Pneumonia (inflammation of the lungs): species, symptoms and treatment in SWAO Moscow

Pneumonia

Pneumonia (lung inflammation) is an acute inflammatory infectious disease. Often develops against the background of Orz and ORVI. Pneumonia sick patients of any floor and age. Essential people and children are especially hard to carry this disease. Mortality of children under 5 years from pneumonia is 15% of all cases of the disease around the world. It is located on the 5th place in the list of causes of death (after cardiovascular and oncological pathologies, COPD and Kebarovascular diseases) and 1 place among infectious diseases.

Pneumonia can be prevented by grafting, strengthening immunity, proper nutrition and minimizing harm from environmental factors. The uncomplicated form of the disease with the timely receipt of medical care is treated for 10-14 days. If you have a suspicion of pneumonia, you can refer to the pulmonist Polyclinic Otradnaya. An experienced doctor will select effective treatment methods taking into account the characteristics of your body and the course of the disease.

What is pneumonia

Pneumonia is a sharp inflammatory process arising in the lungs. The infection is most often transmitted by air-droplet, however, there are cases of infection and through blood flow (especially during childbirth). Also, the disease may occur when reproduction inside the body of conditionally pathogenic bacteria: under normal conditions, they do not harm and are included in the microflora of a healthy person. However, under certain conditions (reducing immunity, overcooling, etc.), they begin to reproduce actively, and an infectious-inflammatory process occurs.

Pathology can develop under the influence of different causative agents of infection, but pneumonia of bacterial origin is still the most common. And the most frequent causative agent and in children, and in adults - Pneumoniae (Streptococcus Pneumoniae). This is a conditional pathogenic microorganism from the kind of streptococci - it is part of the normal microflora of the upper respiratory tract of a healthy person.

Pneumonia

Also common pathogens of pneumonia are:

  • Hemophilic stick (Haemophilus Influenzae Type B) is also a conditional pathogenic bacterium, is part of the microflora of the respiratory organs.
  • Respiratory synthetic virus.
  • Pneumocystis Jiroveci is a yeast-like mushroom, often causing inflammation of the lungs in patients with AIDS.

Light consist of alveoli - multiple structures in the form of bubbles. When a person does inhale, they are filled with air. When infecting pneumonia in the alveoli, liquid and pus accumulate. It makes it difficult to breathe, makes it painful. The body gets less oxygen.

Classification

Pneumonia is classified according to the following signs:

  • Peculiarities of the patient and the cause of (etiology).
  • Pathogenesis (development mechanism).
  • Localization.
  • Volumes involved in the pathological process of tissues.

According to the peculiarities of the patient and the cause of the occurrence Pathology can be:

  1. Typical.
  2. Against the background of immunity impairment.
  3. Aspiration.

Typical pneumonia develops in people without pronounced immunity violations and maybe:

  1. Bacterial.
  2. Viral.
  3. Fungal.
  4. Mycobacterial (mycobacteria is bacteria that are capable of forming mycelium on one of the stages of their development as fungi).
  5. Parasitic.

Against the background of a pronounced impairment of immunity Pneumonia is observed in patients with AIDS, as well as suffering from other diseases.

Aspiration pneumonia It occurs when penetrating (inhalation or passive hit) in the lungs of a foreign agent: most often the vomit, but also foreign bodies, chemicals, etc.

By mechanism The development of pneumonia happens:

  1. Primary - arises as an independent disease.
  2. Secondary - develops against the background of other pathologies, most often than influenza.
  3. Radiation - is the consequence of radiation treatment of oncological diseases.
  4. Post-traumatic - observed after the injuries of the chest; Inflammation occurs due to the delay of sputum.

Localization :

  1. One-sided - on the right or left side of the lungs.
  2. Bilateral - immediately on both sides.

On the involvement of fabrics The following varieties of pneumonia are distinguished:

  1. Total - striking the lung completely.
  2. The focal - a small focus of infection is formed (an example of such pathology - bronchopneumonium, which affects respiratory departments and bronchi).
  3. Drain - several foci merge into one.
  4. Segmental - the disease affects one or more lung segments.
  5. The equity - striking the share of the lung (the most common variety is a bruboral pneumonia, which extends to the alveoli and partly on the pleura).
Pneumonia

The most common signs of pneumonia:

  • Pain in the chest area from one or two sides - some patients take them for heartfall.
  • Student, difficulty breathing, wheezing, shortness of breath.
  • Fever - fever proceeds to chills, the body temperature rises to 39-40.5 degrees.
  • The discharge of sputum - may contain blood impurities that fall into the sputum during alveolum microtraums caused by inflammation.
  • Signs of intoxication: weakness, headaches, increased fatigue, nausea, vomiting, sweating.
  • ORVI symptoms: runny nose, cough, sneezing, sore throat, nasal congestion (observed in secondary pneumonia, developed due to influenza and other sharp respiratory viral infections).

Important! There is an atypical pneumonia at which there are several other symptoms: slow development, dry cough, horses and pain, muscle pain, weakness, abdominal pain.

The most bright symptoms are expressed in children, older people and patients with reduced immunity. They have pathology proceeds especially hard.

Reference! Sometimes patients take pneumonia for the "cold" disease. However, at ARVI, a few days later, an improvement in well-being is observed, and when there is no lung inflammation. Therefore, if the symptoms do not subscribe, you should immediately consult a doctor.

Risk factors

The risk of the development of pneumonia increases the following factors:

  • Supercooling.
  • Stress.
  • Injuries.
  • Increased physical exertion.
  • Violation of local or general immunity.
  • Recently transferred ORVI.

Inflammation of the lungs most often arises against the background of the following diseases:

  • Diabetes.
  • Coronary artery disease.
  • Tuberculosis.
  • COPD (chronic obstructive pulmonary disease).
  • Oncopathology.
  • Chronic alcoholism.

Complications

The disease is especially dangerous by their complications - it is they lead to a fatal outcome, so it is very dangerous to engage in self-medication!

Most often found:

  • Edema, abscess, lung gangrena.
  • Purrites - inflammation of pleural leaves.
  • Myocarditis is the inflammation of the heart muscle.
  • Purulent arthritis.
  • Acute cardiovary and pulmonary failure.
  • Meningitis.
  • Sepsis - blood infection.
  • Endocarditis - inflammation of the inner heart shell.
  • Infectious toxic shock.

Diagnostics

Pneumonia

At first, the doctor collects history and examines the patient, then prescribes laboratory and instrumental research:

  • X-rays of light;
  • Spirography;
  • Bacterial sowing sputum;
  • blood and urine tests;
  • biopsy pleura, lung;
  • bronchoscopy;
  • Computed tomography of the chest.

Treatment of pneumonia

At pneumonia, bedding is shown. Treatment can be carried out both outpatient and in the hospital. The reference tactics determines the doctor focusing on the patient's condition.

With pneumonia, depending on the mechanism of development and features of the pathology, the following medicines are applied:

  • Antibiotics - with bacterial form.
  • Antiviral drugs - if the disease is caused by the virus.
  • Antipyretic means.
  • Glucocorticosteroids - in the presence of complications.
  • Medicines that dilute sputum (mercolics).
  • Expectorant medicines.
  • Antihistamines.
  • Immunomodulators.
  • Low molecular weight heparins - if the patient has a difficult condition and there is a risk of thromboembolism (acute blockage of the blood vessel, a thrombus).

Also assigned:

  • Physiotherapy (UHF, electrophoresis), chest massage, inhalation and healing physical culture - to reduce the intensity of inflammation and improving sparkling of sputum.
  • Infusion therapy is an introduction to the blood flow of therapeutic and prophylactic solutions.
  • Oxigenic therapy (saturation of the body with oxygen).

Pneumonia prevention

Preventive measures to reduce the risk of lung inflammation include:

  • Healthy lifestyle: proper nutrition, moderate exercise, stay in the fresh air.
  • Frequent wet cleaning, air ventilation.
  • Avoiding supercooling, drafts.
  • Reception of vitamins and immunomodulators.

During the EPID epidemic, contacts with infected people should be avoided. Prevention is vaccination: from pneumonia and from influenza (since inflammation of the lungs may be its complications). Vaccinations are especially recommended for patients who are included in the risk group: children, elderly people.

Overview

Pneumonia (lung inflammation) is inflammation of the fabric in one or both light caused by infection.

At the end of the breathing tubes in the lungs (alveolar strokes) there are tiny bags filled with air (alveoli) collected in bundles. With pneumonia, these bags are inflamed and filled with liquid.

How are the human alveoli with pneumonia

The most common symptoms of pneumonia:

  • cough;
  • heat;
  • labored breathing.

The most common cause of pneumonia is a pneumococcal infection, however there are many other types of bacteria and viruses causing pneumonia.

Patients with a light form of pneumonia are usually treated at home. They give antibiotics, abundant drink and provide peace. People with good health usually recover without any consequences.

In patients with other diseases, pneumonia can be in severe, and they may need treatment in the hospital. This is caused by the fact that pneumonia can give complications, which, depending on the state of health and the age of the patient, can even lead to a fatal outcome.

According to various data in Russia, pneumonia sicks every year 1-2 million people. People often sick pneumonia in autumn and winter. Mortality from community-hospital pneumoniums in Russia is of different data from 1% to 5%, but among patients requiring hospitalization and in older people, this indicator is many times more. Pneumonia can be sick at any age.

Symptoms of pneumonia

Symptoms of pneumonia can develop very quickly (for 24 to 48 hours) or relatively slowly, within a few days. The manifestations of the disease differ and can be similar to the symptoms of other respiratory infections, such as acute bronchitis.

For pneumonia is characterized by cough. It may be dry or accompanied by the release of sputum (thick mucus) of yellow, green, brownish color or even bleeding.

Other common symptoms:

  • Difficult breathing - the breaths are frequent and shallow, possibly shortness of breath even during rest;
  • heart palpitations;
  • a strong increase in body temperature;
  • common poor well-being;
  • sweating and chills;
  • lack of appetite;
  • Pain in the chest.

Among the less common symptoms are the following:

  • cough with blood (hemopying);
  • headaches;
  • fatigue;
  • nausea;
  • vomiting;
  • whistling breathing;
  • pain in the joints and muscles;
  • Loss of orientation in time and space (especially in the elderly).

If you have discovered the symptoms of pneumonia, consult a doctor to diagnose. If you have pronounced symptoms, in particular, rapid breathing, pain or disorientation in space, consult a doctor immediately.

Causes of pneumonia

The most common cause of pneumonia is infection, usually bacterial origin.

However, pneumonia causes various types of bacteria, viruses and (occasionally) fungi, depending on where pneumonia began. For example, microorganisms causing pneumonia, praised in the hospital, differ from those that can cause it in ordinary life.

Microorganisms that cause infection usually fall into the lungs when inhaled. In rare cases, pneumonia can be caused by infection in another body part. Then the pathogen of pneumonia penetrates into the lungs through blood.

