What does pneumonia show? What are the stages of development of pneumonia? Therapeutic exercise for pneumonia

Despite the fact that pneumonia is not a death sentence in the 21st century, pneumonia is still quite dangerous. In addition, it is not so easy to assess its seriousness at home. How not to catch an infection, what symptoms should alert and why it is not necessary to go to the hospital, we tell below.

Pneumonia is an infectious disease that affects the lung alveoli. Alveoli are small "vesicles" that are found at the ends of the thin branches of the bronchi. They are associated with circulatory system capillary network. In the body of a healthy person, oxygen enters the alveoli through the bronchi, and from there into the blood. In pneumonia, the infection affects the alveoli: they enlarge, fill with fluid or pus. Because of this, oxygen enters the body in insufficient volume.

Reasons for the development of the disease

There are quite a few causes of pneumonia, and microbes do not always play a major role.

Vasily Shtabnitsky

Pneumonia occurs when the body's specific and nonspecific defenses are weakened and the body is faced with an increased microbial load. Let me give you an example: a person weakened after a long operation lies a lot, cannot take care of himself, including brushing his teeth. accumulates in the oral cavity a large number of microorganisms - they enter the lungs, but the body cannot immediately destroy them. That is, pneumonia is not just an infection, it is a confluence of adverse factors. In addition, the development of the disease largely depends on the person himself.

The causative agents of pneumonia can be:

• viruses;
• bacteria;
• fungi;
• foreign particles that have accidentally entered the lungs (for example, chemicals).

In addition to microbes, the likelihood of developing pneumonia increases:

Symptoms of pneumonia

Finding out which microorganism caused pneumonia is not so easy. The most common symptoms are:

• heat;
• cough with yellow or greenish sputum;
• shallow breathing and shortness of breath;
• cardiopalmus;
• increased fatigue;
• chills;
• chest pain.

Vasily Shtabnitsky

Candidate of Medical Sciences, pulmonologist at the Chaika and Rassvet clinics

Unfortunately, there is no specific symptom or group of symptoms that accurately indicate pneumonia. However, persistence of a temperature above 38 degrees for more than one week, cough with purulent or bloody sputum, chest pain, shortness of breath, rapid breathing, severe weakness, hypotension, and impaired consciousness should alert.

In order to determine the correct treatment, the doctor must prescribe certain tests and studies:

• x-ray - will show the focus of inflammation;
• complete blood count - will show how actively the immune system fights the infection;
• a blood culture test - will answer the question of whether bacteria have entered the bloodstream.

To rule out other lung conditions, your doctor may order a sputum test, a bronchoscopy, and a pleural fluid test.

Treatment of pneumonia

Inflammation of the lungs is a serious disease, there can be no talk of any self-treatment. However, going to the hospital is not always necessary. If within a few days you observe several symptoms of pneumonia, then the first thing to do is to see a doctor.

Vasily Shtabnitsky

Candidate of Medical Sciences, pulmonologist at the Chaika and Rassvet clinics

Not every pneumonia requires hospitalization, but it is worth remembering that with the mildest variant of the course of the disease, the probability of death is almost zero, and with the most severe it can exceed 50%. It means that the doctor should assess the severity of the patient's condition and the need for hospitalization. For a patient with mild pneumonia, hospitalization can do more harm than good, as being in a hospital increases the risk of so-called nosocomial infection and complications from intravenous therapy. It is believed that patients with mild pneumonia should stay at home, while patients with severe and extremely severe pneumonia should be treated in a hospital. Patients with moderate pneumonia may be hospitalized at the discretion of the physician.

If you have pneumonia that does not require hospitalization and you can take medication on your own, you will only need pills to treat it. In most cases, inhalation, UHF therapy, vibration massage and other physiotherapy methods are not needed. The effectiveness of various manual exposure techniques is also.

Vasily Shtabnitsky

Candidate of Medical Sciences, pulmonologist at the Chaika and Rassvet clinics

Electrophoresis, UHF, and other physical therapy options (not to be confused with physical therapy) play no role in the treatment of pneumonia. This means that such interventions are unable to affect such indicators as mortality, length of stay in the hospital, and the likelihood of complications.

Disease prevention

If you follow simple rules, then the risk of pneumonia can be minimized.

Get vaccinated

Most often, pneumonia occurs against the background of other diseases. Therefore, the first step for those who do not want to get sick is a flu shot. In addition, pneumococcal vaccination has been included since 2014. It is recommended for children under five years of age and adults over 65 years of age - at this age the body is more susceptible to infections. Of course, such a vaccination will not save you from all types of pneumonia, but it will protect you from the most common ones.

Wash your hands

Handshakes, doorknobs, and keyboards expose your hands to millions of microbes every day. And when you touch your eyes or nose, they can easily get inside and cause various diseases. Therefore, it is important not only before meals, but also during the day. This banal advice from childhood.

