Pneumonia: symptoms, signs, treatment of pneumonia of the lungs
- Etiology of pneumonia
- Mechanism of development of pneumonia
- Classification of pneumonia
- Symptoms of pneumonia
- Complications and possible consequences of pneumonia
- Diagnosis of pneumonia
- Treatment of pneumonia
- Prevention of pneumonia
Pneumonia (pneumonia) is an acute inflammatory lesion of the lungs of a predominantly infectious genesis, affecting all elements of the organ structure, especially the alveoli and interstitial tissue. This is a fairly common disease, diagnosed in about 12-14 people out of 1000, and in elderly people, whose age has exceeded 50-55 years, the ratio is 17: 1000.
Despite the invention of modern antibiotics of a new generation with a wide range of activity, the incidence of pneumonia remains relevant until now, as is the likelihood of serious complications. The mortality from pneumonia is 9% of all cases, which corresponds to the 4th place in the list of the main causes of mortality. It stands after cardiovascular problems, cancer, injuries and poisoning. According to WHO statistics, pneumonia accounts for 15% of all deaths among children under 5 years old in the world.
Etiology of pneumonia
Pneumonia differs in its polyethiologic character, i.e. The causes of the disease are numerous. The inflammatory process is both non-infectious and infectious. Pneumonia develops as a complication of the underlying disease or proceeds in isolation, as an independent disease. Bacterial infection is on the first place among the factors provoking the defeat of lung tissue. The onset of inflammation can also cause a 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 species) - 2.5%.
- Gram-negative enterobacteria: Klebsiella pneumoniae (from 3 to 8%), Pseudomonas aeruginosa (Pseudomonas aeruginosa) and Pfeiffer's Haemophilus influenzae (not more than 7%), legionella (Legionella pneumophila), rod-shaped intestinal bacterium (Escherichia coli) Etc. - up to 4,5%.
- Mycoplasma pneumoniae is 6% to 20%.
- Various viruses: adenoviruses, picornaviruses, influenza or herpes viruses, accounting for 3-8%.
- Mushrooms: candida (Candida), dimorphic yeast fungus (Histoplasma capsulatum) and others.
Causes of non-infectious nature that contribute to the development of pneumonia:
- Inhalation of poisonous substances of asphyxiant type (chlorophos, kerosene, gasoline, oil).
- Chest injuries (compression compression, blows, bruises).
- Allergens (pollen of plants, dust, animal microparticles, some medicines, etc.).
- Burns of the respiratory tract.
- Radiation therapy, used as a method of treatment of 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:
- Hereditary immunodeficiency;
- Intrauterine asphyxia or fetal hypoxia;
- Congenital malformations of the lungs or heart;
- Cystic fibrosis;
- Trauma in the process of difficult births;
- Early smoking;
- Chronic foci of infection in the sinuses of the nose, 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;
- Pathology of the endocrine system;
- Drug addiction, especially the inhalation of narcotic drugs through the nose;
- Immunodeficiencies, including those associated with HIV infection and AIDS;
- Prolonged forced presence in the supine position, for example, in stroke;
- As a complication after surgical operations on the chest.
Mechanism of development of pneumonia
Pathways of penetration of pathogens into the lung parenchyma:
The bronchogenic pathway is considered the most common. Microorganisms get into bronchioles with inhaled air, especially if there is any inflammatory nasal lesion: the swollen mucosa with the ciliated epithelium due to inflammation can not hold germs, and the air is not fully purified. It is possible to spread the infection from the chronic foci found in the pharynx, nose, sinuses, tonsils, into the lower parts of the respiratory tract. The development of pneumonia is also facilitated by aspiration, various medical manipulations, for example intubation of the trachea or bronchoscopy.
The hematogenous path is detected much less often. Penetration of microbes into the lung tissue with blood flow is possible with sepsis, intrauterine infection or intravenous injection of narcotic drugs.
The lymphogenous path is the rarest. In this case, the pathogens first penetrate into the lymphatic system, then with the current of the lymph are carried throughout the body.
In one of the above pathogens, pathogenic agents enter mucosal respiratory bronchioles, where they settle and begin to multiply, leading to the development of acute bronchiolitis or bronchitis. If the process is not stopped at this stage, the microbes through interalveolar septa extend beyond the terminal branches of the bronchial tree, provoking focal or diffuse inflammation of the interstitial tissue of the lung. In addition to segments of both lungs, the process affects bifurcation, paratracheal and bronchopulmonary regional lymph nodes.