Below in detail the four types of pneumonia are described.

Bacterial pneumonia

The most common cause of pneumonia in adults - Bacteria Streptococcus Pneumoniae. This form of pneumonia is sometimes called pneumococcal.

Less often, the causative agents of pneumonia are other types of bacteria, including:

  • Haemophilus influenzae;
  • Staphylococcus aureus;
  • Mycoplasma Pneumoniae (outbreaks of morbidity occur on average every 4-7 years, usually among children and young people).

In very rare cases, pneumonia causes the following bacteria:

  • Chlamydophila Psittaci: This bacterium is a rare form of pneumonia, which is called ornithosis or psitactosis, which is transmitted to people from infected birds, such as pigeons, canary, long-tailed and wavy parrots (this form of pneumonia is also called a parrot disease or a parrot fever);
  • Chlamydophila pneumoniae;
  • Legionella Pneumophila: Causes Legionells, or "Legionnaire Disease", an unusual form of pneumonia.

Viral pneumonia Possible way of transferring pneumonia

Viruses can also cause pneumonia, most often it is a respiratory syncitial virus (RSV) and sometimes influenza virus type A or B. Viruses are most often becoming pathogens of pneumonia in young children.

Aspiration pneumonia

In rare cases, the cause of pneumonia is getting into the lungs

  • vomiting;
  • foreign bodies, such as peanuts;
  • harmful substance, such as smoke or chemical.

An inhaled object or substance causes irritation of the lungs or damages them. This phenomenon is called "aspiration pneumonia."

Fungal pneumonia

Pneumonia caused by fungal infection of the lungs is rarely found in people with strong health. More often, it affects people with a weakened immune system (see below). Although fungal pneumonia is rare, people travel more often traveling to the places where this type of infection is more common: individual regions of the United States, Mexico, South America and Africa.

Some medical names of fungal pneumonia: histoplasmosis, cocidioidomycosis and blastomicosis.

Risk Groups for Lung Inflammation

People in the following groups are more susceptible to risk of pneumonia disease:

  • Breast babies and young children;
  • elderly people;
  • smokers;
  • patients with other diseases;
  • People with a weakened immunity.

Diseases increasing the likelihood of pneumonia disease:

  • Other lung diseases, such as asthma or fibrosis (fibrous-cystic degeneration or cystic fibrosis);
  • heart diseases;
  • diseases of the kidneys and liver;
  • Weed immunity.

Your immunity can weaken:

  • recently suffered disease, such as influenza;
  • cancer treatment, such as chemotherapy;
  • Some medicines taken after the transplantation of the body (they are specifically taken to weaken the immune system, thereby reducing the rehabilitation of the transplanted organ);
  • HIV or AIDS.

Diagnosis of pneumonia

The doctor often can diagnose pneumonia, interviewing you about the symptoms and inspected the chest. In some cases, additional research may be required. Sometimes pneumonia is difficult to diagnose, as many symptoms coincide with other diseases, such as colds, bronchitis and asthma.

To make a diagnosis, the doctor may first ask:

  • Do you breathe more often than usual;
  • Do you suffer from shortness of breath (you feel the fattened);
  • How long do you have a cough;
  • Expectors are you sputum, and what color is it;
  • Chest pains in breathe or exhale are enhanced.

The doctor will most likely measure the temperature to you and listens to the stethoscope in front and behind, to determine whether characteristic crackling or rattling sounds are heard. It can also listen to your chest, tapping on it. If your lungs are filled with liquid, they make a sound, which differs from the wrong, healthy lungs.

To confirm the diagnosis, the doctor will send you to the chest x-ray and other studies. The chest x-ray can show how much your lungs are amazed. X-ray also helps the doctor to distinguish pneumonia from other infectious diseases of the lungs, for example, bronchitis. In addition, a sputum analysis and blood test is carried out. Analysis of sputum or blood samples helps determine the cause of infection - bacterium or virus.

Screening on lung cancer

Although it is rarely found, but pneumonia can be a symptom of hidden lung cancer in smokers and people over the age of 50. If you fall into one of these groups, your doctor can direct you to the chest x-ray. Lung cancer on X-ray usually looks like a lot of "white-gray".

If X-ray examination has not revealed cancer, it is recommended to make a re-image after 6 weeks. This is done in order to accurately make sure that with your lungs are all right.

Treatment of pneumonia (inflammation of the lungs)

Patients with a light form of pneumonia are usually successfully treated at home. They give antibiotics, abundant drinking and provide complete peace. In more severe cases, treatment may be required in the hospital.

Treatment of inflammation of light houses (outpatient)

Cough can last another 2-3 weeks after the end of the course of antibiotics, and the feeling of fatigue can remain even longer, because your body will be recovered after the disease. If the symptoms are not started to take place within two days after the start of treatment, report it to your doctor. The effect of treatment may not be for the following reasons:

  • Bacteria causing an infection may be resistant to those antibiotics that you have taken - your doctor can register you another antibiotic in return or in addition to the first;
  • The infection can cause a virus, and not bacterium - antibiotics do not act on viruses, and the immune system of your body will have to struggle with a viral infection, producing antibodies.

To facilitate the symptoms of pneumonia, you can take painful, such as paracetamol or ibuprofen. They will help relieve pain and knock down a high temperature. You should not take ibuprofen if you have:

  • Allergies to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs);
  • Asthma, kidney disease, stomach ulcer or digestion disruption.

It is not recommended to take a cough medicine that hovering the cough reflex (codeine, libeksin, etc.). Cough helps to clean the lungs from sputum, so if you stop the cough, the infection can remain in the body longer. In addition, there is little evidence that the cough funds are effective. Warm drink with honey and lemon will help to remove discomfort caused by cough. Drink a lot of fluid to prevent dehydration, and a lot of rest to your body recover.

If you smoke, now it is ever important to quit smoking, as it harms your light.

Pneumonia is rarely transmitted from one person to another, so the patient can be surrounded by people, including family members. However, people with a weakened immune system should avoid contact with pneumonia patients before it starts to get better.

After facilitating the symptoms, you may need some time for complete recovery. At the same time, the cough can be preserved. If it bothers you, talk to your attending physician.

Treatment of pneumonia in hospital (stationary)

With severe symptoms, you may need to go to the hospital for treatment. Treatment in the hospital will include the reception of antibiotics and fluids intravenously through the dropper and / or the supply of oxygen through the oxygen mask to relieve respiration.

In very severe cases of pneumonia, air supply to the lungs can be carried out through the device for artificial ventilation of the lungs in the resuscitation and intensive therapy.

The doctor will most likely ask you to come again after 6 weeks after the start of taking antibiotics. In some cases, it can prescribe repeated studies, for example, an x-ray of the chest if:

  • Symptoms did not appear less;
  • Symptoms returned;
  • Do you smoke;
  • You are over 50 years old.

Complications of pneumonia

Complications at pneumonia are more often observed in the elderly, small children and people with some chronic diseases, for example, diabetes. In case of complications, you will be guided by treatment to the hospital.

The most common complications for pneumonia - pleurisy, lung abscess and blood infection (sepsis) are described below.

Scheme of the development of inflammation of the pleura

Pleurisy - Inflammation of the pleura, thin shell between the lungs and chest. In more rare cases, liquid can accumulate between the lungs and walls of the chest cavity. This phenomenon is called "pleural effusion". Pleural effusion is observed by half of people treated from pneumonia in the hospital.

Liquid can put pressure on the lungs, makes it difficult to breathe. Pleural effusion usually passes as pneumonia treatment. Approximately in one of 10 cases of treatment of pneumonia in the hospital there is a liquid in the pleural cavity by bacteria, which causes the accumulation of pus - the so-called empy.

Typically, purulent releases are displayed using a needle or thin tube. In the most difficult cases, surgical intervention may be required to remove pus and eliminate the harm caused by Plegre and easy.

Abscess light - A rare complication of pneumonia, which most often happens in people with already existing serious diseases or in persons abusing alcohol. The abscess of the lung is filling the cavity in the lung tissues. Wet excavation with an unpleasant smell, swelling of the fingers and legs - the symptoms of the lung abscess.

Abscesses are often treated with antibiotics. Usually prescribed the course of antibiotics intravenously, then the reception of antibiotics in the form of tablets for 4-6 weeks. Most patients have improved well-being for 3-4 days. It is important not to throw the prescribed course of antibiotics, even if you feel completely healthy to avoid re-infection of the lungs. Approximately one of 10 people with lung abscess requires an operation to pump a pus from an abscess or removing the affected part of the lung.

Blood poisoning - Another rare and severe complication of pneumonia, also known as sepsis. Sensis symptoms:

  • High body temperature (heat) - 38º C or higher;
  • Hardness and breathing;
  • Low blood pressure (hypotension), in which dizziness is felt in the vertical position of the body;
  • change behavior, for example, disorientation in space and time;
  • reduced urination;
  • Cold, pale and sticky leather;
  • loss of consciousness.

When infecting blood, the infection may spread to other organs, such as:

  • External brain shells (meningitis);
  • Abdominal shell (peritonitis);
  • The inner sheath of the heart (endocarditis);
  • joints (septic arthritis).

These types of infection are also called "metastatic infections" (from the word "metastasis" - a remote secondary center of the pathological process) and usually occur hard. For their treatment, large doses of antibiotics intravenously prescribe.

What doctor to contact with pneumonia?

With the help of the service, you can find a good therapist or pediatrician who are usually involved in diagnosing and outpatient treatment of lung inflammation. If you are offered hospitalization, you can independently choose an infectious hospital.

How not to infect others at pneumonia

Stop the spread of microorganisms from you to other people can be compliance with hygiene rules. For example, when coughing or sneezing, close the mouth and the nose with a disposable handkerchief. Severate used disposable handkerchiefs used in the garbage bucket or toilet - microorganisms can live a few hours after the nasal or mouth cavity leaves. We wash your hands regularly to prevent the transmission of pathogens to other people and their transfer to various items.

To protect against pneumonia, people from high-risk groups must make vaccinations. The following vaccinations are recommended:

  • Village from pneumococcus (pneumococcal vaccine);
  • Influenza vaccination.

Smoking, alcohol abuse and drug use intravenously can increase the likelihood of pneumonia. Smoking harms your lung, and as a result they become more susceptible to infection. Therefore, if you smoke, the best way to prevent pneumonia is to quit smoking.

There is evidence that the non-harmony and long-term use of alcohol weakens the natural mechanisms of protection of the lungs from infections, which makes them more susceptible to pneumonia. According to one study, 45% of people hospitalized with the diagnosis of pneumonia, abused alcohol.