Quit smoking

Smoking increases the chances of not only catching pneumonia, but also. Smoking causes processes in the lungs that make you more vulnerable to infections. For example, the number of cells that produce sputum increases, but some of the sputum remains in the lungs. In addition, the work of the ciliated epithelium is disrupted - this is the type of tissue that covers the mucous membrane of the respiratory tract. The cells of the ciliated epithelium are covered with fine hairs - they do not allow dust and microbes to enter the lungs. Cigarette smoke destroys these cells.

Pneumonia is an acute infectious and inflammatory pathology characterized by damage to all structures of the lung - alveoli and interstitium. The disease always proceeds with intraalveolar exudation and characteristic clinical and radiological signs.

Symptoms and treatment of pneumonia depend on the cause of the disease, the state of the patient's immune system, and the method of infection.

Acute pneumonia remains topical issue. Despite the emergence of effective antimicrobial drugs, the mortality rate from this disease is about 10%. Inflammation of the lungs in mortality is second only to diseases of the cardiovascular system, oncopathology, trauma and poisoning. Pneumonia is the cause of death for AIDS patients.

Pneumonia is an acute infectious inflammation of the lungs, often of bacterial etiology, which is contagious for malnourished and debilitated patients who have undergone surgery, childbirth, and also those suffering from endocrine pathology, oncopathology. Pneumonia is transmitted by airborne droplets from a sick person to a healthy one. Hypothermia, physical and nervous strain contribute to the development of the disease and the appearance of symptoms of pneumonia in adults and children.

Etiology

Pneumonia is a polyetiological disease, most often of an infectious origin.

Bacterial infection is the most common cause of pathology. Streptococcus pneumoniae is the main causative agent of pneumonia. Other pathogens:

1. Gram-positive cocci - pneumococci, Staphylococcus aureus, streptococci,
2. Gram-negative rods - Acinetobacter,
3. "Atypical" - chlamydia, mycoplasma, legionella,
4. Enterobacteria - Klebsiella, Escherichia, Proteus,
5. Anaerobes - actinomycetes, fusobacteria.

Viral infection often precedes the development of bacterial pneumonia. Influenza, herpes viruses, respiratory syncytial virus, cytomegalovirus, as well as weaken the body's immune defenses and create favorable conditions for the reproduction of bacteria and their manifestation of virulent properties.

Pathogenic fungi - causative agents of histoplasmosis, coccidioidomycosis, blastomycosis, candidiasis.

The causative factors of non-infectious pneumonia are injuries, radiation, exposure to certain toxins and allergens.

Etiological signs

• Staphylococcal pneumonia is characterized by the development of necrotic foci in the lung, surrounded by neutrophils. In this case, the alveoli are filled with fibro-purulent exudate, in which there are no bacteria. In severe cases, staphylococcal pneumonia ends with the destruction of lung tissue.
• Pneumonia caused by pneumococci is rarely complicated by abscess formation. Commonplace inflammation usually develops in the lung tissue.

• Streptococci cause necrotic damage to the lung tissue with a hemorrhagic component and lymphogenous dissemination.
• Pseudomonas aeruginosa can lead to the appearance of grayish-red foci of doughy consistency in the lung tissue, as well as pinpoint hemorrhages.
• Klebsiella pneumonia is characterized by the defeat of the entire lobe of the lung, the formation of mucous exudate and extensive areas of necrosis.
• Mycoplasma and viral pneumonias are characterized by inflammation of the interstitium of the lung - its edema and infiltration. There are no pathological changes in the alveoli.

Provoking factors:

Pathogenesis

The upper respiratory tract is most exposed to pathogenic biological agents that can cause a number of pathologies in humans.

Upper respiratory protection factors:

Lower respiratory protection factors:

1. cough reflex,
2. mucociliary clearance,
3. The functioning of the ciliated epithelium,
4. Special structure of the respiratory tract,
5. Lung surfactant,
6. Immunoglobulins A and G,
7. Macrophage link of phagocytosis,
8. T-cell immunity.

These specific and non-specific factors prevent the development of infectious pathology.

There are a number of conditions in which defense mechanisms are violated, the composition of the normal microflora of the respiratory organs changes, and the activity of saprophytic microorganisms decreases.

These states include:

• Irrational nutrition,
• systemic pathology,
• prolonged hospitalization,
• Stay in a nursing home
• Irrational or prolonged antibiotic therapy,
• Smoking,
• Nasogastric or endotracheal intubation
• exhaustion
• Nervous strain.

Infection with pneumonia occurs by hematogenous, lymphogenous and bronchogenic routes.