Violation of bronchial conduction ends with the development of emphysema - the foci of pathological expansion of the air cavities of the distal bronchioles, as well as atelectasis - the collapse of the affected area or lobe of the lung. In the alveoli, mucus is formed, which prevents the exchange of oxygen between the vessels and the tissue of the organ. As a result, respiratory failure develops with oxygen starvation, and in severe course - heart failure.
Inflammation of the viral nature often leads to desquamation and necrosis of the epithelium, inhibiting humoral and cellular immunity. The formation of an abscess is typical for pneumonia caused by staphylococci. In this purulent necrotic focus contains a large number of microbes, along its perimeter there are zones of serous and fibrinous exudates without staphylococci. Inflammation of serous nature with the spread of pathogens that multiply in the inflammation zone is typical for pneumonia caused by pneumococci.
Classification of pneumonia
According to the classification used, pneumonia is divided into several species, forms, stages.
Depending on the etiology of pneumonia happens:
Starting from epidemiological data:
- In the recipient with the organ transplanted.
- With immunodeficiency;
- Without compromising immunity.
Concerning clinical and morphological manifestations:
Depending on the nature of the course of the disease:
- Acute lingering;
Based on the spread of the process:
Concerning the mechanism of development of pneumonia happens:
Given the presence or absence of complications:
The severity of the course of the inflammatory process:
- Moderate severity;
Symptoms of pneumonia
Almost every type of pneumonia has the characteristic features of the flow, due to the properties of the microbial agent, the severity of the course of the disease and the presence of complications.
Croupous pneumonia begins suddenly and acutely. The temperature reaches a maximum in a short time and lasts up to 10 days, accompanied by chills and severe symptoms of intoxication - headaches, arthralgia, myalgia, severe weakness. The face looks haggard with cyanosis of the lips and the area around them. A fever flush appears on his cheeks. It is possible to activate the herpes virus, which constantly finds in the body, which is manifested by herpetic eruptions on the wings of the nose or the lip of the lips. The patient is concerned about chest pain on the side of the inflammation, shortness of breath. Cough at first dry, "barking" and unproductive. From the second day of inflammation during coughing, vitreous sputum of a viscous consistency with blood veins begins to flow away, then perhaps a uniform blood staining, because of what it acquires a red-brown color. The amount of detachable increases, sputum becomes more diluted.
At the onset of the disease, breathing can be vesicular, but weakened due to the forced restriction of the person's respiratory movements and the defeat of the pleura. Approximately on 2-3 days at auscultation various varieties of dry and wet wheezing are heard, crepitation is possible. In the future, as the fibrin accumulates in the alveoli, the percussion sound is dulled, crepitus disappears, bronchophonia intensifies, bronchial breathing appears. Liquefaction exudate leads to a decrease or disappearance of bronchial breathing, the return of crepitus, which becomes more rough. The absorption of mucus in the respiratory tract is accompanied by severe vesicular breathing with wet rales.
In severe conditions, an objective examination reveals rapid rapid breathing, deaf heart sounds, frequent arrhythmic pulse, lowering of blood pressure.
On average, the febrile period lasts no longer than 10-11 days.
Focal pneumonia is characterized by a different clinical picture. The inconspicuous onset of the disease with a gradual wave-like course is due to the different stage of development of the inflammatory process in the foci of the affected segments of the lung. At a mild degree, the temperature does not exceed 38.0 0С with fluctuations during the day, accompanied by sweating. The heart rate corresponds to the temperature in degrees. In case of moderate pneumonia, the febrile temperature is higher - 38.7-39.0 0 C. The patient complains of severe shortness of breath, chest pain when coughing, and inhaling. Cyanosis and acrocyanosis are observed.
At auscultation, breathing is hard, sonorous dry or wet small, medium or large bubbling rattles are heard. With the central location of the focus of inflammation or deeper than 4 cm from the surface of the body, increased vocal tremor and dullness of percussion sound may not be determined.
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 gangrene of the lung;
In the severe form of acute pneumonia with extensive damage and destruction of lung tissue, the effects of exposure to toxins develop:
- Acute cardiac, respiratory and / or hepatic insufficiency;
- Pronounced shift of acid-base balance;
- Shock infectious-toxic;
- Thrombohemorrhagic syndrome;
- Failure of the kidneys.