Alcohol abuse is a regular use of over permissible norm. Under regular use it is understood as the admission of alcoholic beverages every day or most of the days of the week. Alcohol abuse not only increases the risk of pneumonia, but also increases the likelihood that it will leak in a more severe form. According to statistics, the likelihood of death from pneumonia among those abusing alcohol, from 3 to 7 times higher than on average in the population.

Daniel Davydov

Medical journalist

Pneumonia, or lung inflammation, is considered one of the most dangerous diseases on Earth.

According to WHO, its share accounts for 15% of deaths of all children under five years. Dangerous pneumonia and adults. Strong with heavy complications and even perish all ill, but especially people over 65 years old and patients with chronic diseases such as diseases of the cardiovascular system and diabetes mellitus.

To make it easier to figure out how to actually act when suspected pneumonia, let's see how easy it works.

Go to the doctor

Our articles are written with love for evidence medicine. We refer to authoritative sources and go for comments to doctors with a good reputation. But remember: responsibility for your health lies on you and at the attending physician. We do not write down recipes, we give recommendations. Rely on our point of view or not - to solve you.

How easy to arrange

Lightweight - paired organs living in the chest, which we need for breathing. During the inhalation, air saturated with oxygen falls into the lungs not immediately. At first it enters the nasal cavity lined with mucous epithelium. The epithelium moisturizes and warms the air to the body temperature, and still distinguishes the mucus, which catches most of the dust and microbes.

Then the warmed and purified air passes through a series of "pipelines": first through the throat, and then through the trachea, which branches into two strokes called bronchi. Bronchas are also lined with epithelium released mucus. The epithelium is covered with small cilia that helps the mucus with dust stuck and microbes climb on the throat in the mouth, where it can be spacing or swallowed.

In the lungs, bronchi begins to branch on smaller tubes - bronchiols, the tiniest of which is the diameter of all half a million. The smallest bronchioles ended with alveoli air bags, the small blood vessels of the capillaries will deteriorate. Alveola - the final stop for the air, which we breathed. It is in them that happens that, for which everything was stood: the blood is saturated with oxygen and part with carbon dioxide.

The alveoli consists of cells that are separated into the lumen Alveol mucus, facilitating their expansion when inhaling. There In the pulmonary fabric, there are immune cells-macrophages: they patrol the alveoli and devour the viruses and microbes, which have missed the barrier from the mucus.

The air path begins in the nose and ends in the lungs alveoli, where gas exchange

Thus, the lungs have three effective protection systems from microbes - mucus, cilia and macrophages. But sometimes protection gives a failure, and in the lungs fall pathogenic microorganisms, with which the macrophages can not cope. In this situation, the lung infection may develop, which is capable of leading to pneumonia.

As we already know, the group of greatest risk includes people who, due to age or other reasons, have problems with immune defense: babies and small children, adults aged 65 years and older, patients with serious diseases.

Get acquainted with Textbook T⁠-⁠ZH

13 free investment courses, mortgage, health and even dogs are waiting for you to see everything

What is pneumonia and what it happens

Pneumonia is inflammation of one or both lungs that provoke pathogenic bacteria, viruses, or, much less often, pathogenic fungi. As a rule, the pathogens of the disease are transmitted from the patient to healthy with sneezing and cough or if a healthy person will touch the subject that the causative agents of the infection.

Both bacteria, and viruses can cause pneumonia. For example, the most "popular" bacterial pathogen of pneumonia - pneumococcus - lives in the nasopharynk and applies to cough, so even absolutely healthy people can pick it up also Simply, like cold. A respiratory-synticial virus is the most common cause of viral pneumonia in children.

But sometimes bacterial pneumonia begins with a viral disease - colds, influenza or coronavirus disease. Some people have viruses so weaken the organism that he temporarily loses immune protection. Pouring bacteria, which in ordinary circumstances, immunity leaves the slightest chance, will be happy to settle in defenseless lungs and cause pneumonia.

Bacterial and viral pneumonia differ slightly from each other. For example, bacterial pneumonia usually lasts longer viral, and its symptoms are harder. Otherwise, pneumonia caused by different pathogens are very similar. When viruses or microbes fall into the lungs, the body includes a universal immune response, designed to protect against any infection pathogens. That's what happens:

  1. The body temperature increases over 38 ° C - with such a heat, viruses and bacteria are seriously multiplied.
  2. In the inflammation zone, that is, alveoli-affected by microbes, multiple immune cells move: they help macrophages to attack pathogens, but at the same time cause an inflammatory response. Death, immune cells remain in the lungs and turn into a pus, giving a green or yellow shade.
  3. In response to inflammation in the Alveoli, more mucus is distinguished - it increases the chance that the microbes will be lit in it and will not cover other parts of the lungs.

Universal immune response protects the lungs from pathogens. But He same and causes symptoms of the disease: a fever, cough, in which the green mucus "crashes", and difficulty breathing, associated with the fact that unnecessary springs in the alveoli interferes with normal gas exchange.

Due to the fact that it is difficult to distinguish pneumonia by the types of pathogens, in practice, doctors use a classification based on where and under what circumstances suffered a patient.

Knowing this, the doctor may assume exactly which microbes caused pneumonia. For example, grab legionelle can, drinking dirty water, and patients hospitals are more often infected with methecylin-stable golden staphylococcus (MRSA). This information allows you to start treatment, without waiting for the results of analyzes and surveys.

Highlight three main types of pneumonia.

Complete pneumonia - The disease that man picked out outside the medical institution, for example, in a bus, at a concert or from colleagues at work. You can get infected with pneumococcal pneumonia anyone who has in contact with the sick, but in babies, people over 65 and patients with chronic diseases. Risk to sick above.

Common-hospital pneumonia, as a rule, cause:

  1. Respiratory viruses, such as influenza viruses A and B;
  2. rinoviruses, adenoviruses and coronaviruses, such as coronavirus causative agent SARS-COV-2 ;
  3. Typical bacteria - pneumococcus, streptococcus group A, hemophilic stick and golden staphylococcus;
  4. Atypical bacteria that react only to antibiotics specially selected for them, such as legionell, mycoplasma and chlamydia.

Sometimes the community-across pneumonia provokes fungal infection. But the fungus is much harder to penetrate the lungs than viruses and bacteria. So, patients with weakened immunity are suffering from fungal infection, for example, infected HIV and non-antiretroviral therapy, or people who are constantly contacting pathogenic fungi, such as farmers.

Non-community pneumonia - a disease that is infected by patients hospitalized completely different about another occasion. It is believed that patients hospitals are more vulnerable because their immune system is already weakened by the "main" disease. And they are held for a long time in hospital walls, that is, they will continue longer to the in-hospital pathogens, and they often put catheters and are subjected to other invasive procedures, due to which drug-resistant bacteria can spawn into the body.

In addition to the antibiotic staphylococcus-resistant antibiotics, pseudomonads, Klebsiella and antibiotic chopsticks resistant to antibiotic sticks cause.

Aspiration pneumonia - a disease that occurs when saliva, vomiting or water from the pond, lake, rivers or other reservoirs fall into the lungs. It happens when the patient is connected to the device for artificial ventilation of the lungs or when it is possible to save the immentable, which managed to spider water.

Aspiration pneumonia causes bacteria living in a rotoglot and non-filled water. It may be streptococci, hemophilic sticks or golden staphylococcus.

Inspection and aspiration pneumonia, people are usually infected in the hospital, so doctors find out about it in place. Therefore, then we will talk about community-friendly pneumonia, since the probability of getting higher to her.

How to suspect pneumonia

Symptoms of non-hospital pneumonia of different origin are usually similar.

Most people complain about fever - When the temperature rises above 38 ° C. But it should be borne in mind that people over 65 can sow pneumonia and without fever.

Fever helps doctors to distinguish bacterial pneumonium from acute viral bronchitis, which does not require treatment with antibiotics. With bronchitis, patients cough 10-20 days In a row, sometimes sprinkling transparent, yellow or green mucus. But There are no fever.

Other frequent symptoms of pneumonia - rapid heartbeat and breathing, shortness of breath, chest pain when breathing, cough, at which transparent, yellow or green wet, nausea, vomiting and diarrhea. Some people have chills and confusion in thoughts.

If you or your loved ones three or four days High temperature and symptoms, reminiscent of a cold, independently in the clinic are better not to come: with fever, safer remain in bed. Call your doctor at home. You can do this for free on the policy of the OMS, and for money - by calling the private clinic.

Due to the epidemic of coronavirus disease, doctors from many private clinics do not go to the house to patients with symptoms resembling a cold. And patients who plan to visit the clinic independently may ask first to pass PCR-smear on the COVID-19 Or write on reception only after prior consultation by phone or online.

The cost of calling a doctor to a house in Moscow - for free or from 4000 Р.

Most patients with pneumonia can recover at home. As a rule, only patients with pneumonia are hospitalized, which:

  1. They are especially hard - with disturbances of consciousness, pressure below 90 60 mm RT. Art. and Tahipne, that is, with a stripped superficial breathing over 30 breaths per minute;
  2. Risk earning serious complications, such as sepsis, that is, blood infection, or the abscess of the lung, in which the cavity filled with pus is formed on the site of living lung tissue. In the risk group, patients with chronic diseases and people over 65 years old.

How to diagnose pneumonia

In our country, doctors are diagnosed with pneumonia if two conditions are met:

  1. The patient on the X-ray shot shows the lesion lesions of the pulmonary fabric.
  2. The patient has any two symptoms from this list: Fever with a temperature above 38 ° C; cough with sputum; In the lungs, wheezing wheezing; In general blood test, leukocyte levels above 10 × 10 9/ l; In the general blood test, more than 10% of the harsh cell leukocytes.

This means that to confirm the diagnosis you need to do the following:

  1. Complete the doctor. The doctor should measure the temperature and listen to breath with a stethoscope.
  2. Make an X-ray snapshot of the chest in front direct and in lateral projections. If it is not known what easy inflammation struck, the snapshot makes in the right side of the projection. About what snapshot is required, you need to ask the doctor.
  3. Rent a general blood test.

How much does the diagnosis cost. Make an X-ray and donate blood testing for free of charge for the Polish OMS or in a private clinic for money.

The cost of the X-ray of the chest in two projections in Moscow - from 370 Р.

The cost of the total (clinical) blood test together with the taking of biomaterial in Moscow - from 475 Р.

In addition, the compilers of Russian clinical recommendations advise to measure saturation - blood saturation with oxygen - to all patients with suspicion of pneumonia. Saturation is measured using a pulse oximeter. Most likely, at the first visit, this will make a doctor. But if a person does not plan to hospitalize, you should ask the Doctor, Has Lie Meaning to buy your own device to observe the health of independently.

Microbiological blood tests or sputum Assign only hospitalized patients - it helps to choose more accurate an antibiotic. Patients who left recovering at home, microbiological analyzes are not recommended. The result will still not affect the tactics of treatment and will not increase the probability to recover.