Bronchogenic pathway the spread of infection is the main one. Large particles with a diameter of more than 10 microns immediately settle on the nasal mucosa and upper respiratory tract. Particles with a diameter of up to 5 microns are in the air for a long time, and then enter the human body. This fine aerosol easily and quickly overcomes the host's defenses. small particles settle on the mucous membrane of the bronchioles and alveoli, causing the development of the disease. The following pathogens of pneumonia penetrate by inhalation: mycobacterium, influenza virus, legionella and many others.

By hematogenous route the infection penetrates from extrapulmonary foci. So, Staphylococcus aureus with blood flow penetrates into the lung tissue with bacterial endocarditis, bronchitis.

Microbes penetrate into the alveoli of the lungs through the protective bronchopulmonary barrier with a decrease in the overall resistance of the organism. Infectious inflammation develops. The exudate formed in the alveoli disrupts the processes of gas exchange in the lungs, which leads to hypoxia, the development of respiratory and heart failure.

Pathomorphology

The leading pathomorphological sign of pneumonia is limited exudative inflammation of the respiratory section of the lungs.

• Lobar pneumonia- inflammation of the lobe of the lung.

• Bronchopneumonia- a disease in which inflammation is limited to the alveoli and neighboring bronchi.

• Drain pneumonia is the fusion of small foci of inflammation into large ones.
• Necrotic pneumonia characterized by the appearance of areas of dead lung tissue, the formation of small cavities in it and lung abscess formation.
• - inflammation of the interstitial lung tissue.

Stages of development of pneumonia:

1. high tide- lasts three days and is accompanied by the formation of fibrinous exudate in the alveoli.
2. red hepatization- lasts three days and is characterized by compaction of the lung tissue. The lungs in structure become like the liver. Blood cells appear in the exudate.
3. gray hepatization- lasts about six days. In the exudate, the breakdown of erythrocytes occurs, leukocytes massively penetrate into the alveoli.
4. Permission- restoration of the normal structure of the lung.

Classification of pneumonia

• On an epidemiological basis Pneumonias are classified into: community-acquired, nosocomial, caused by immunodeficiency, aspiration.
• Origin inflammation of the lungs can be: bacterial, viral, mycoplasmal, fungal, caused by protozoa, caused by helminths, non-infectious, mixed.
• pathogenetically pneumoniae are divided into the following types: Independent pathologies - primary, arising against the background of concomitant diseases - secondary, developing after a chest injury - post-traumatic, postoperative.
• By localization pathological focus: unilateral - right-sided or left-sided, bilateral.
• With the flow: sharp, lingering.

Symptoms

Focal pneumonia- complication, or. The disease begins gradually: the temperature becomes subfebrile, fluctuates, then appears with a hard-to-separate mucous membrane or, sweating, acrocyanosis.
Patients complain of pain in the chest during coughing.

The characteristic symptoms of pneumonia found on physical examination are:

1. Weakening of percussion sound over the area of ​​inflammation,
2. hard breathing,
3. Various wheezing,
4. Crepitus is a high-frequency pathological breath noise detected during auscultation.

If the lesions merge, then the patient's condition deteriorates sharply - shortness of breath and cyanosis appear.

Croupous pneumonia proceeds much more severely than focal and is manifested by more pronounced symptoms. This is due to inflammation of the whole lobe of the lung and part of the pleura.

Pathology develops rapidly: fever, symptoms of intoxication, shortness of breath and chest pain appear. The main clinical sign of the disease is, which eventually becomes productive with the discharge of "rusty" sputum. High fever and cough with sputum persist for 10 days.

In severe cases, the skin turns red, cyanosis and herpetic eruptions appear in the nose, lips and chin. Breathing becomes rapid and shallow, the wings of the nose swell, blood pressure drops, heart sounds are muffled. Auscultation revealed moist rales and crepitus.

Given the risk of complications and the severity of the symptoms of pneumonia, it should be treated in a pulmonology department.

A whole group of diffuse lung diseases, in which there is a steady progression of inflammatory changes in the interstitial tissue. In this case, the parenchyma of the organ is affected - the endothelium of the pulmonary vessels, alveolar septa. The connective interstitial tissue becomes inflamed and swells, gas exchange is disrupted, and the lung elements stick together irreversibly.

The disease develops slowly, often over several years. Shortness of breath is the main symptom of pneumonia in an adult. It is often accompanied by a rise in temperature, a cough with scanty sputum and streaks of blood. Patients have weight loss, rhinitis, conjunctivitis, headache. Auscultation reveals harsh breathing without wheezing.

Interstitial pneumonia usually develops in individuals with congenital and acquired immunodeficiency.

Occult or asymptomatic pneumonia usually develops in weakened and emaciated individuals against the background of a decrease in the overall resistance of the organism. immune cells are in a depressed, inactive state and become non-aggressive against pathogenic microorganisms. Patients complain only of mild malaise and increased sweating. These signs are the only symptoms diseases associated with a high level of intoxication of the body. Bacterial toxins circulate in the blood for a long time, are not inactivated and are not completely eliminated by the liver and kidneys. This is how the internal organs are damaged - the brain, heart, blood vessels. Pneumonia without fever, cough, headache and myalgia is a life-threatening disease.

