a year.
4. The fourth group consists of patients with a constant cough, with a lot of sputum, subfebrile condition, short remissions, complications of the disease, with disability (II disability group). Patients are observed 4 times a year.

Clinical follow-up is performed by a pulmonologist, a district therapist. Recommended methods of examination: radiography of the lungs (large-frame fluorography), spirography, pneumotachometry, ECG, general blood test, sputum, urine, allergic examination in the presence of allergic manifestations.

The antirecretive complex for patients with chronic pneumonia includes the following measures:

• the first group - breathing exercises, massage, multivitamin therapy, adaptogens; in patients with frequent relapses - immunomodulators (N. R. Paleev, 1985); sanation of the nasopharynx; UFO of the thorax, galvanization;
• the second and third groups - the same measures as in the first group, but, in addition, measures to improve the drainage function of the bronchi (position drainage, intra-tracheal lavage, inhalation of aerosols of bronchodilators with bronchial obstructive syndrome, mucolytics, expectorants facilities);
• the fourth group - all the above measures, but, in addition, the means of preventing the progression of complications already existing patient (obstructive bronchitis, myocardial dystrophy, amyloidosis, etc.): metabolic therapy, calcium antagonists, bronchodilators and other

An important measure of anti-relapse prevention is the annual spa treatment in all groups of patients.

Indicators of effectiveness of clinical examination are: a decrease in the frequency of exacerbations of the inflammatory process and the period of temporary incapacity for work, stabilization of the process.

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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:

• Temperature

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.

• Breath

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.

zdravotvet.ru

What can be dangerous inflammation of the lungs?

Inflammation of the lungs (pneumonia) is an ailment that affects people of any age. Not everyone knows about the dangerous inflammation of the lungs. Although many will call the symptoms of the disease, they say that it is treated with antibiotics, and after the illness the body will recover for a long time.

To make sure of the danger of pneumonia, you must first understand what it is.

What is pneumonia?

This disease is caused by fungi, bacteria or viruses.Normally, for each person, pathogenic microorganisms live on the pharyngeal mucosa, nose, and lungs. But as soon as the body's immunity decreases, pathogenic microbes begin to multiply at a tremendous rate, causing pneumonia. Inflammation can begin directly in the lungs or get there gradually, starting its "journey" from the throat or nose. In such cases, doctors explain that "the infection has subsided."

Inflammation can be exposed to the whole lung or part of it.

Symptoms of this disease are: pain in the side, intensifying with deep inspiration or cough, very high body temperature, dry or wet cough, shortness of breath, chills. For the correct diagnosis, you will need a radiographic examination of the lungs, a blood test and sputum. These studies will help establish the nature of the disease and begin adequate therapy.

When treating pneumonia, doctors usually prescribe antibacterial drugs. Depending on the severity of the disease, the patient can be placed in the hospital, where he is injected several times a day. With properly selected antibiotic, the patient's condition improves after 5-6 days from the beginning of treatment. If no improvement occurs, doctors usually prescribe a different drug to the patient. Further it is important to dilute and withdraw from the lungs formed sputum. To this end, the patient may be prescribed inhalation, massage. In parallel, the patient is prescribed antiviral and immunomodulating drugs. Complete recovery usually occurs 3-4 weeks later.

Inflammation of the lungs is a very serious disease, from which, despite a wide range of modern antibiotics, people continue to die. About self-treatment speech can not even go. This is fraught with serious consequences.

Danger of pneumonia for children

For a child's organism pneumonia is a very serious test, even if the child has received medical help on time. Most often, infirmity affects children of preschool age. Doctors believe that up to 6 years the child is developing immunity. During this period, they are very vulnerable to all kinds of infections, including streptococcal, which in most cases causes babies pneumonia.

In addition to the symptoms of pneumonia listed above, the nasolabial triangle (cyanosis) is often marked in children. This is a very serious indicator, indicating that the disease is not all right with the cardiovascular system of the child.

The danger of pneumonia is also that in the course of the disease the lungs can not continue to function in full: the baby's breathing becomes shallow, he has a feeling of lack air. Therefore sick children sleep very badly, eat, show constant concern.