Computer tomography and chest ultrasound Doctors are prescribed only to clarify the diagnosis and in difficult cases. Most patients do not need these studies.

How to treat pneumonia

The main purpose of the treatment of community-hospital pneumonia is to get rid of infection and prevent complications.

When the doctor puts the diagnosis of "pneumonia", he most often does not know what caused it - viruses or bacteria. But he can appreciate the severity of symptoms and knows where and as a man has become infected. This allows you to choose treatment aimed at combating the most likely pathogens.

As a rule, patients with community-hospital pneumonia without serious diseases that are underly 65 years and recover at home, write a recipe for antibiotics that help against pneumococcus and other "popular" pathogens. It is usually amoxicillin that needs to be taken three times a day.

Sometimes doctors add another antibiotic. For example, from the class of macrolides - azithromycin or doxycycline. Most patients are enough antibiotics for five days, but some people have fever and other symptoms of illness during this time do not pass. In such a situation, the doctor can extend the course of antibiotics.

Amoxicilline cost - from 111 Р, azithromycin - from 150 Р, doxycycline - from 297 Р.

Patients with chronic diseases of the heart, lungs, kidneys or liver, with diabetes mellitus, alcohol dependence or immunosuppression, smokers and patients who have taken antibiotics over the past three months, need another set of antibiotics - for example, amoxicillin with clavulanic acid. The price of this drug begins from 96 Р.

At the same time there are people with allergies to amoxicillin and individual contraindications, among them patients who take medicines incompatible with some of the "basic" antibiotics. Therefore, doctors still have to adapt standard therapy under a particular patient.

Some patients, in the lungs of which were formed a thick viscous mucus, from which it was difficult to get rid of the cough, the doctor may prescribe a mucolytic - a drug diluted with a wet. For example, a drug with acetylcysteine ​​or a bromgexine-based medicine.

The cost of the drug with acetylcysteine ​​- from 132 Р, with bromgexine - from 223 Р.

Washing the nasal salt solution. Help relieve breathing and get rid of snotes. Salt solution can be made independently or buy - the price begins from 50 Р.

Vaconishing drops. Help from staging in the nose. The main thing is to remember that it is possible to apply them no longer than three or four days. The price of naphtizin begins from 40 Р.

Antipyretic preparation based on paracetamol or ibuprofen. It will help people who have over 39.4 ° C and those who have a bad fever. Price begins from 25.5 Р.

Combined preparation with paracetamol, phenylephrine and phnethyramine. This medicine is three in one: it works like antipyretic, vasoconstrictor and anti-edema. People who choose it do not need vasoconstrictor drops and antipyretic drugs. Price begins from 178 Р.

Hospitalized patients with community-hospital pneumonia are also prescribed antibiotics. Combined therapy are usually used: beta-lactams are prescribed and antibiotic from the macrolide class. If the patient has an allergy to one of these drugs, a fluoroquinolone antibiotic is prescribed.

In addition to antibiotics, patients recovering in the hospital, and those who have developed very heavy inflammation can prescribe a hormonal drug - for example, a glucocorticoid prednisolone.

Such treatment helps most hospitalized patients. However, some disease does not undergo complications. Such patients are translated into intensive care, continue to be treated with antibiotics and provide them with artificial ventilation of the lungs with the help of an IVL apparatus, which delivers the oxygen mixture directly into the lungs. Typically, the patient on the IVL is introduced into a drug to whom so that it does not feel discomfort and pain, but feed through the catheter.

What funds are useless for pneumonia

It is useless to take antiviral medicines like Rimantadina, immunomodulators like kagocel, vitamin C in additives and homeopathic agents. Rimantadine is a medicine for influenza, which has already lost its strength. Immunomodulators and high doses of vitamin with little evidence of efficiency, and homeopathy in principle does not work.

Preparations from cough On the basis of butamirate, at pneumonia, it is also not worth applying. Cough is a protective reaction that helps to throw the mucus from the body in which bacteria and viral particles are bogged down. So safer and more useful to suffer.

Supplements with probiotics and prebiotics. Bada with useful intestinal bacteria from Lactobacillus and Bifidobacterium groups often advise to take together with antibiotics to fill the loss of beneficial intestinal microbes. However, there is no one about the benefits of such practices.

Some experts believe that adversions with probiotics and prebiotics are most likely useless, because the bacteria from the additives do not take root in the intestine.

On the other hand, the members of the World Gastroenterological Organization claim that there are evidence that probiotics are useful for the prevention of diarrhea associated with antibiotics. And the researchers from the Cochrane Community came to the conclusion that when prescribing probiotics with antibiotics, the risk of developing diarrhea antibiotics caused by clostridium is reduced by an average of 60%.

The situation is complicated by the fact that additives differ significantly in the specified composition of useful bacteria, and at their concentration. Therefore, the choice of probiotics makes sense to discuss with the attending physician.

How to avoid pneumonia: prevention

Make a vaccination from influenza and pneumococcus. Influenza vaccination every year makes all citizens of Russia - on the policy of OMS for free.

In our country, there are two vaccines from pneumococcus: "Prevenar 13", protecting from 13 strains, and "Pnemovaks 23", protecting from 23 strains. On the policy of the OMS, only children in 2, 4.5 and 12 months, recruits and people over 65 years from the risk group are vaccinated. This vaccination began to make children only in 2014, so most adult people have no protection. Those who were not vaccinated from the pneumococcus, it is worth thinking about vaccination in a private clinic for money. The cost of vaccination against pneumococcus in a private clinic in Moscow with a traffic inspection - 4700 Р.

Wash your hands. Especially after the street, toilet and before meals. Otherwise there is a chance to swallow the virus or bacteria that can provoke a disease.

Take care of yourself if you were cold. Give yourself a time to relax - so less the chance that bacterial and pneumonia will be added to the viral infection.

Try to quit smoking. Tobacco smoke damages the lungs, so smokers have a higher risk of sick pneumonia. People who continue to smoke come into one of the high-risk groups, which is recommended to make a vaccination from pneumococcus.

On the treatment of pneumonia, you can spend from 5500 Р

Purpose Price in Moscow
Call a doctor Free or from 4000 Р
Common blood test together with the taking of biomaterial From 475. Р
Salt solution, vasoconducting drops, antipyretic or combined drug From 400. Р
X-ray of the chest in two projections From 370. Р
Azithromycin or doxycycline From 150. Рor from 297. Р
Amoxicillin From 111. Р

Call a doctor

Free or from 4000 Р

Common blood test together with the taking of biomaterial

From 475. Р

Salt solution, vasoconducting drops, antipyretic or combined drug

From 400. Р

X-ray of the chest in two projections

From 370. Р

Azithromycin or doxycycline

From 150. Рor from 297. Р

Pneumonia - This is an infectious inflammatory disease of the lung tissues. Other names are common - pneumonia .

Currently, pneumonia (inflammation of the lungs) is successfully treated in overwhelming majority. For confidence in a prosperous outcome, it is enough to consult a doctor in a timely manner and strictly follow the recommendations received. However, one should not forget that pneumonia still remains a formidable disease, and in the absence of proper treatment, it is capable of death to death.

Causes of pneumonia

Image 3: Pneumonia - Family Doctor Clinic

Most often, the cause of pneumonia is a bacterial infection. In 30-40% of cases, the inflammation of the lung inflammation is pneumococcus (a variety of streptococcal infection). In addition to bacteria, pneumonia can also be caused by viruses, mycoplasmas, chlamydia.

Typically, the pathogen enters the light air generated - with inhaled air. But it is also possible to get infections with blood flow from an already existing focus of inflammation (for example, during peritonitis). The penetration of infection through the upper respiratory tracts is also in most cases progressively occurs - first the focus of inflammation in the nasopharynk or throat arises, and only then the infection is "descending" into the lungs. Thus, any viral disease of the upper respiratory tract (ARVI, influenza) can become a trigger mechanism for the development of pneumonia, since viral lesion creates favorable conditions for the activation of pathogenic bacteria. In case of disease, tracheite or bronchitis, it is necessary to observe the experienced physician to prevent or detect the penetration of infection into the lungs themselves.

Factors contributing to the emergence of pneumonia (inflammation of the lungs)

In some cases, the danger of the occurrence of pneumonia increases. Children are most vulnerable (due to the undevelopability of immunity, respiratory muscles, narrower and short respiratory tract). Also often inflammation of the lungs develops in older people (from 60 years), it is associated with age-related imminent, loss of muscle tone and low mobility.

Factors that increase the risk of pneumonia disease are also:

  • chronic diseases of the internal organs (kidneys, hearts) in the aggravation stage;
  • oncological diseases;
  • Endocrine diseases (diabetes mellitus);
  • diseases of the central nervous system (including epilepsy);
  • weakened immunity;
  • constant stress, oppressed state;
  • defective nutrition (insufficient use of fruits, vegetables, fish, meat);
  • supercooling;
  • smoking;
  • Alcohol abuse.

Types of pneumonia

Image 1: Pneumonia - Clinic Family Doctor

Depending on the degree of lesion of pulmonary fabric distinguish Focal pneumonia (when only a small focus of the lungs is affected - for example, bronchi with adjacent respiratory departments, such a form of the disease is called Bronchopneumonia ), segmental affecting one or more lung segments and Dolovaya flowing with the lesion of the lung share (such a form is also called Brewing pneumonia ; The inflammatory process in this case can be involved and pleura - the shell covering the lungs). The focal pneumonia proceeds relatively easily, and the brute pneumonia is the most dangerous form of the disease.

If only one light is involved in the inflammatory process, such pneumonia is called one-sided. Bilateral pneumonia, that is, inflammation immediately both lungs are much harder.

The inflammation of the lungs caused by atypical microflora (mycoplasmas, chlamydia) is called Atypical pneumonia . The flow of atypical pneumonia is significantly different (in particular, its primary manifestations may coincide with the usual cold).

Pneumonia in children

Image 2: Pneumonia - Family Doctor Clinic

Children of the first years of life more often sick pneumonia than adults. This is explained, first of all, the fact that the respiratory system of kids is still formed, and therefore has a number of features that make it particularly vulnerable, such as:

  • immature pulmonary fabric;
  • narrow and short respiratory tract;
  • Small lung volume;
  • The mucous membrane of the respiratory tract quickly swells, and the weak and fragile cilia epithelium is poorly removed.

Children often occurs atypical pneumonia. The pathogens that in adults relatively rarely cause inflammation of the lungs - viruses, mycoplasma, chlamydia, falling into the child's respiratory system, are easily caused by pneumonia. And this means that the disease can proceed not as we used to observe it in an adult environment. Therefore, parents must be particularly vigilant and not miss the development of the disease. Suspecting the pneumonia in a child can be in case of a combination of some of the following signs:

  • high temperature (38 ° C and higher), which keeps more than 3 days;
  • shortness of shortness of breath;
  • the pallority and the imagining of the nasolabial triangle (the nasolabial triangle is an area that includes the nose from the base of the nose, from the bottom limited mouth, and from the sides - nasolabial folds);
  • unreasonable sweating;
  • Weakness and refusal of food.