Pneumonia in children

The upper respiratory tract of the child is not sufficiently developed: they cannot "keep" the viruses that quickly descend into the bronchi and lungs. A banal runny nose and a slight cough can lead to the development of tracheitis, bronchitis and even pneumonia. That is why it is necessary to eradicate the infection as soon as possible in children's body and relieve inflammation. At home, you can give the child a massage, rub the chest and back, give a freshly prepared decoction medicinal herbs or herbal tea.

Classification of pneumonia in children by etiology:

• The causative agents of pneumonia in newborns are usually group B beta-hemolytic streptococcus, gram-negative rods, cytomegalovirus and pathogenic listeria.
• In children from 3 weeks to 3 months - influenza viruses, RSV, pneumococcus, Staphylococcus aureus, bordetella, chlamydia.
• In children from 3 months to 4 years - group A streptococci, pneumococci, influenza virus, adenovirus, RSV, mycoplasma.
• In children from 4 to 15 years old - pneumococci, mycoplasmas, chlamydia.

Pneumonia caused by, pneumococcus, and Pseudomonas aeruginosa, the most dangerous for newborns and infants.

Symptoms of pneumonia in children are very similar to clinical manifestations diseases in adults. Shortness of breath and respiratory rate are the main signs of pneumonia to look out for Special attention when examining a sick child. Shortness of breath against the background of SARS and a respiratory rate of more than 40 per minute are symptoms that threaten the child's life.

Among children, the most common pneumonia caused by "atypical" pathogens - mycoplasmas, chlamydia and legionella. Treatment of such diseases should be carried out with macrolide antibiotics.

Children with pneumonia should only be treated in a hospital to avoid such dangerous complications as acute respiratory and cardiovascular failure.

Severity

1. For pneumonia mild degree characterized by mild intoxication syndrome, subfebrile temperature, shortness of breath after exercise. X-ray signs - a small focus of inflammation.
2. At medium degree symptoms of intoxication appear - fever, chills, weakness, weakness, irritability, lowering blood pressure, tachypnea, shortness of breath at rest. The radiograph clearly shows lung infiltration.
3. Severe degree pneumonia is manifested by pronounced signs of intoxication, fever, impaired consciousness, a sharp drop in blood pressure, the appearance of symptoms, and the development of complications.

Complications of pneumonia

Pulmonary complications

Extrapulmonary complications

1. - a complication of pneumonia on the part of the cardiovascular system, the occurrence of which is associated with circulatory disorders in the pulmonary circulation. Stagnation in the lung tissue leads to the fact that the lungs fill with fluid, and the patient suffocates.
2. Inflammation various parts hearts - myocarditis, endocarditis, pericarditis.
3. Sepsis and toxic shock lead to dysfunction of internal organs and are associated with the penetration of microbes into the bloodstream. If urgent treatment is not started, intravascular coagulation will develop, and the patient will die.

Diagnosis of pneumonia

Diagnosis of pneumonia is based on the study of the patient's complaints, anamnesis of life and disease, as well as on the data of additional research methods - instrumental and laboratory.

Clinical signs that make it possible to suspect the disease are fever, intoxication, cough.

On physical examination, a dullness of percussion sound is found, which indicates an existing seal in the lung. On auscultation, specialists note small bubbling rales and crepitus.

Instrumental diagnostic methods

Among the additional instrumental methods, the leading ones are:

• Radiography of the lungs in two projections,
• X-ray,
• CT scan,
• electrocardiography,
• echocardiography,
• Ultrasound examination of the organs of the chest cavity.

X-ray of the lungs allows you to make the correct diagnosis and determine the localization of the lesion. Usually the pathological process is located in the lower lobes of the lung.

Pneumonia

Radiographic signs of pneumonia:

1. Changes in the parenchyma of the organ - focal or diffuse shadows,
2. Interstitial changes - increased lung pattern, perivascular and peribronchial infiltration.

More exact method study of patients with suspected pneumonia is CT scan lungs. It is used in the following cases:

• If x-ray examination does not reveal the lesion, and the patient has characteristic symptoms of pathology,
• With a recurrent course of pneumonia with the location of the focus of inflammation in the same lobe of the lung,
• If the clinic and X-ray diagnostic data do not correspond to each other.

Laboratory diagnostics

Treatment of pneumonia

Treatment of patients with severe pneumonia, as well as in the presence of complications, is carried out in a hospital - in the pulmonology department.

Uncomplicated forms of the disease do not require hospitalization. Treatment of pneumonia of mild and moderate severity is carried out on an outpatient basis by general practitioners, therapists, pediatricians, family doctors.