The following factors aggravate the situation:

1. Later, seek medical help.
2. Presence of concomitant chronic diseases in the baby.
3. Incorrect treatment of the child.

Each of these factors increases the risk of illness for the child several times. At the initial stage, the disease is very similar to the usual viral infection, so doctors prescribe antibiotics not immediately. If antiviral treatment did not work for 3 days (high fever persists and cough does not stop), this is an excuse to contact the doctor again. Such a picture of the disease means its bacterial nature. At this stage, the intake of antibiotics is mandatory. Not all mothers know this. Many continue to treat the child according to the original scheme prescribed by the doctor, losing valuable time. Within a few days the child may develop acute respiratory failure, sometimes death occurs. This is the danger of pneumonia.

Another dangerous consequence of untreated pneumonia in children is neurotoxicosis. It is characterized by first increased activity of the child, his excitement, frequent crying, whims. This state is smoothly replaced by the opposite: the child is apathetic, does not eat, sleepy, muscle tone is reduced. At the third stage, the temperature rises, the child has convulsions, develops pulmonary insufficiency (until the breath stops).

To reduce the risk of developing a baby's inflammation of the lungs, my mother has to adhere to a few simple rules:

1. Try to breast-feed at least 1 year.
2. Do not give up vaccinating the baby.
3. Ensure the child's diet of foods rich in zinc.
4. Engage in tempering a child, spend a lot of time walking in the open air.
5. Observe the basic rules of home hygiene: more often to ventilate the premises and conduct wet cleaning.

Effects of pneumonia in adults

No less dangerous is pneumonia and for adults. The most common consequences:

1. Abscess of the lung.
2. Fibrosis of the lung.
3. Bronchial asthma.
4. Heart failure.
5. Respiratory failure.

Especially dangerous are the first two diseases.

Abscess of the lung is the decomposition (decay) of the lung tissue in the part where there was inflammation. The hearth can be one. Sometimes there are several. During the period of abscess formation, the patient's fever rises, weakness, lack of appetite, difficulty breathing, severe pain in the chest, cough. In the next stage, the formed abscess is opened, sputum in large quantities (up to 1 liter per day) exits through the respiratory tract. With the right treatment for several years, the tissue of the lung becomes scarred, and a full recovery comes.

Fibrosis of the lung is a condition of the patient, in which the connective tissue begins to form on the site of the damaged pulmonary tissue. Lungs can not work at full power, breathing becomes difficult, chest pain occurs. The disease progresses very quickly, so it requires immediate treatment in a medical institution. It is impossible to get rid of lung fibrosis completely. Treatment is usually aimed at alleviating the symptoms and preventing the further development of the disease. In extreme cases, the patient is shown lung transplantation.

How to avoid the negative consequences of pneumonia?

The mortality from pneumonia in our country, despite the sufficient level of development of medicine, remains quite high.

To quickly recover and avoid negative consequences, you need to be very attentive to health.

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In Russia it is accepted to go to the doctor when there are already very serious problems. It is not right. In the case of pneumonia, this can lead to death. Medical care should be handled as soon as the first symptoms of the disease have appeared, and the temperature is still not so high. Do not neglect and analysis, which appoints the doctor. Their results will help the doctor immediately make a scheme for effective treatment.

Mom, caring about the health of her baby, should know that at the slightest suspicion of any disease she must show the child to the doctor. Statistics show that the largest infant mortality from pneumonia is observed among toddlers under the age of 1 year. In the case of children's pneumonia, do not neglect hospitalization.

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Both adults and children will be protected from pneumonia by physical training, proper nutrition, vitamins and microelements, hardening, frequent stay in the open air and close attention to your health.

respiratoria.ru

Pain in the lungs after pneumonia

Pain in the lungs after pneumonia - what could be the reason? And the reason often lies in the inadequate attention to one's health. Often, we do not even think about the consequences of pneumonia, not treated or transferred on the feet, and the ignored rules of rehabilitation after pneumonia. Alas, in our modern life, the first place for many is the availability of uninterrupted serviceability.

