Pneumonia: symptoms, signs, treatment of pneumonia of the lungs
- Etiology of pneumonia
- The mechanism of pneumonia
- Classification of pneumonia
- Symptoms of pneumonia
- Complications and possible consequences of pneumonia
- Diagnosis of pneumonia
- Pneumonia treatment
- Prevention of pneumonia
Pneumonia (pneumonia) is an acute inflammatory lesion of the lungs, predominantly of infectious origin, affecting all elements of the structure of the organ, especially the alveoli, and interstitial tissue. This is a fairly common disease, diagnosed in about 12–14 people out of 1000, and in older people whose age has passed for 50–55 years, the ratio is 17: 1000.
Despite the invention of modern antibiotics with a new generation, with a broad spectrum of activity, the incidence of pneumonia remains relevant until now, as is the likelihood of joining serious complications. Mortality from pneumonia is 9% of all cases, which corresponds to the 4th place in the list of the main causes of mortality. She stands after cardiovascular problems, cancer, injuries and poisoning. According to WHO statistics, pneumonia accounts for 15% of all cases of mortality in children under 5 years of age in the world.
Etiology of pneumonia
Pneumonia is distinguished by its etiology, i.e. The causes of the disease are many. The inflammatory process is both non-infectious and infectious. Pneumonia develops as a complication of the underlying disease, or it occurs in isolation, as an independent disease. Bacterial infection is in the first place among the factors that trigger lung tissue damage. The onset of inflammation can also cause viral or mixed (bacterial viral) infection.
The main pathogens of the disease:
- Gram-positive microbes: pneumococci (Streptococcus pneumoniae) - 70–96%, staphylococci (Staphylococcus aureus) - no more than 5%, streptococci (Streptococcus pyogenes and other less common types) - 2.5%.
- Gram-negative enterobacteria: Klebsiella (Klebsiella pneumoniae) - from 3 to 8%, Pseudomonas aeruginosa (Pseudomonas aeruginosa) and Pfeiffer (Haemophilus influenzae) - not more than 7%, Legionella (Legionella pneumophila), in the case of a choleopterae (Haemophilus influenzae) - not more than 7%; e. - up to 4.5%.
- Mycoplasma (Mycoplasma pneumoniae) - then 6% to 20%.
- Various viruses: adenoviruses, picornaviruses, influenza or herpes viruses, they account for 3-8%.
- Mushrooms: Candida (Candida), dimorphic yeast fungus (Histoplasma capsulatum) and others.
Causes of non-infectious nature, contributing to the development of pneumonia:
- Inhalation of asphyxiating toxic agents (chlorophos, kerosene vapor, gasoline, petroleum).
- Thoracic injuries (compression compression, blows, bruises).
- Allergens (pollen of plants, dust, microparticles of animal hair, some medicines, etc.).
- Burns to the respiratory tract.
- Radiation therapy, used as a treatment for oncology.
Acute pneumonia can be caused by the causative agent of the main dangerous disease, against which it develops, for example, anthrax, measles, scarlet fever, leptospirosis and other infections.
Factors that increase the risk of developing pneumonia
In young children:
- immunodeficiency of hereditary nature;
- intrauterine asphyxia or hypoxia;
- congenital malformations of the lungs or heart;
- cystic fibrosis;
- injuries during heavy labor;
- early smoking;
- chronic foci of infection in the sinuses, nasopharynx;
- caries ;
- cystic fibrosis;
- acquired heart disease;
- weakening of immunity due to frequently recurring viral and bacterial infections.
- chronic diseases of the respiratory tract - bronchi, lungs;
- decompensated stage of heart failure;
- endocrine system pathologies;
- addiction, especially inhalation of the drug through the nose;
- immunodeficiency disorders, including those with HIV infection and AIDS;
- prolonged forced stay in the supine position, for example during a stroke;
- as a complication after surgery on the chest.
The mechanism of pneumonia
Ways of penetration of pathogens into the lung parenchyma:
Bronchogenic way is considered the most common. Microorganisms enter the bronchioles with inhaled air, especially if there is any inflammatory lesion of the nasal cavity: the swollen mucosa with cilia of the epithelium swelled due to inflammation cannot retain germs and the air is not fully cleansed. It is possible to spread the infection from a chronic lesion located in the pharynx, nose, sinuses, tonsils, to the lower respiratory tract sections. Aspiration, various medical procedures, such as tracheal intubation or bronchoscopy, also contribute to the development of pneumonia.
Hematogenous pathway is detected much less frequently. The penetration of microbes into the lung tissue with the blood flow is possible with sepsis, intrauterine infection or intravenous drug use.
Lymphogenous path is the rarest. In this case, the pathogens first penetrate the lymphatic system, then with the current lymph are spread throughout the body.