Treatment of pneumonia at home is possible subject to all medical recommendations. Patients are shown bed rest, plenty of fluids, a complete, balanced diet containing a sufficient amount of proteins, carbohydrates and vitamins.

Traditional treatment

Etiotropic treatment - antibacterial:

• Macrolides - "Azithromycin", "Sumamed",
• Penicillins - "Amoxiclav", "Flemoxin",
• Cephalosporins - Suprax, Cefataxime,
• Fluoroquinolones - "Ciprofloxacin", "Ofloxacin",
• Carbapenems - "Imipenem",
• Aminoglycosides - "Streptomycin", "Gentamicin".

The choice of drug is determined by the result of microbiological analysis of sputum and determination of the sensitivity of the isolated microorganism to antibacterial agents. The duration of taking antibiotics is 7-10 days.

If the causative agent of pneumonia remains unknown, then a combination of 2 antibacterial drugs is prescribed, one of which can be replaced.

Antiviral treatment should be started as early as possible, preferably within the first 48 hours. To do this, use "Ribavirin", "Rimantadine", "Ingavirin", "Acyclovir". These drugs reduce the duration of the disease and the severity of symptoms. They are indicated to prevent unwanted outcomes of viral pneumonia.

Symptomatic treatment It is aimed at eliminating the main clinical manifestations of the disease and improving the patient's condition.

1. Expectorant and mucolytic agents are prescribed to patients who are tormented by a cough with sputum difficult to separate - ACC, Ambroxol, Bromhexin.
2. Bronchodilators are prescribed to patients with the development of shortness of breath - "Eufillin", "Berodual", "Salbutamol". These drugs are best taken by inhalation through a nebulizer.
3. Detoxification therapy consists in the drip administration of a glucose solution and saline solutions - physiological, "Disol", Ringer's solution.
4. Antihistamines - "Cetrin", "Diazolin", "Loratodin".
5. Immunomodulators - "Polyoxidonium", "Pyrogenal", "Bronchomunal".
6. Antipyretic drugs - "Ibuklin", "Nurofen".
7. Multivitamins - "Centrum", "Vitrum".

Video: antibiotic in the treatment of pneumonia, “Doctor Komarovsky”

Physiotherapy

After stabilization of the general condition of the patient and elimination of the symptoms of the acute period, they proceed to physiotherapeutic procedures.

Patients are prescribed:

• Electrophoresis with antibiotics, bronchodilators,
• UHF therapy,
• massage and vibrotherapy,
• corticosteroid inhalations,
• infrared laser therapy,
• ultrasound therapy,
• oxygen therapy,
• magnetotherapy,

Alternative therapy

Traditional medicine can only complement the traditional treatment of pneumonia, but not replace it completely.

Prevention

Effective preventive measures:

• To give up smoking,
• annual vaccination,
• The use of antiviral drugs during epidemics,
• hardening,
• Increasing the overall resistance of the organism,
• Sanitation of foci of chronic infection - treatment of carious teeth, tonsillitis, sinusitis,
• Breathing and therapeutic exercises.

Forecast

Factors on which the outcome of the disease depends:

1. Pathogenicity and virulence of the pathogen,
2. resistance of microorganisms to antibiotics,
3. patient's age,
4. The presence of comorbidities
5. The state of the immune system
6. Timeliness and adequacy of treatment.

Pneumonia associated with immunodeficiency often has a poor prognosis.

If the treatment of pneumonia was timely and adequate, then the disease usually ends in recovery. Most often, the structure of the lungs is completely restored.

Risk factors for death:

• Aspiration,
• Old age - over 65 years old,
• The child is less than a year old
• The prevalence of the pathological process - the defeat of more than 1 lobe of the lung,
• The number and nature of comorbidity,
• severe immunosuppression,
• Certain causative agents of infection are pneumococci,
• The development of septic syndrome,
• Damage to internal organs,
• Exacerbation of concomitant diseases - cardiac and hepatic kidney failure.

Video: pneumonia, “Doctor Komarovsky”

Despite the fact that pneumonia has been well studied as a pathology, diagnostic methods have improved, the identification of pathogens has become effective, and the treatment of the disease has become effective. from which patients massively died earlier, nevertheless, the disease is widespread and sometimes manifests itself in complex forms.

According to statistics in Russia, about 400 thousand people fall ill with pneumonia every year, given the fact that patients go to the hospital already with an acute form of the disease, it is worth assuming that approximately the same number of citizens suffer pneumonia “on their feet”.

Pneumonia most often affects the lower respiratory tract.

Is an infectious disease therefore, not only the patient, but also the people around at work, at home, in public transport can be at risk.

The inflammatory focus affects the following components:

1. Bronchi.
2. Bronchioles.
3. Alveoli.
4. Lung parenchyma.

Influence factors.