We go out to work during illness, we carry the virus "on our feet" and very often we are proud of it. Pain in the lungs after pneumonia (inflammation of the lungs) is precisely the reaction of the body to our frivolous attitude to this serious illness.

Symptoms of pain in the lungs after pneumonia

Patients are troubled by seizures that occur when inhaled and manifest as minor tingling, or acute attacks. These attacks can sometimes be accompanied by shortness of breath and palpitations. In this case, the degree of pain, depends on the severity of the disease, the speed and quality of its treatment.

The symptoms listed above most often indicate the presence of an adhesion process in the body.

Spikes are a pathological fusion of organs. Spikes are formed as a result of chronic infectious pathologies, as well as mechanical injuries or internal bleeding.

In a patient with pneumonia, adhesions (adhesions) can occur between the pleura sheets, one of which lining the lungs and the other - the thorax. When inflammation of the pleura or the flow of inflammation from the lungs to the pleura, the release of fibrin, gluing the pleura with each other. The area of ​​the glued leaflets of the pleura is called spike.

Spikes are divided into two types - single and multiple. In critical cases, they envelop the pleura whole, causing its displacement and deformation and thus making breathing difficult. This pathology has a very severe course, sometimes aggravated by acute respiratory failure. Limited mobility of respiratory organs, frequent acute attacks of pain during breathing, the presence of mechanical obstruction - require immediate surgical intervention.

Multiple spikes in the pleural cavity can sometimes support a slow inflammatory process. This happens if the spikes limit the inflamed area from all sides, forming a capsule around it.

Adhesive pathology that causes pain in the lungs after pneumonia is a serious enough process, so the doctor should determine the diagnosis and treatment.

Doctors detect the presence of adhesions in the lung area by X-ray examination of the chest, CT or MRI of the thoracic cavity.

The course of therapy for adhesions is determined by the doctor and depends on the degree of its manifestation. In the presence of adhesions in the lungs, medicamental treatment is most often attributed, and surgical intervention is undertaken only when the patient's life is in danger.

Who should I contact if you have pain in the lungs after pneumonia?

Everyone should remember that the lungs are the most important organ of human life, responsible for the circulation of oxygen in the body. Therefore, patients should abandon attempts to self-diagnosis and self-treatment, as well as rely on intuition, knowledge in this area, advice of unqualified in the field of medicine acquaintances! Carry out the necessary diagnostics and prescribe the treatment you can therapist, family doctor, phthisiatrist.

Treatment of pain in the lungs after pneumonia

In modern medicine, the main methods of drug treatment of adhesive pathology in the lungs are heating and electrophoresis. The heating of the respiratory system can be paraffin, clay or mud.

For the treatment of pain in the lungs after pneumonia, an important role is played by the patient's response rate to the pain symptom, the patient's awareness and the urgency of the prescribed treatment. Only timely begun therapy can guarantee the complete cure of the patient. To exclude the complication after the inflammation of the lungs, to restore the weakened from the transferred organism, the right rehabilitation will help. The main function of rehabilitation measures is restoration of respiratory organs, exclusion of the possibility of development of chronic bronchial and pulmonary pathology.

To recover from pneumonia, it is often advisable to visit health resorts, massage certain points of the chest, oxygen therapy respiratory insufficiency, electrotherapy, artificial ventilation, complete quitting, general strengthening and quenching procedures, exercise therapy and physiotherapy. In addition, the patient must protect the body against colds, especially during two months after the illness, to refuse to stay in professional places pollution.

ilive.com.ua

Signs of pneumonia in adults without fever. Symptoms of pneumonia without fever

Pneumonia is a serious infectious disease. Under normal conditions, it can have a fairly pronounced clinical course, but certain factors can strongly lubricate the main manifestations of the disease.

Pneumonia in adults: symptoms, signs, causes in normal conditions

This disease occurs due to the development of microflora in the lung tissue and its gradual destruction. The beginning of such a pathological process is capable of getting into the body of a wide variety of infections.