One of the above pathways pathogenic agents fall on the mucosa of the respiratory bronchioles, where they settle and begin to multiply, leading to the development of acute bronchioolitis or bronchitis. If the process is not stopped at this stage, the microbes through the interalveolar septa extend beyond the terminal branches of the bronchial tree, causing focal or diffuse inflammation of the interstitial lung tissue. In addition to the segments of both lungs, the process affects the bifurcation, paratracheal and bronchopulmonary regional lymph nodes.
The violation of bronchial conduction ends with the development of emphysema — foci of pathological expansion of the air cavities of the distal bronchioles, as well as atelectasis — with a collapse of the affected area or lung lobe. In the alveoli, mucus is formed, which prevents the exchange of oxygen between the vessels and organ tissue. As a result, respiratory insufficiency with oxygen starvation develops, and in severe cases heart failure.
Inflammation of the viral nature often leads to desquamation and necrosis of the epithelium, inhibiting humoral and cellular immunity. An abscess formation is typical of pneumonia caused by staphylococci. At the same time, the purulent-necrotic focus contains a large number of microbes, along its perimeter there are zones of serous and fibrinous exudate without staphylococci. Inflammation of serous nature with the spread of pathogens that multiply in the area of inflammation, is characteristic of pneumonia caused by pneumococci.
Classification of pneumonia
According to the used classification of pneumonia are divided into several types, forms, stages.
Depending on the etiology of pneumonia is:
Based on epidemiological data:
- in a recipient with a transplanted organ.
- with immunodeficiency;
- without compromising immunity.
Regarding clinical and morphological manifestations:
Depending on the nature of the disease:
- acute protracted;
Based on the distribution process:
Regarding the mechanism of pneumonia is:
- heart attack pneumonia;
Given the presence or absence of complications:
The severity of the inflammatory process:
- moderate severity;
Symptoms of pneumonia
Almost every type of pneumonia has the characteristic features of the course, due to the properties of the microbial agent, the severity of the disease and the presence of complications.
Croupous pneumonia begins suddenly and acutely. The temperature in a short time reaches its maximum and stays high for up to 10 days, accompanied by chills and severe symptoms of intoxication - pain in the head, arthralgia, myalgia, severe weakness. The face looks sunken with cyanosis of the lips and the area around them. A feverish blush appears on the cheeks. Possible activation of the herpes virus, which is constantly found in the body, which is manifested by herpetic eruptions on the wings of the nose or lip. The patient is worried about chest pain on the side of inflammation, shortness of breath. The cough is dry, barking and unproductive. From the 2nd day of inflammation during cough, the vitreous sputum of viscous consistency with streaks of blood begins to depart, then even blood staining is possible, due to which it becomes red-brown in color. The amount of discharge increases, sputum becomes more liquefied.
At the onset of the disease, breathing may be vesicular, but weakened due to the forced restriction of the person to respiratory movements and damage to the pleura. For about 2–3 days, auscultation listens to different-sized dry and wet rales, crepitus is possible. Later, as fibrin accumulates in the alveoli, the percussion sound is dulled, the crepitus disappears, bronchophony increases, and bronchial respiration appears. The dilution of the exudate leads to a decrease or disappearance of bronchial respiration, the return of crepitus, which becomes more rough. Resorption of mucus in the respiratory tract is accompanied by hard vesicular breathing with moist rales.
With a severe course, an objective examination reveals rapid shallow breathing, deaf heart sounds, frequent irregular pulses, a decrease in blood pressure.
On average, the febrile period lasts no longer than 10–11 days.
For focal pneumonia is characterized by a different clinical picture. Imperceptible onset of the disease with a gradual undulating course due to different stages of the development of the inflammatory process in the lesions of the affected segments of the lung. With a mild degree, the temperature is not higher than 38.0 0 C, with fluctuations during the day, accompanied by sweating. Heart rate corresponds to the temperature in degrees. With moderate pneumonia, the febrile temperature figures are higher - 38.7–39.0 0 C. The patient complains of severe shortness of breath, pain in the chest when coughing, inhaling. Observed cyanosis and acrocyanosis.
During auscultation, breathing is hard, there are loud, dry or wet small, medium or large bubbling rales. With the central location of the center of inflammation or deeper than 4 cm from the surface of the organ, the enhancement of voice tremor and the dullness of percussion sound may not be detected.
Complications and possible consequences of pneumonia
The course of the disease and its outcome largely depend on the developed complications, which are divided into extrapulmonary and pulmonary.
Extrapulmonary complications of pneumonia:
- bronchitis ;
- atelectasis of the lung;
- parapneumonic exudative pleurisy ;
- abscess or lung gangrene;
In severe forms of acute pneumonia with extensive damage and destruction of lung tissue, the effects of exposure to toxins develop:
- acute heart, respiratory and / or liver failure;
- pronounced shift of acid-base balance;
- infectious shock;
- thrombohemorrhagic syndrome;
- kidney failure.