The age of the patient. Over the years, immunity is steadily weakening, so it is easier for pathogenic microorganisms to enter the human body. Older people are at greater risk than young and middle-aged people. Children of infants, infants, preschool and early school age are at high risk, since their immunity is not fully formed.

Smoking- one of the factors that reduces the body's ability to fully resist viruses, bacteria. Resins and nicotine destroy the barrier function of the epithelium of the bronchi and alveoli, which means that it is easier for microorganisms to penetrate into the lungs and develop in a favorable environment.

Alcohol- Ethyl alcohol is recognized as a toxic substance, poison. Once in the blood, it destroys leukocytes and other antibodies that can counteract pneumonia pathogens. In addition, alcohol is excreted from the body not only through genitourinary system but also the lungs, damaging the respiratory mucosa.

Other causes of the development of the disease

Other factors, such as congenital and acquired abnormalities, also provoke the development of pneumonia.

The main types of pneumonia

Pneumonia- a disease that can be caused by various types of pathogens. Depending on the causes and pathogens, the very nature of the course of the disease is formed.

Nosocomial pneumonia occurs in public organizations (hospitals, clinics, educational institutions), where the pathogen circulates. The classic pathogen are staphylococci, viruses, streptococci that affect the lung tissue. It takes 3 days for the first symptoms of nosocominal pneumonia to appear.

Aspiratory pneumonia. Causative agents get with food, water and other products that have cysts of microorganisms or viral particles that provoke the disease.
Community-acquired form - obtained as a result of contact with infected children, animals at home or on the street.

Immunodeficiency inflammation of the lungs. The focus has long been in the lungs, but was in a dormant state. After a decrease in immunity, pathogens intensify their activity, creating favorable conditions for their development, affecting the lung tissues.

SARS is a form of the disease, the causes of which may differ from those described above.

Features of the disease

The disease can develop with the active development of bacterial, viral and fungal pathogens in the lungs. Depending on the cause of the occurrence, pulmonologists prescribe the most effective treatment.

Pathogens are bacterial

Bacteria are more likely than other organisms to infect the lungs. The causes that provoke inflammation are the following groups of bacteria:

• pneumococci;
• staphylococci;
• streptococci;
• hemophilic bacillus;
• moraxella.

These are the most common pathogens. But actually. The causes of occurrence can be very diverse. Almost any bacterium that enters the lungs can, under favorable conditions, create inflammatory foci in the lung tissue. Pneumonia often occurs under the influence of various viruses.

Both in children and adults, the causes that provoke pneumonia can be intracellular organisms (chlamydia, legionella, other microorganisms). Pneumonia, which occurs when these pathogens multiply rapidly, proceeds relatively easily.

Viral pathogens

Viral pathogens affect the lung tissue in 90% of cases in children, only in 10% of a hundred in adults. Viral pneumonia is caused by measles viruses chickenpox, cytomegalovirus, manifests itself if the patient's immunity drops sharply.

Unlike bacterial pneumonia, viral pneumonia has a seasonality, and activity is observed in the cold season.

Fungal pathogens

Fungal microorganisms rarely affect the lungs. The reason for their rapid development in the lungs with tissue damage can only be immunodeficiency. In fact, saprophytes are found in humans in the oral cavity, GI tract, and on the skin. When immunity drops to a critical level, these microorganisms penetrate the lungs and develop there.

An inflammatory focus in the lungs also occurs when bacteria and viruses are combined, then it is more difficult to establish the cause of the disease, and pneumonia takes on a complex form.

Depending on the cause and factor of occurrence, the form of the disease will also depend. If the disease is provoked by the influenza virus, then the inflammation will be more difficult than when exposed to adenoviruses. This is due to the fact that the influenza virus causes intoxication of the body as a whole.

Inflammation of the lungs name various diseases under a common name pneumonia. All infections of the respiratory system rank first among all human infectious diseases. Although pneumonia is usually caused by an infectious microorganism, it can also be associated with the inhalation of irritating gases or particles. The lungs have a complex defense system: strong branching and narrowing of the bronchial passages make it difficult for foreign bodies to penetrate deep into the lungs; millions of tiny hairs, or cilia, in the walls of the bronchi constantly capture particles from the respiratory tract; when coughing, irritants are ejected from the lungs at high speed, and white blood cells, known as macrophages, capture and destroy many carriers of the infection.

Despite this defensive capability, pneumonia still occurs frequently. Inflammation can be limited to the air sacs (alveoli) of the lungs (lobar pneumonia) or develop in foci throughout the lungs, originating in the airways and spreading to the alveoli (bronchopneumonia). The accumulation of fluid in the alveoli can disrupt the supply of oxygen to the blood.

Undoubtedly, pneumonia is a polyetiological disease. And exactly etiological factor is decisive both in the clinical course of the disease and in the choice of antibiotic therapy. It also largely determines the severity of the course of pneumonia and its outcome.