With atypical pneumonia, cough may be absent or seemed to be superficial. The main feature of the disease is the combination of stable high temperature and shortness of breath.

Possible complications of pneumonia

Pneumonia can lead to such complications as:

  • inflammation of the pleura (pleurisy);
  • pulmonary edema;
  • lung abscess (occurrence in the lightweight cavity filled with pus);
  • Breathing disorder.

Symptoms of pneumonia

In most cases, the defeat of bacterial infection began the beginning of the disease is sharply. Atypical pneumonia caused by mycoplasmas, chlamydia, legionell has a blurred beginning, similar to the usual cold illness.

In the typical flow of pneumonia, the main symptoms are:

Temperature

For pneumonia, a typical significant increase in body temperature (from 37.5 ° C to 39.5 ° C and above)

More about symptom

Symptoms intoxication

The complex of symptoms of intoxication in pneumonia includes headaches, weakness, high sweating, loss of appetite.

Cough

Cough with pneumonia at the beginning is usually dry, after 3-4 days it becomes wet, with the release of abundant sputum of reddish or greenish color.

More about symptom

Dyspnea

The more extensive focus of the defeat, the stronger the shortness of breath. Inhalation is especially difficult.

More about symptom

Methods of diagnosis of pneumonia

The diagnosis of pneumonia is carried out on the basis of the inspection of the patient. Assumination (percussion) and listening to (auscultation) are performed to identify noise in the lungs. Laboratory and instrumental research can also be appointed.

Microscopic examination

A microcryptic study of sputum with gram color makes it possible to detect the presence of gram-negative microorganisms. It is gram-negative pathogens that cause atypical pneumonia that flows the most dangerous to the patient.

PCR diagnostics

In suspected atypical nature of pneumonia, PCR diagnostics are conducted. The studied biological material is the sputum. The study by the PCR method allows the presence of the pathogen and confirm the diagnosis.

Read more about the diagnostic method

Radiography of the chest

Bronchoscopy.

With complicated forms of pneumonia, bronchoscopy can be conducted. The method involves the introduction through the nose in the lumen of the trachea of ​​a special endoscopic tool - bronchoscope. The bronchoscope is equipped with backlight and optical system that allows the doctor to see the situation with his own eyes.

To accurately dig a disease, sign up for reception to the specialists of the "Family Doctor" network.

Methods of treatment of pneumonia

Image 4: Pneumonia - Family Clinic

The patient with suspicion of pneumonia should examine the doctor. In the "Family Doctor" you can call a doctor or pediatrician at home.

The patient is assigned bedding. With severe forms of inflammation of lungs, hospitalization is required. In the case of pneumonia flowing in a light form, treatment is carried out at home, but necessarily under the control of the doctor.

The patient needs abundant drinking (desirable warm) and a rational diet, eliminating oily foods and sweet meals. The room where the patient is located should be regularly ventured and undergo a wet cleaning.

The doctors of the "Family Doctor" have extensive experience in the diagnosis and treatment of pneumonia. Observing in the "Family Doctor", you will reduce the risk of developing complications and relapse of the disease.

Medicia treatment

Medical treatment is aimed primarily to suppress the causative agent of the disease. Also usually take measures to reduce the temperature and purify the respiratory tract from sputum.

Physiotherapy

To therapeutic physical education resorted after temperature normalization. The purpose of the LFC at pneumonia is to strengthen the overall condition of the patient, improving blood circulation, preventing the formation of pleural adhesions, strengthening the heart muscle.

Read more about the treatment method

Do not self-medicate. Contact our specialists who correctly put the diagnosis and prescribe treatment.

Rate how much the material has been useful

Pneumonia

Pneumonia - acute defeat of light infectious inflammatory character, in which all structural elements of lung tissue are involved, mainly alveoli and interstitial lung tissue. The pneumonia clinic is characterized by fever, weakness, sweating, pain in the chest, shortness of breath, a cough with a wet (mucous, purulent, "rusty"). Pneumonia is diagnosed based on the auscultation pattern, lung radiography data. In the acute period, treatment includes antibiotic therapy, disinfecting therapy, immunostimulation; reception of flux, expectorant, antihistamine; After the cessation of fever - physiotherapy, LFC.

General

Pneumonia is inflammation of the lower respiratory tract of various etiology, which flows with intrastallyolar exudation and accompanied by characteristic clinical and radiographic signs. The sharp pneumonia occurs in 10-14 people out of 1000, in the age group over 50 years old - 17 people from 1000. The relevance of the incidence of acute pneumonia is preserved, despite the introduction of new antimicrobial drugs, as well as the high percentage of complications and mortality (up to 9% ) From pneumonia.

Among the causes of mortality, pneumonia stands on a 4th place after heart disease and vessels, malignant neoplasms, injury and poisoning. Pneumonia can develop in weakened patients, joining the flow of heart failure, oncological diseases, violations of cerebral circulation, and complicates the outcome of the latter. Patients with AIDS pneumonia is the main direct cause of death.

Pneumonia

Pneumonia

Causes and mechanism for the development of pneumonia

Among the etiphorts causing pneumonia, there is a bacterial infection in the first place. Most often, the pathogens of pneumonia are:

  • Gram-positive microorganisms: pneumococci (from 40 to 60%), staphylococci (from 2 to 5%), streptococci (2.5%);
  • Gram-negative microorganisms: Fredlender wand (from 3 to 8%), hemophilic stick (7%), enterobacteria (6%), protea, intestinal wand, legionella, etc. (from 1.5 to 4.5%);
  • Mycoplasma (6%);
  • viral infections (herpes, influenza and paragrippa viruses, adenoviruses, etc.);
  • fungal infections.

Also, pneumonia can develop due to the impact of noncommunicable factors: injuries of the chest, ionizing radiation, toxic substances, allergic agents.

Risk factors

The risk group for the development of pneumonia includes patients with stagnant heart failure, chronic bronchitis, chronic nasopharyngeal infection, congenital lung defects, with severe immunodeficiency states, weakened and exhausted patients, patients, long-term beddown, as well as senior and senile facial .

Particularly subject to the development of pneumonia smokers and alcohol abusers. Nicotine and alcohol pairs damage the mucous membrane of the bronchi and oppress the protective factors of the bronchopulmonary system, creating a favorable environment for the introduction and reproduction of infection.

Pathogenesis

Infectious pathogens of pneumonia penetrate into light bronchogenic, hematogenic or lymphogenic paths. With the reduction of the protective bronchopulmonal barrier in Alveoli, infectious inflammation develops, which through permeable intervalolar partitions is distributed to other departments of lung tissue. In Alveola, the formation of an exudate that prevents oxygen gas exchange between the pulmonary fabric and blood vessels. Oxygen and respiratory failure develop, and with a complicated flow of pneumonia - heart failure.

In the development of pneumonia 4 stages are allocated:

  • the stage of the tide (from 12 hours to 3 days) is characterized by a sharp blood flow of vessels of lungs and fibrinous exudation in the alveoli;
  • Stage of red oven (from 1 to 3 days) - a piece of lung tissue occurs, according to the structure resembling the liver. Erythrocytes in large quantities are found in alveolar exudate;
  • The stage of gray compelling - (from 2 to 6 days) - is characterized by the decay of the red blood cells and the massive leakocyte output in the alveoli;
  • The resolution stage is restored by the normal structure of the lung tissue.

Classification

1. Based on epidemiological data, pneumonia distinguishes:
2. On the etiological factor, with the clarification of the pathogen, pneumonia happens:
3. Under the development mechanism, pneumonia is distinguished:
  • Primary, developing as independent pathology
  • Secondary, developing as a complication of concomitant diseases (for example, stagnant pneumonia)
  • Aspiration, developing in the affiliation of foreign bodies in bronchi (food particles, vomit, etc.)
  • Post traumatic
  • Postoperative
  • Infarction pneumonia, developing due to thromboembolism of small vascular branches of the pulmonary artery.
4. According to the degree of interest of lung tissue there are pneumonia:
  • One-sided (with the defeat of the right or left light)
  • bilateral
  • Total, equity, segmental, subdollated, roasting (central).
5. By the nature of the flow of pneumonia can be:
  • sharp
  • sharp protracted
  • Chronic
6. Taking into account the development of functional disorders of pneumonia proceeds:
  • With the presence of functional disorders (indicating their characteristics and severity)
  • With the lack of functional disorders.
7. Taking into account the development of complications of pneumonia there are:
8. Based on clinical and morphological features, pneumonia distinguishes:
  • Parenchimato (Burent or Share)
  • Focal (bronchopneumonia, pneumonia)
  • interstitial (more often with mycoplasma lesion).
9. Depending on the severity of the flow of pneumonia divide on:
  • Easy degree - It is characterized by poorly pronounced intoxication (clear consciousness, body temperature up to 38 ° C, blood pressure, tachycardia is not more than 90 liters. In min.), Shortness of breath is missing, x-ray is determined by a small focus of inflammation.
  • Middle degree - Signs of moderately pronounced intoxication (clear consciousness, sweating, pronounced weakness, body temperature up to 39 ° C, the hell is moderately reduced, tachycardia is about 100 ° C. in min.), Respiratory rate - up to 30 per minute. At rest, radically determined pronounced infiltration.
  • Heavy degree - It is characterized by pronounced intoxication (fever 39-40 ° C, turbidity of the creation, adamiya, nonsense, tachycardia over 100 liters. In min., Collapse), shortness of breath to 40 per minute. At rest, cyanosis, radiologically determined extensive infiltration, the development of complications of pneumonia.

Symptoms of pneumonia

Brewing pneumonia

It is characteristic of a sharp beginning with a fever over 39 ° C, chills, pain in the chest, shortness of breath, weakness. The cough is worried: first dry, unproductive, further, for 3-4 days - with "rusty" sputum. The body temperature is constantly high. With a bruboral pneumonia, fever, cough and sputum of sputum hold up to 10 days.

With a severe degree of flow of brunt pneumonia, the hyperemia of the skin and cyanosis of the nasolabial triangle is determined. On lips, cheeks, chin, nose wings are visible herpetic rash. Patient condition is severe. Surface breathing, rapid, with inflating the wings of the nose. Auscultatively listened to the crepitution and wet small-pushed wheezes. Pulse, frequent, often arrhythmic, Hell is reduced, heart tones deaf.

Heat pneumonia

It is characterized by a gradual, lowest beginning, more often after transferred by ORVI or acute tracheobronchita. The temperature of the body febrile (38-38.5 ° C) with daily oscillations, cough is accompanied by the disheve of the mucous-purulent sputum, sweating, weakness, with breathing - chest pain on the breath and with cough, acrocyanosis. With focal drain pneumonia, the patient's condition deteriorates: pronounced shortness of breath, cyanosis appear. With auscultation, hard breathing is listened, exhalation is elongated, dry fine and medium-reported wheezes, attitudes above the hearth inflammation.