Another factor contributing to the development of pneumonia, is a local or general decrease in immunity.

Among the main symptoms of this disease, it is necessary to note primarily a rise in temperature body, a strong cough, the occurrence of dyspnea with the least physical exertion, poor general state of health.

Pneumonia in adults: symptoms, causes, types in unusual conditions

There are two main reasons why the clinical manifestations of the inflammatory process in the lungs will differ from the classics. Among them it is necessary to note the following:

• decreased immunity;
• uncontrolled use of antibacterial agents.

Both of these causes can significantly change the clinical picture of pneumonia.

Incorrect use of antibiotics

To date, the uncontrolled use of antimicrobials has become a real problem for society. The fact is that this circumstance gradually leads to the formation of resistance to an antibacterial agent in infection. As a result, the antimicrobial drug simply ceases to have a sufficient effect on pathogenic bacteria.

In addition, the independent reception of such drugs can significantly reduce the severity of the main clinical manifestations of the disease. For example, pneumonia occurs in children and adults. Without a temperature reaching high enough values, few will immediately become worried and make a decision to consult a doctor. As a result, the disease will proceed in a latent form, and the patient will not receive rational treatment. This will lead to the gradual involvement in the pathological process of new and new areas of lung tissue. As a result, the patient will have other, more health-threatening clinical manifestations. The main signs of pneumonia in adults without temperature are the increase in dyspnea, the appearance of blood veins in escaping coughing sputum, as well as pain in the chest, arising from involvement in the pathological process pleura.

Now doctors are trying to limit the independent reception of antibacterial drugs by patients. One of the main ways was the issuance of such drugs only by prescription.

On the decrease of immunity

The clinical picture of inflammation of the lungs can vary greatly not only under the influence of antibacterial agents, but also in the conditions of reducing the protective properties of the body. As a result, typical first signs of pneumonia in adults may not be present. As a result, the patient does not immediately notice a serious problem. Signs of pneumonia in adults without a temperature in such conditions are expressed in the appearance of a painful blush on the side of the lesion of the lung tissue. Especially high diagnostic value this symptom has in the case of isolated lesions of one lung.

The increase in temperature in this case is not observed for the reason that the defenses of the body are depleted. At the same time, hyperthermia is the most important factor of defense. The fact is that in conditions of elevated temperature, pathogenic bacteria are much more difficult to grow and multiply. As a result, they are gradually destroyed by white blood cells.

Additional signs

Symptoms of pneumonia without temperature in adults are quite diverse. First of all, we are talking about the appearance of a painful blush. This symptom is especially well distinguished if the patient has unilateral pneumonia without temperature. Signs of bilateral pneumonia are noticeable worse, as the blush will be located on both cheeks.

In addition, a patient with pneumonia, which is not treated rationally, has a pale complexion. When breathing, there may be a lag in the excursion of the half of the chest in which the inflammatory process is taking place. Naturally, such signs of pneumonia in adults without a temperature are well detected only in cases with one-sided pathology. Thus the second cheek can be paler than usual.

There are a few other signs that pneumonia develops in children and adults. Without a temperature, people often do not pay attention to the soreness in the chest, which increases with every breath. This approach is dangerous in that you can skip a serious pathology. So, when there are painful sensations in the chest, intensifying during inspiration, it is better to consult a specialist so that he excludes the inflammatory process in the lung tissue.

When should shortness of breath make you think?

Symptoms of pneumonia without temperature in adults, as you can already see, are quite diverse. One of the manifestations of the disease is shortness of breath. Normally, it can occur in any person after certain physical exertion. In the event that dyspnea appears at rest, one of the reasons may be an inflammatory process that occurs in the lung tissue. In this case, despite the lack of motor activity, without rational antibacterial therapy, dyspnea gradually only increases.

However, this symptom does not always indicate that pneumonia develops without temperature. Signs of the same type can also occur in cardiac pathology, when the patient gradually develops stagnant phenomena. Identify the exact cause of dyspnea with this help radiography chest organs.