The main role in the occurrence of pneumonia belongs to pneumococci, streptococci and Haemophilus influenzae, the total proportion of which can reach 80%. Pneumonia can also be caused by staphylococci, Klebsiella, Proteus, Pseudomonas aeruginosa, Escherichia coli, but their specific gravity is relatively small. At the same time, during influenza epidemics, the frequency of staphylococcal pneumonia naturally increases. In weakened patients with impaired immunity, pneumonia caused by Klebsiella, Proteus and Escherichia coli is more common. In patients with chronic bronchitis, staphylococcus, Haemophilus influenzae, as well as gram-negative flora and pneumococcus are of great importance. There are also atypical pneumonias, the etiology of which is associated with mycoplasma, legionella, chlamydia. Their frequency has increased markedly in recent years.

The independent etiological role of a viral infection in pneumonia is highly doubtful. However, it is undoubtedly an important factor contributing to the occurrence of pneumonia.

In modern conditions, in connection with the need to choose an adequate variant of etiotropic therapy, the establishment of the etiology of pneumonia with the identification of a probable pathogen is of decisive importance. This is also important because pneumonias of different etiology are characterized by different clinical course, different symptoms, including x-ray symptoms, have different prognosis and require a differentiated determination of the duration of treatment.

Meanwhile, the quality and possibilities of bacteriological diagnostics in pneumonia do not always allow us to correctly resolve the issue of the etiology of pneumonia. In this regard, the role of assessing clinical manifestations and the epidemiological situation for the approximate establishment of the etiology of pneumonia is increasing.

This is also important for the reason that, as a rule, the situation requires an immediate start of treatment even before a bacteriological diagnosis is established, and the results of a bacteriological examination can be obtained no earlier than 48 hours later.

The cells of the body may thus lack oxygen, and in serious cases this may result in respiratory failure. Before the advent of antibiotics, pneumonia was the leading cause of death, and more recently strains of the most common bacterial pneumonia (caused by Streptococcus pneumoniae) have become resistant to penicillin. Pneumonia is especially common in the elderly or those who are weakened by the underlying disease. It currently remains among the top 10 causes of death.

However, despite the serious health risks associated with the disease, the prospect for a full recovery is good, especially with early detection and treatment. For the elderly and those at high risk, there is a vaccine that provides protection against 23 different strains of S. pneumoniae (which cause 90 percent of streptococcal pneumonia cases).

According to the International consensus and the Russian therapeutic protocol (Order of the Ministry of Health of the Russian Federation No. 300, 1998), additional characteristics have been introduced into the classification of pneumonia, providing for their division into:

community-acquired pneumonia;

Nosocomial (hospital, nosocomial) pneumonia;

Pneumonia in immunocompromised patients different origin;

aspiration pneumonia.

In contrast to the "typical" pneumonias caused by pneumococcus, the so-called atypical pneumonias have been isolated.

The term "SARS" appeared in the 40s of the XX century. and it was understood as a lesion of a milder course than a typical lobar pneumococcal pneumonia. Initially, the causative agent of this "SARS" was unknown and it was assumed that it was the so-called agent

Eton. Subsequently, it was deciphered as Mycoplasma pneumoniae, and then Chlamidia pneumoniae and Legionella pneumophila were also assigned to the number of pathogens that cause the occurrence of this variant of pneumonia.

A.I. Sinopalnikov and A.A. Zaitsev (2010) proposed to distinguish between:

a) protracted, or slowly resolving;

b) progressive and

c) persistent pneumonia.

Each of these variants of pneumonia is characterized by a different duration of the course, the severity and nature of complications, and, finally, the choice of adequate therapy.

Diagnostics

Medical history and physical examination.

Chest x-ray.

Culture of blood and saliva.

In difficult cases, a lung tissue biopsy may be performed.

Causes

Viral or bacterial infections are the most common causes of pneumonia.

Although the bacteria are usually inhaled, they can spread to the lungs through the bloodstream from elsewhere in the body.

Inhalation of chemical irritants such as poisonous gases can lead to pneumonia.

Vomit that enters the lungs (which can happen when a person passes out) can cause a disease known as aspiration pneumonia.

Young or very old age, smoking, recent surgery, hospitalization, and use of chemotherapeutic agents and immunosuppressants are risk factors for pneumonia.

Other diseases increase the risk of developing pneumonia and may cause complications. These diseases include asthma, Chronical bronchitis, poorly controlled diabetes mellitus, AIDS, alcoholism, Hodgkin's disease, leukemia, multiple myeloma and chronic kidney disease.

Symptoms

Symptoms vary greatly depending on the type of pneumonia. Older and very sick people usually have less severe symptoms and less fever, even though pneumonia is more dangerous for these patients.