Complications of pneumonia

Features of the flow of pneumonia are due to the degree of severity, the properties of the pathogen and the presence of complications. The amount of pneumonia is considered complicated, accompanied by developing in the bronchopulmonary system and other organs of inflammatory and jet processes caused directly by the inflammation of the lungs. The presence of complications largely depends on the course and outcome of pneumonia. Complications of pneumonia can be pulmonary and extractive.

Light complications for pneumonia can be:

Among the extravalous complications of pneumonia often develop:

Diagnostics

When diagnosing pneumonia, several tasks are solved at once: the differential diagnosis of inflammation with other pulmonary processes, the clarification of the etiology and the severity (complications) of pneumonia. Pneumonia in the patient should be suspected on the basis of symptomatic signs: the rapid development of fever and intoxication, cough.

  1. Physical research. The sealing of the pulmonary tissue is determined (based on the percutive dullness of the pulmonary sound and the amplification of the bronchophone), a characteristic auscultation pattern - focal, wet, fine-duct, sonorous wheezes or crepitations.
  2. Laboratory diagnostics. Changes in the general blood test in pneumonia are characterized by leukocytosis of 15 to 30 • 109 / l, with a launching shift of the leukocyte formula from 6 to 30%, with an increase in ESP to 30-50 mm / h. In general, urine analysis can be determined by proteinuria, less often microhematuria. Bakanalize sputum at pneumonia allows you to identify the pathogen and determine its sensitivity to antibiotics.
  3. Lung radiography. Radiographs for pneumonia are usually made at the beginning of the disease and after 3-4 weeks to control the permission of inflammation and exclusion of other pathology (more often of bronchogenic lung cancer). With any kinds of pneumonia, the process captures the lower lobes of the lung. On radiographs, with pneumonia, the following changes can be detected: parenchymal (focal or diffuse darkens of various localization and length); Interstitial (pulmonary pattern is strengthened due to perivascular and peribroscial infiltration).
  4. Ultrasound. According to echocardiography and ultrasound of the pleural cavity, the pleural effusion is sometimes determined.
CT OGK. Plot of pneumonic infiltration in the upper share of the left lung.

CT OGK. Plot of pneumonic infiltration in the upper share of the left lung.

Treatment of pneumonia

Patients with pneumonia, as a rule, are hospitalized into a general-merating department or a branch of pulmonology. For the period of fever and intoxication, bedding is prescribed, abundant warm drinking, high-calorie, rich in vitamins. With discharged respiratory failure phenomena, patients with pneumonia are prescribed oxygen inhalation. The main directions of therapy:

  • Antibiotic therapy. The main in the treatment of pneumonia is antibacterial therapy. Antibiotics should be prescribed as soon as possible, without waiting for the determination of the pathogen. The selection of the antibiotic is carried out by the doctor, no self-treatment is unacceptable! In extractive pneumonia, penicillins are prescribed more often (ampicillin with clavulano k-th, ampicillin, etc.), macrolides, cephalosporins. The choice of a method for administering an antibiotic is determined by the severity of the flow of pneumonia. Penicillins, cephalosporins, fluoroquinolones (ciprofloxacin, ophloxacin, etc.), carbapenes, aminoglycosides are used to treat internal hospitals pneumonium. With an unknown pathogel, combined antibiotic therapy of 2-3 drugs are prescribed. The course of treatment can continue from 7-10 to 14 days, an antibiotic change is possible.
  • Symptomatic therapy. In pneumonia, it shows the conduct of disinfecting therapy, immunostimulation, the appointment of antipyretic, expectorant and musolitic, antihistamine.
  • Physical. After the discontinuation of fever and intoxication, the regime is expanding and prescribed physiotherapy (calcium chloride electrophoresis, potassium iodide, hyaluronidase, UHF, massage, inhalation) and leafc for stimulating the resolution of the inflammatory hearth.

Treatment of pneumonia is carried out until the patient's complete recovery, which is determined by the normalization of state and well-being, physical, radiological and laboratory indicators. With frequent repeated pneumonia, the same localization is solved by the issue of surgical intervention.

Forecast

With pneumonia, the forecast is determined by a number of factors: the virulence of the pathogen, the patient's age, background diseases, immune reactivity, adequacy of treatment. The complicated variants of the flow of pneumonium, immodeficiency states, the stability of pathogens to antibiotic therapy, are unfavorable. Especially dangerous pneumonia in children under 1, caused by staphylococcus, a blue rod, Chlebseyella: mortality with them ranges from 10 to 30%.

With timely and adequate medical events, pneumonia ends with recovery. According to changes in pulmonary fabric, the following outcomes of pneumonia may be observed:

  • the complete restoration of the structure of the pulmonary fabric is 70%;
  • the formation of a portion of local pneumosclerosis - 20%;
  • the formation of the local carnigation section is 7%;
  • Reducing the segment or share in size - 2%;
  • Warming segment or share - 1%.

Prevention

The prevention measures of the development of pneumonia are to harden the body, maintaining immunity, the exclusion of the factor of hypothermia, the rehabilitation of chronic infectious foci of nasopharynx, the fight against dusting, stopping smoking and alcohol abuse. In weakened lying patients in order to prevent pneumonia, it is advisable to conduct respiratory and medical gymnastics, massage, the purpose of antiagregants (pentoxyfalline, heparin).

Inflammation of lungs or pneumonia is a viral disease that affects the lightweight tissue and prevents the normal oxygen exchange between air and blood. Inflammatory discharges that fall into the alveoli do not allow the body to obtain a sufficient oxygen volume. And if the disease captures most of the lungs, acute respiratory failure is developing.

Pneumonia are subject to people with a weak immune system, children and elderly. Every year, only 1.5 million people suffer from the disease from the disease and 30% of them make up children of younger and people over 70 years old.

But pneumonia can be treated! And it is recommended to do this with a comprehensive approach. Treatment of any disease begins with the correct diagnosis. Therefore, at the first signs of the development of pathology, please contact a specialist.

What are the first symptoms of pneumonia, as properly and comprehensively approaching treatment and what is required to diagnose the disease, we will tell in this article.

Causes of the development of pneumonia

Pneumonia develops when bacteria and viruses and viruses fall into the lungs, as well as foreign agents that affect the part or all the pulmonary fabric. Pathology pathogens fall into the human body with a respiratory way, rarely - through blood.

Why is the disease rapidly develop in a human body with reduced immunity? In our body there are constantly present bacteria, but the protective mechanisms do not give them multiply by causing pathology. But if the immune system is weakened, the harmful microflora increases the population, which leads to the appearance of the inflammatory process.

Also develops viral pneumonia against the background of the spread of colds of the upper respiratory tract (bronchitis, tracheitis). Also, the cause of inflammation of the lungs can be the supercooling of the body, stress, overwork, abuse of smoking. The risk of developing the disease increases in people with chronic diseases and obesity.

Signs of pneumonia in adult

Signs of pneumonia in adult

When a disease occurs, a person increases the body temperature, which can reach 38 °, there is a general weakness throughout the body, a headache, a patient wants to lie down and relax. A few days later there is a strong bakery cough, a sprome appears.

Pain in the chest, especially in the focus of inflammation, as well as the appearance of shortness of breaths, talk about the severity of the situation and clearly indicate inflammation of the lungs.

Here are general features, however, the nature and time of their manifestation may differ depending on the type of pneumonia. With viral pneumonia, the first symptoms appear rapidly and the patient feels a sharp deterioration in state of health. From the very beginning of the disease, there is pain in the muscles, high body temperature, severe headache, painful dry cough.

Bacterial pneumonia on the contrary develops gradually. The disease begins only 2 weeks after the appearance of the first signs. After that, there is a sharp relief, improving the overall condition of the patient, then the temperature rises again, the headache occurs, the cough occurs, the purulent sprome appears.

One of the serious types of disease is atypical bilateral pneumonia, which extensively affects the lightweight tissue and develops breathing insufficiency. In their symptoms, bilateral pneumonia resembles a cold viral infection, and characteristic wheezing are not yet heard in the lungs. Many begin to be treated independently, which aggravates the state.

At first, the sick thinks that his condition has improved, the symptoms of pathology begin to leave. But then the cough is aggravated and the second wave of the disease begins.

Symptoms in the elderly may differ slightly. First of all, a dry cough appears, shortness of breath during small physical exertion on the body or even at rest. Often the disease occurs without increasing the temperature in people of mature age.

Signs of pneumonia in a child

Signs of pneumonia in a child

Often, pneumonia in children appears as a complication of any viral infection (ARVI, flu, etc.).

  • Cough, which is enhanced with time;
  • If the well-being of the baby improved, and then it became bad again, it can talk about the presence of complications;
  • Each deep breath leads to a strong cough rig;
  • There is a strong pallor of the skin against the development of the listed symptoms;
  • The appearance of shortness of breath.

Is pneumonia?

The inflammatory process in the pulmonary system most often appears due to the breeding of the virus and as a complication of the transferred influenza or ARVI. It is impossible to get sick itself in such cases, but it is easy to grab the disease that has become the root cause. That is, the pneumonia itself is not infection, but the development of inflammation in lungs is an independent complication that arose against the background of weakened immunity and improper self-treatment.

How is pneumonia transmitted?

The disease can be transmitted in different ways, among which:

  • Air-drip method. During the disease on the mucous membrane of the mouth and the nose, drops are formed that apply to air during sneezing and cough. You can get an airframe in any public place: hospital, shop, public transport. The pathogenic pathogen spreads through the air together with mucus particles, sputum, saliva.
  • Contact. Also, the infection is transmitted during contact - handshake, embrace, kiss. People are subjected to infections when they touch contaminated subjects or during when they touch the mouth, eyes, nose dirty hands.
  • Domestic. The infection can be transmitted through towels, dishes and shared bedding. Therefore, the patient needs to be provided with personal objects of hygiene, and as it is possible to change them more often and washing.
  • However, processing personal hygiene items are very carefully. It has been proven that viral microorganism is able to survive up to 4 hours on any surface. Frost is unbrained by the pathogenic bacteria, even a chlorine can be destroyed only five minutes after direct processing.

  • Fecal. The virus survives up to two days in fecal masses at normal intestinal emptying. You can easily be taken over the disease with improper cleaning of toilet or personal hygiene. In order not to be infected, especially from young children, it is important to constantly wash your hands after cleaning a children's pot, often change diapers and thoroughly wash the place of feces.

Pneumonia and bronchitis: What is the difference?

Both diseases affect the human respiratory system, which means that have similar symptoms. Often, two pathologies are difficult to distinguish from each other.