Diagnosis of pneumonia
The basis for the diagnosis is the data of a physical examination (collection of anamnesis, percussion and auscultation of the lungs), the clinical picture, the results of laboratory and instrumental research methods.
Basic laboratory and instrumental diagnostics:
- Biochemical and clinical analysis of blood . According to certain indicators (leukocytosis, an increase in ESR and the number of stab neutrophils), the presence of inflammation in the body is judged.
- X-ray examination of the lungs in two projections is the most important method of diagnosing the lesion of the lung elements. A radiograph can reveal diffuse or focal dimming of different sizes and locations, interstitial changes with an increase in pulmonary pattern due to infiltration, and other radiologic signs of pneumonia.
An X-ray is taken at the beginning of the disease to clarify the diagnosis, the control one at the 10th day of treatment to determine the effectiveness of the therapy, on the 21st-30th day the radiograph is done for the last time with the purpose of radiologic confirmation of resorption of the inflammatory process and elimination of complications.
- A bacteriological study of sputum culture to identify a microbial agent and determine its sensitivity and resistance to antibiotics, antifungal agents or other drugs.
- The gas composition of the 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 accessible and more commonly used non-invasive method for calculating the degree of oxygen saturation of blood.
- Sputum microscopy with Gram staining . Helps identify gram-positive or gram-negative bacteria. When suspected of tuberculosis - prescribe a study with a color according to Tsilyu-Nielsen.
- Bronchoscopy with possible biopsy.
- Paracentesis of the pleural cavity with pleural biopsy.
- Lung biopsy.
- CT 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 study of a smear from the nose and throat .
- Polymerase chain reaction (DNA polymerase method).
- Immunofluorescence blood test.
Treatment of pneumonia
The moderate and severe course of pneumonia requires hospitalization in the therapeutic or pulmonology department. Uncomplicated pneumonia of mild degree can be treated on an outpatient basis under the supervision of a district therapist or a doctor-pulmonologist visiting a patient at home.
Bed rest with a plentiful drink and a balanced, sparing diet should meet the entire period of fever and severe intoxication. The room or room where the patient is located should be regularly ventilated and quartzed.
The most important in the treatment is etiotropic therapy, aimed at destroying the causative agent of the disease. Proceeding from the fact that pneumonia of bacterial genesis is more often diagnosed, etiotropic treatment of the disease of such origin consists of a course of antibacterial therapy. The choice of the drug or a combination thereof is performed by the attending physician based on their condition and age of the patient, the severity of the symptoms, the presence or absence of complications and individual characteristics, for example, drug allergy. The multiplicity and method of administration of an antibiotic is chosen, based on the severity of the course of pneumonia, more often this is parenteral (intramuscular) administration.
For the treatment of pneumonia, antibiotics of the following pharmacological groups are used:
- Semi-synthetic penicillins - oxacillin, carbenicillin, amoxiclav, ampiox, ampicillin;
- Macrolides - sumamed, rovamycin, clarithromycin;
- Lincosamides - lincomycin, clindamycin;
- Cephalosporins - ceftriaxone, cefazolin, cefotaxime and others;
- Fluoroquinolones - avelox, ciprobay, moxifloxacin;
- Aminoglycosides - gentamicin, amikacin or kanamycin;
- Carbapenems - meronem, meropenem, thienes.
The average duration of the course varies between 7-14 days, sometimes it takes longer. During this period, it is possible to replace some drugs with others.
The basis of etiotropic treatment of pneumonia of fungal genesis are antifungal drugs, viral - antiviral drugs.
- Antipyretics for lowering temperature;
- Mucolytics and expectorants for liquefaction and excretion of sputum;
- Antihistamines for blockade of histamine receptors and removal of allergization manifestations;
- Bronchodilators for bronchial dilatation, restoration of drainage and elimination of dyspnea;
- Immunomodulatory therapy for anti-infection protection and stimulation of immunogenesis;
- Detoxication therapy, which removes intoxication;
- Corticosteroids for the removal of inflammation;
Physiotherapy procedures after temperature normalization:
- UHF and microwave;
- Paraffin therapy;
Prevention of pneumonia:
- Hardening of the body;
- Strengthening of immunity;
- Sanation of chronic foci of infection;
- Timely treatment of caries;
- Avoidance of hypothermia;
- Refusal to smoke and alcohol abuse;
- Fighting dust;
- Change of place of work if it is associated with harmful production;
- Exclusion of contacts with allergens.
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