It must also be remembered that young patients should pay special attention to dyspnea at rest, since in the overwhelming majority of cases they have no expressed cardiac pathology.

What should I do first?

In the event that there are typical first signs of pneumonia in adults, you should immediately turn to a specialist - doctors, therapist or pulmonologist. They will conduct a general examination, including auscultation of the lungs. Based on the results of the primary diagnostic measures, the doctor will decide whether it is necessary to perform an X-ray examination of the chest organs. If the doctor suspects something and sends the patient to such a survey, then in no case should you refuse. After radiography, the doctor will be able to accurately establish the diagnosis and prescribe rational treatment.

What is the danger of pneumonia without temperature?

This disease, if it occurs without hyperthermia, is very insidious. The fact is that, in itself, even under the condition of timely rational treatment, pneumonia is very, very dangerous. If, with inflammation of the lung tissue, antibiotic therapy is not performed, then there is a real danger that the disease will lead to the most disastrous consequences. But not only this should frighten pneumonia without temperature. Such a disease is also dangerous because the patient, most likely, has weakened immunity, or he recently took certain antibacterial drugs. In both cases, one usually has to use one of the most modern antimicrobial agents. In a situation with reduced immunity, it is a matter of the fact that the body itself does not have the strength to resist infection. In the second situation, the resistance of pathogenic microorganisms to one or another form of antibiotics has already been developed.

How to reduce the risk of pneumonia?

First of all, you must avoid serious hypothermia. The fact is that with a significant decrease in temperature in this or that area of ​​the human body, the level of local immunity decreases. As a result, pathogenic microorganisms have an excellent opportunity to multiply unhindered, hitting more and more sections of lung tissue.

In addition, it is very important to take antibacterial drugs strictly according to the recommendations of doctors. At the same time, it is necessary to stop using them when the signs of an infectious disease cease to make themselves felt, but only after the completion of a full course of treatment. Otherwise, a number of pathogens will persist. The next time the use of this same antibiotic will have a much more modest success, and will have to change the drug.

Another important point is the support of immunity. In order for it to be normal, it is necessary to maintain a normal level of physical activity, to eat properly and in sufficient quantities, to give the proper time to sleep and ordinary rest.

About laboratory research

They are carried out in the event that there are signs of pneumonia in adults. Without temperature or with hyperthermia, this disease occurs - laboratory tests are necessary. First of all, we are talking, of course, about a general analysis of blood. This study allows you to assess how pronounced the infectious process is in the lung tissue. In this case, doctors are most interested in the number of leukocytes, as well as the rate of erythrocyte sedimentation. The fact that the process has an infectious etiology will be said to increase the level of white blood cells (more than 9 * 109 / L). The fact that there is inflammation in the body will be indicated by an increased level of erythrocyte sedimentation rate. Often, the doctor does not assign a usual general blood test, but a study with a formula that allows the doctor to determine which type of microorganisms triggered the development of pathology. With an increased level of neutrophils, we can talk about bacterial pneumonia, and with an increase in the number of lymphocytes - about the viral etiology of this disease.

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What are the consequences of the transferred pneumonia?

Answers:

Vasilisa

The best way to completely restore health after pneumonia is to relax in a pulmonary health resort. Such sanatoria, as a rule, are located in the forest zone, in the low mountains or on the sea coast. Cool air facilitates breathing, stimulates sputum discharge, improves sleep. And drink as much as possible (up to -3 liters per day). Cranberry and cowberry fruit drinks, fruit and vegetable juices, and rose hips are good.
If you have pleurisy or a purulent process, be patient. Untreated pneumonia can give rise to such a serious disease as bronchial asthma.

Mask

Weak immunity, With a year, probably all kinds of sores stick, vitamins should be drunk

Neurophysiologist

If pneumonia is correctly treated, then there should be no consequences. If the treatment course was not very qualified, not completed, not neatly passed, etc. reasons, then in this case the consequences will inevitably be in the form of a significant decrease in the immunity and tolerance of the organism, a possible transition of pneumonia to a chronic course, etc.

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