Pneumonia Bronchitis
In most cases, accompanied by a sharp increase in temperature to 38-39 ° and a feverish state. There is a slight increase in temperature. Accompanied by a strong dry cough. In some cases, the sputum of greenish color or with streaks of blood may appear. Wet cough, the wet has a light shade.
When listening to the chest, "wet" wheezing are heard. When listening to the chest, "dry" wheezes are heard.

How is the diagnosis of pneumonia?

How is the diagnosis of pneumonia?

If the child suffers from the disease, you need to seek a pediatrician inspection. If an adult - sign up for a reception to the therapist, which will guide you if necessary for a narrow-profile specialist. The doctor will conduct an external inspection, will collect anamnesis, examines the history of the disease and learns about the symptoms of the disease.

You will be sent to the delivery of laboratory tests:

  • General blood analysis;
  • General urine analysis;
  • Wet analysis is carried out to determine the inflammatory process in the body, as well as the pathogen of pneumonia and its sensitivity to antibiotics.

From diagnostic research methods, you will be prescribed:

  • Radiography of the chest - snapshots appear in the pictures in places of tissue damage;
  • Computer tomography and magnetic resonance imaging - used as additional measures when other methods do not allow an accurate diagnosis.

Methods Treatment of pneumonia

If pneumonia has a bacterial nature, prescribe antibiotics. Their effectiveness can be estimated after 48-72 hours. If the temperature falls, the cough becomes less often, and the patient begins to feel better, the reception continues. It is impossible to interrupt the course of drugs, and it is important to take them correctly on the prescription of the doctor. If antibiotics do not help, they prescribe another treatment or change to the drug from another group.

With viral pneumonia, antibiotics are not effective, therefore antiviral drugs are prescribed. Vitamins and immunomodulators can be appointed as auxiliary substances.

As soon as the body temperature of the patient returned to normal, it is possible to prescribe physiotherapy. It allows you to bring the wet from the lungs. For this, phytopreparations are often taken, such as licorice root or complex breast fees.

Together with medication treatment, patients need bed regime, food with protein and vitamins, abundant warm drinking. For better effect, therapeutic methods are recommended - electrophoresis, inhalation, massage, magnetotherapy, etc.

Grafting from pneumonia as prevention

Bringing from the pneumococcal infection is in cases where:

  • Frequent outbreaks of disease occur;
  • Visiting public areas;
  • Work in the bacteriological laboratory;
  • Frequent pneumonia, ORVI and influenza, from which the patient suffers.

There are several drugs that are introduced intravenously against disease protection. All of them differ in their composition, cost and latitude of the spectrum of action.

In adulthood, the vaccination is made by one, a persistent immune response to the causative agent is produced in 2-3 weeks. But at the same time, experts recommend vaccinated once every 5 years.

Specialists of the Clinic "Medunion" are engaged in the diagnosis and treatment of pneumonia. You can make an appointment with a specialist one of the ways convenient for you:

  1. Online on our website Medyunion.ru. Fill out an electronic form by specifying your contact details, a specialization of a doctor, convenient date and time for reception.
  2. Order a callback by specifying your name and phone number. Our managers will call you back within 15 minutes and answer your questions.
  3. Call the registration of a medical clinic by phone number +7 (391) 202-95-80.

Publication date July 31, 2018. Updated April 26, 2021.

Definition of the disease. Causes of the disease

Pneumonia (inflammation of the lungs) - a variant of acute respiratory infection, affecting a lightweight fabric. Lights consist of small fabricated formations (Alveol), which during the respiratory act of a healthy person must fill with air. With pneumonia, the alveoli is filled with liquid (exudate) and pus, which worsen gas exchange. [one]

Alveoli is normal and at pneumonia 

Complete Pneumonia (VP) - This is an acute infectious disease, especially common among residents of cities. According to the statistics provided by different authors, about 1,500,000 people are ill in pneumonia annually. In the mortality structure, pneumonium in Russia in 2015 accounted for up to 50% (in the group of diseases of the respiratory organs), in 2016 the mortality from this disease reached 21 for every 100 thousand inhabitants. [2]

The list of possible causative agents of VI includes more than a hundred microorganisms (viruses, mushrooms, simplest, but mainly bacteria). However, most often the disease is associated with a relatively small circle of microbial agents, including:

  • Pneumococcus (S. pneumoniae);
  • Mycoplasma (M. pneumoniae);
  • Chlamydofila (C. pneumoniae);
  • Hemophilic stick (H. Influenzae) ;
  • respiratory viruses;
  • enterobacteria;
  • Golden Staphylococcus (S. aureus);
  • Legionella Pneumophila (L. Pneumophila).
Patoes of community-hospital pneumonia 

Risk factors

The greatest risk of the development of pneumonia is subject to:

  • children up to two years;
  • People over 65 years old.

Other risk factors include:

  • treatment in the hospital;
  • Chronic diseases - asthma, chronic obstructive pulmonary disease (COPD) or heart disease;
  • Weakened immune system - patients with HIV, as well as people who have transferred transplants receiving chemotherapy or long-receiving steroids are at high risk;
  • smoking [12] .

An unfavorable outcome risk factors are: age, male floor and related diseases [3] .

Inage pneumonia

Pneumonia can cause many different microorganisms. Many of them are transmitted from a person to a person, but not all when exposed to the same microbes develop pneumonia.

How pneumonia is transmitted

Viruses and bacteria leading to the development of pneumonia can be transmitted by air-drip and contact-domestic way. Mushroom pneumonia is usually developing when people inhale microscopic particles of the environment.

Warning

When you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of pneumonia

The supercooling of the body often becomes the cause that runs the process of developing inflammation of the lungs in adults. Then the symptoms of the disease appear consistently.

How to recognize the symptoms of pneumonia:

  • unexpected and very fast rise body temperature to febrile digits (over 38 ° C);
  • nonspecific manifestations of systemic intricensication of the body (depression, lethargy, fatigue, muscle weakness, drowsiness, headache);
  • After 3-4 days, a dry cough occurs, which after a few more days becomes wet - the mucus (sputum) begins to flick, often it has a rusty or brown color;
  • There may be pain in the chest on the side of the affected light (or on both sides, if the inflammation is bilateral), which is enhanced by coughing and breathing;
  • When breathing may be listened to wheezing in the chest (not all patients are heard);
  • shortness of breath (frequent breathing) - is the result of massive lesion of the lung and manifestation of respiratory failure;
  • One of the sides of the chest (amazed) can fall behind with breathing. [four]

Signs of pneumonia in an adult:

The main symptoms of pneumonia 

Signs of pneumonia at the child

In children, the symptoms of pneumonia are usually pronounced more - they are sick with a higher temperature at which febrile cramps may develop. In addition, children, especially very small, often badly know how to dig a sputum, so it is not always possible to notice her purulent character - yellow or green color and an unpleasant smell.

Pathogenesis of pneumonia

Leading mechanisms that lead to the development of VP:

  1. penetration into the lower respiratory paths of the content of the rotogling (aspiration);
  2. Inhalation of aerosol suspension containing various microbial agents;
  3. penetration of microorganisms from the focus of infection, located outside the lungs, through blood;
  4. Moving infectious agents from neighboring affected organs (direct contact) or as a result of attachment of infection with invalid objects (weapons) into the chest. [3]

Attachment (adhesion) of microbial agents to the surface membrane cell epithelium cells of the bronchi, especially the preceding dysfunction of the celibery epithelium and change of mukiciliary clearance, is becoming the starting pulse of the development of pneumonia of lungs.

Stage of the inflammatory process 

The next step in the formation of inflammation is the reproduction of the microbial agent in the cells of the bronchial epithelium. The disorder of the integrity of the membrane of these cells leads to intensive products of biologically active substances - cytokines. They cause directional motion (chemotaxis) of macrophages, neutrophils and a number of other cells in the inflammation area.

In the following stages of the inflammatory process, consistent penetration (invasion), the vital activity of microorganisms inside the cells and products of toxins plays a very significant role. All these processes ultimately end with exudative inflammation inside Alveol and bronchiol. The phase of clinical manifestations of the disease occurs. [four]

Mechanism of development of pneumonia 

Classification and stage of development of pneumonia

In the international classification of the diseases of the 10th revision (ICD-10) in the section "H. Respiratory diseases »allocate the following types of pneumonia:

  • non-classified viral pneumonia (adenovirus and others);
  • Pneumococcal pneumonia ( S. Pneumoniae. );
  • Pneumonia caused by hemophilic stick ( H. INFLUENZAE. );
  • non-classified bacterial pneumonium caused by the impact of Klebsiella ( Klebsiella Pneumoniae. ), staphylococcus ( Staphylococcus SPP. ), streptococcus group in and other fiefococcus, intestinal sticks ( Escherichia Coli. ), other aerobic gram-negative bacteria and micallopasms ( Mycoplasma pneumoniae. ). Also, this group includes other bacterial pneumonia and pneumonia of unspecified etiology.
  • Pneumonia, which emerged due to the impact of other infectious pathogens: Chlamydia (Chlamydia SPP), as well as other infections established pathogens.
  • pneumonia arising from diseases classified in other categories (with actinomycosis, Siberian ulcer, gonorrhea, nocardiosis, salmonellosis, tularemia, abdominal title, coughus; for cytomegalovirus disease, measles, rubella, wind pump; under the Mikosakh; under parasitosis; under ornithosis, ku-fever, acute rheumatic fever, spirochetose);
  • Pneumonia without refining the pathogen.

This classification is built on the etiological principle, that is, it is based on the form of a pathogen who caused the cause of inflammation of the lungs. [five]

Also separately allocated Aspiration pneumonia , which has been attributed to inhalation or passive getting into light different substances in a large amount, most often vomit, which cause an inflammatory response.

Aspiration pneumonia leads:

  • the regulation of the gastric content in the respiratory tract at reanimation, shock, disorders of consciousness (including in alcohol and heroin intoxication);
  • Violation of swallowing in various neurological disorders and diseases of the esophagus.

Features of the treatment of aspiration pneumonia is the use of endoscopic methods for washing and purifying respiratory tract, antibacterial and expectorant drugs.

In modern clinical practice, the most popular classification is the classification that takes into account the three main factor: the conditions for the appearance of pneumonia, the features of infection of the pulmonary tissue and the status of the patient's immune system. In this aspect it is very important to distinguish Complete-headed pneumonia (VP) and Non-community pneumonia (Nosocomial, NP), since the concepts of their treatment will differ. The community is considered pneumonia, which developed outside the hospital or detected in the first 48 hours after hospitalization in the hospital. Since 2005, a number of authors outreach Pneumonia associated with medical intervention .[6]

Signs of community-friendly, nosocomial (nosocomial) and related to the provision of medical assistance of pneumonia

Classification under the conditions of the appearance of pneumonia 

Complications of pneumonia

Many authors allocate two categories of complications developing at pneumonia - "light" and "extreme".