Diagnosis of pneumonia
The basis for the diagnosis is the data of the physical examination (collection of anamnesis, percussion and auscultation of the lungs), the clinical picture, the results of laboratory and instrumental methods of research.
Basic laboratory and instrumental diagnostics:
- Biochemical and clinical blood analysis . According to certain indicators (leukocytosis, an increase in ESR and the number of stab neutrophils), the presence of inflammation is judged in the body.
- X-ray examination of the lungs in two projections is the most important method for diagnosing lesions of lung elements. A radiograph can reveal diffuse or focal dimming of different sizes and localization, interstitial changes with increased pulmonary pattern due to infiltration, other radiological signs of pulmonary inflammation.
An X-ray is taken at the beginning of the disease to clarify the diagnosis, a follow-up is on the 10th day of treatment to determine the effectiveness of the therapy, on days 21-30, the X-ray is taken for the last time in order to radiologically confirm the resorption of the inflammatory process and rule out complications.
- Bacteriological examination of sputum culture to identify a microbial agent and determine its sensitivity and resistance to antibiotics, antifungal or other drugs.
- Gas composition of blood with the determination of the partial pressure of carbon dioxide and oxygen, the content of the latter in percent, and other indicators.
- Pulse oximetry is a more affordable and more commonly used non-invasive method of counting the degree of blood oxygen saturation.
- Microscopy of sputum with Gram stain . Helps to detect gram-positive or gram-negative bacteria. If you suspect that you have tuberculosis , you are prescribed a study with coloring according to Ziehl-Nielsen.
- Bronchoscopy with a possible biopsy.
- Paracentesis of the pleural cavity with pleural biopsy.
- Lung biopsy.
- CT scan or nuclear magnetic resonance of the chest.
- Ultrasound of the pleural cavity.
- Blood test for sterility and blood culture .
- PCR diagnostics.
- General urine analysis.
- Virological or bacteriological examination of a nasal and pharyngeal smear .
- The study of polymerase chain reaction (DNA polymerase method).
- Immunofluorescent blood test.
Moderate and severe pneumonia requires hospitalization in a therapeutic or pulmonary department. Mild uncomplicated pneumonia can be treated on an outpatient basis under the supervision of a district general practitioner or a pulmonologist visiting the patient at home.
Bed rest with abundant drinking and balanced gentle nutrition the patient must observe the entire period of fever and severe intoxication. The room or chamber where the patient is located should be regularly ventilated and quartz.
The most important in the treatment is etiotropic therapy aimed at the destruction of the pathogen. Based on the fact that bacterial genesis pneumonia is more often diagnosed, the etiotropic treatment of a disease of this nature of occurrence consists of a course of antibacterial therapy. The selection of the drug or their combination is carried out by the attending physician on the basis of their state and age of the patient, the severity of symptoms, the presence or absence of complications and individual characteristics, such as drug allergies. The multiplicity and method of administration of the antibiotic is chosen based on the severity of pneumonia, more often it is parenteral (intramuscular) administration.
Antibiotics from the following pharmacological groups are used to treat pneumonia:
- semi-synthetic penicillins - oxacillin, carbenicillin, amoxiclav, ampioks, ampicillin;
- macrolides - sumamed, rovamycin, clarithromycin;
- lincosamides - lincomycin, clindamycin;
- cephalosporins - ceftriaxone, cefazolin, cefotaxime and others;
- fluoroquinolones - avelox, cyprobay, moxifloxacin;
- aminoglycosides - gentamicin, amikacin or kanamycin;
- carbapenems - meronem, meropenem, thienam.
The average duration of the course varies from 7-14 days, sometimes longer. During this period, it is not excluded the replacement of some drugs by others.
The basis of etiotropic treatment of fungal pneumonia is antifungal drugs, viral - antiviral.
- antipyretic drugs to reduce the temperature;
- mucolytics and expectorant drugs for thinning and removing sputum;
- antihistamines for blocking histamine receptors and relieving allergization manifestations;
- bronchodilators for the expansion of the bronchi, drainage recovery and dyspnea;
- immunomodulating therapy for anti-infective protection and stimulation of immunogenesis;
- detoxification therapy, removing intoxication;
- corticosteroids to relieve inflammation;
Physiotherapy prescribed after temperature normalization:
- UHF and microwave;
- paraffin therapy;
Prevention of pneumonia:
- hardening of the body;
- immunity strengthening;
- rehabilitation of chronic foci of infection;
- timely treatment of caries;
- avoid hypothermia;
- smoking cessation and alcohol abuse;
- dust control;
- change of employment, if it is associated with harmful production;
- Avoid contact with allergens.
- Tuberculosis: symptoms, treatment of pulmonary tuberculosis
- Pulmonary edema: causes, symptoms, treatment
- Pleurisy: symptoms, treatment
- Lung abscess
- Bronchitis: symptoms, treatment