К "Easy" complications relate:

  • parapneumonic pleurisy;
  • Empiama pleura;
  • abscess and gangrene lung;
  • acute respiratory failure;
  • Respiratory Distress syndrome.

"Extreme" complications are:

  • septic shock;
  • polyorgan deficiency;
  • meningitis;
  • myocarditis;
  • DVS syndrome.

Currently, such a division is very conditional, since intoxication syndrome in pneumonia applies to the entire body.

Pleurisy - an inflammatory disease in which an excess amount of liquid accumulates in the pleural cavity. It is observed especially often with the bacterial and viral nature of the pathogen.

Abscess liga - Pathological infectious process, manifested by the formation of a more or less limited cavity in a lightweight tissue (> 2 cm in diameter) due to the local intake of tissues and the subsequent purulent decay. Very often, the development of abscesses is infected with anaerobic microorganisms.

Empiama pleura - The accumulation of pus in the pleural cavity, quite often becomes the extremely adverse outcome of the flow of exudative pleuritis.

Empiama pleura 

Acute respiratory failure - A sharp impairment of breathing, in which the oxygen transport is reduced into lungs, and ensuring the proper gas composition of arterial blood becomes impossible. As a result of insufficient oxygen intake, "oxygen starvation" (hypoxia) occurs. Significant oxygen deficiency threatens the life of the patient and may require deploying measures of emergency intensive therapy.

Sepsis - It is the most formidable and severe complication of pneumonia. It develops when the infectious agent penetrates the infectious agent, and then its circulation on the bloodstream occurs. The feature of sepsis is to form purulent foci throughout the body. The clinical manifestations of sepsis are very bright: the body temperature rises to febrile numbers, there is a heavy intoxication syndrome, manifested by headache, nausea, vomiting, less often diarrhea, the skin becomes an "earthy" shade).

DVS syndrome - Pathology from the hemostasis system (the resulting and anticorant blood system), leading to a change in normal microcirculation in the vascular channel due to massive bleeding with the simultaneous formation of thrombov. [7]

Diagnosis of pneumonia

Diagnostic studies with VI are aimed at clarifying the diagnosis, determination of the pathogen, the assessment of the severity of the flow and forecast of the disease, as well as to detect complications.

The diagnostic algorithm for suspected VP includes:

  • detailed collection of anamnesis;
  • Analysis of patient complaints;
  • physical examination;
  • Laboratory and instrumental studies, the volume of which can be determined individually and is due to the severity of the EP's flow, the emergence and character of complications concomitant patient diseases.

The diagnosis of VP is proven when identifying a patient focal infiltration of light tissue confirmed radiologically And, at least two of the signs listed below:

  • acutely occurring fever at the beginning of the disease (body temperature> 38.0 ° C);
  • cough with sputum;
  • Physical signs identified during the full physical examination (local attitudes or small-pushed wheezes, bronchial respiration, dulling sound at percussion);
  • An increase in the total number of leukocytes (> 10 · 109 / l) and / or a halochloride shift (> 10%).

Important! In the absence or inaccessibility of x-ray confirmation of focal infiltration in the lungs, the diagnosis of "VP" is considered unspected. At the same time, the diagnosis of "pneumonia" can be justified by the data of epidanamnesis (medical history), the presence of relevant complaints and local manifestations. [3]

Left-sided lower-grade pneumonia 

A very important point in the diagnosis of pneumonium is the use of pulse oximetry method. In all clinical recommendations, the need to measure saturation from EVERY Patient with inflammation of lungs. [nine]

Pulse oximetry method 

Currently, there are a number of diagnostic techniques that allow you to divide all VN into two categories - heavy and notching. Thus, the main task of the gravity assessment scale (ballroom systems) is to identify patients with an unfavorable forecast and a high risk of complications. [eight] Examples of such scales are:

  • PSI - gravity index of pneumonia;
  • CURB-65 scale;
  • SMART-COP scale.
SMART-COP scale 

After determining the severity, the attending physician decides on the place of treatment - outpatient surveillance or hospitalization.

How to distinguish inflammation of the lungs from ARVI, flu and bronchitis

To distinguish the inflammation of the lungs from seasonal ARVI, influenza and bronchitis, visualization of lungs - radiography of the chest organs, digital fluorography or computer tomography of the chest organs. These methods allow you to detect infiltrates in lightweight fabric.

Treatment of pneumonia

Which doctor treats the disease

Pneumonia treats the therapist or pulmonologist.

When to consult a doctor

To the doctor should be applied when problems with breathing, chest pains, a permanent fever (over 38 ° C) and cough, especially with a sputter.

Indications for the disease

Treatment of patients with VI is comprehensive and based on several basic principles:

  • appointment of antimicrobial drugs;
  • adequate respiratory support if necessary;
  • the use of nonantibacterial drugs (only in the event of indications);
  • Prevention of complications.

It is extremely important to the timely detection and treatment of decompensation or exacerbation of related diseases, since their presence / severity can radically affect pneumonia. [10]

Antimicrobial preparations

Important! Antibacterial therapy (ABT) can only be appointed by a doctor, otherwise the risk of drug sustainability (resistance) of microorganisms increases sharply.

The main groups of antimicrobial preparations used in the treatment of pneumonia are:

  • Beta-lactam antibiotics (penicillins and cephalosporins);
  • macrolides;
  • Respiratory fluoroquinolones.

In some cases, in the presence of special indications, preparations of other groups (tetracycles, aminoglycosides, lincoosamides, vancomycin, linoxolid can be used.

In viral pneumonia (usually associated with the influenza virus), inhibitors of neuraminidase (oseltamivir and zanamivir) are most important, which have high activity against influenza a and b. viruses

In the treatment of outpatient patients, preference is given to oral antibiotics (usually in tableted form). In the treatment of patients in the hospital, a stepped approach is used: begin with parenteral administration of antibiotics (intravenous path preferred), in the future, as the patient's clinical stabilization is translated to oral administration (tablets).

The duration of antimicrobial therapy of the Night EP is determined individually, with a heavy VP of unspecified etiology - continues at least 10 days. The implementation of longer courses ABT (from 14 to 21 days) is recommended only in the development of the complications of the disease, the presence of foci of inflammation outside of light tissue, infection S.Aureus. , Legionella SPP. ., Nonfernifying microorganisms ( P.aeruginosa. ).

In clinical practice, it is very important to decide on the possibility of stopping AMT at the right moment. For this, sufficiency criteria have been developed:

  • resistant decrease in body temperature <37.2ºС for at least 48 hours;
  • lack of manifestations of intoxication syndrome;
  • normalization of breathing frequency (<20 / min);
  • No purulent sputum;
  • Reducing the number of leukocytes in the blood (<10 · 109 / l), neutrophils (<80%), young forms (<6%);
  • Lack of negative dynamics on the radiograph. [3]

Respiratory support

Acute respiratory failure (ODN) is the leading cause of the death of patients with VP, therefore adequate respiratory support is the most important component of the treatment of such patients (of course, in conjunction with systemic antibiotic therapy). Respiratory support is shown to all patients with VEs with RO2 <55 mm Hg. or SrO2 <88% (with air breathing). [four]

Oxygen therapy It is carried out in the case of a moderate lack of oxygen in the blood with a simple nasal mask or mask with a consumable bag.

Oxygen therapy 

Artificial ventilation lungs (IVL) is used in the event that even with oxygen inhalations, the target level of blood saturation oxygen is not achieved.

Artificial ventilation lungs 

Indications to the IVL at one on the background of the VP:

  • Absolute: Stop breathing, violation of consciousness (copor, coma), psychomotor excitation, unstable hemodynamics (blood pressure <70 mm Hg, heart rate <50 / min);
  • Relative: ChDD> 35 / min RAO2 / FIIO2 <150 mm Hg, Raising Raso2> 20% of the initial level, violation of consciousness.

Neanctibacterial therapy

Presented by three major grades of drugs:

  • Systemic glucocorticosteroids (GKS);
  • intravenous immunoglobulins (IG);
  • Some immunostimulants.

Glucocorticosteroids

The question of the appointment of GCS is considered primarily for the heavy EP, which is complicated by septic shock. GKS contribute to the limitation of the destructive influence of systemic inflammation using various genomic and non-mentioned effects.

Immunoglobulins

The use of the IG for the treatment of infections complicated by sepsis is based on a variety of effects: from neutralizing bacterial toxins until the cell reactivity is reduced during the phenomenon of the "immune paralysis".

In the treatment of sepsis, polyclonal ig, which, compared with placebo, reduce the relative risk of death. The routine use of intravenous IG patients with severe VP complicated by sepsis is impractical.

Immunostimulators

Interest in these drugs is associated with their ability to strengthen phagocytosis, education and maturation of neutrophils. However, due to the lack of a convincing evidence base, they currently have practically not used in routine practice.

Contraindications for the disease

At pneumonia, it is extremely recommended to engage in self-medication, especially using antibiotics. At the moment there are many groups of antibacterial drugs, for the selection of adequate therapy, the doctor will ask several questions about the history of the disease, drug intolerance, the previous use of antibiotics and what other preparations the patient takes regularly. In the acute period of the disease, it is recommended to refrain from the active use of physiotherapeutic treatment methods, especially related to the heating of tissues.

Forecast. Prevention

A favorable or unfavorable outcome of the VP depends on several factors:

  • the age of the patient;
  • the severity of the flow;
  • The presence / absence of concomitant diseases.

The risk of death is minimal in young and middle-aged patients with the well-mentioned pulp and non-accompanying diseases. In patients of elderly and senile age, there is a risk of fatal outcome in the presence of significant concomitant pathology (COPD, malignant neoplasms, alcoholism, diabetes, chronic heart failure), as well as in situations of development of heavy VP.

The main cause of the death of patients with severe VP is a steady lack of oxygen, septic shock and insufficiency of all organs and systems. According to research, the main factors associated with the unfavorable prognosis of patients with severe VI, are:

  • Age> 70 years;
  • Conducting IVL;
  • bilateral localization of pneumonia;
  • Septic and infection with a blue-purulent stick.

Speaking of Russia, it should be mentioned later to refer to patients for qualified medical care. This becomes an additional risk factor for an unfavorable outcome.

How to prevent pneumonia

At the moment, highly effective means are available throughout the world, allowing themselves to protect themselves and their relatives from this formidable disease - pneumococcal and influenza vaccines.

In order to specific prophylaxis of pneumococcal infections, including pneumonia, two vaccines are used in adults:

  • 23-valence non-conjugated vaccine (contains purified capsular polysaccharide antigens 23 serotypes S.pneumoniae. );
  • 13-valence pneumococcal conjugated vaccine.

All patients with high risk of pneumonium should be protected by such vaccines. [eleven]

Leave a Reply