Temperature (above 38°C, possibly up to 40.5°C) and chills.

Cough, possibly with bloody yellow or green sputum. (Cough may persist for up to six to eight weeks after the infection subsides, especially if it is a viral infection.)

Pain in the chest when inhaling.

Headache, sore throat and muscle pain.

General malaise.

Weakness and fatigue.

Profuse sweat.

Loss of appetite.

In serious cases: difficulty breathing, bluish skin tone, confusion.

Community-acquired (home) pneumonia

There was an idea that pneumococcus, Haemophilus influenzae, streptococcus, gram-negative flora, and mycoplasma are of leading importance in the occurrence of community-acquired pneumonia.

However, legionella pneumonia ranks second (after pneumococcal) in terms of the frequency of lethal outcomes of the disease.

Community-acquired pneumonia is one of the most important health problems associated with high morbidity and mortality, as well as significant direct and indirect costs associated with this disease.

The incidence in Europe ranges from 2 to 15 cases per 1000 population, and in Russia - up to 10-15 cases per 1000 people per year.

These rates are significantly higher in elderly patients, ranging from 25 to 44 cases per 1000 people per year in patients over 70 years of age and from 68 to 114 in patients in nursing homes and nursing homes.

Pneumonia caused by various pathogens has clinical and radiological features that allow the doctor with a fairly high probability to determine its etiology and thereby not only formulate a nosological diagnosis, but also determine the treatment tactics.

The etiology of community-acquired pneumonia, as well as the mechanisms of spread of the pathogen are very diverse. Often they are associated with the microflora that usually colonizes the upper respiratory tract.

The main mechanism is microaspiration of bacteria that make up the normal microflora of the oropharynx. In this case, the massiveness of the dose of microorganisms or their increased virulence against the background of damage to the protective mechanisms of the tracheobronchial tree matters. Of particular importance in this case can be a viral respiratory infection, which is associated with impaired function of the ciliated epithelium and a decrease in the phagocytic activity of alveolar macrophages.

Less frequent way in the event of pneumonia - inhalation of microbial aerosol, which can occur when infected with obligate pathogens (for example, Legionella spp., etc.).

Even less important is the hematogenous route of spread of microorganisms from the extrapulmonary focus of infection, which is usually observed in sepsis.

Finally, the direct spread of infection from a focus associated with pathology of the liver, mediastinum, or as a result of a penetrating wound of the chest is possible. The pathogenesis of pneumonia largely determines its etiological structure.

The etiological diagnosis of community-acquired pneumonia is extremely complicated by such factors as the absence of sputum, the impossibility of obtaining bronchial secretions by invasive methods due to the serious condition of the patient or insufficient qualification of medical personnel, contamination of bronchial contents by the microflora of the oropharynx, and a high level of carriage of a number of pathogens (from 5 to 60% in different age groups), the use of antibiotics in the prehospital stage.

The diagnostic value of the study of freely coughed up sputum using microscopy or culture, for the reasons stated above, is rather limited. Sputum is considered satisfactory in quality if microscopy by Gram smear at 100 magnification reveals more than 25 neutrophils and less than 10 epithelial cells. The significance of sputum culture is, in particular, in the identification of resistant strains of the likely causative agent of pneumonia.

Patients with community-acquired pneumonia who are treated on an outpatient basis are shown bacteriological examination of sputum, which should be carried out before starting antibiotic therapy. Serological study may be necessary if legionellosis or mycoplasmal pneumonia is suspected.

However, more often the latter is useful for the retrospective diagnosis of legionella pneumonia during its epidemic outbreak.

pneumococcal pneumonia

Historically, the beginning of clinical research on lobar pneumonia was laid by Corvisart and his student Laennec. They also introduced auscultation into clinical practice, and Laennec invented the stethoscope and described such physical phenomena as crepitus, dry and wet rales, bronchophony and egophony. The term "croupous pneumonia" was introduced by S.P. Botkin to indicate a particularly severe course of the disease, as evidenced by the appearance of signs of croup. The term "croupous pneumonia" is used only in Russian literature. It is now recognized that typical lobar pneumonia is always pneumococcal. However, the term "croupous pneumonia" is still used in clinical practice, although it is not always lobar, and may be, in particular, segmental, and sometimes multilobar. It cannot be emphasized that up to 60% of focal pneumonias are also pneumococcal.

Up to 75 types of pneumococci have been described, of which no more than two or three can be the causative agents of the so-called lobar pneumonia.

The infection enters the body through the aerogenic route. A rapid, almost simultaneous lesion of a lobe of the lung and a sudden onset of the disease gave reason to believe that the basis of its occurrence is the presence of a hyperergic reaction. Predisposing factors are cooling, overwork, dystrophy, severe cardiovascular diseases, etc. Under these conditions, the infection spreads very quickly, affecting the whole lobe, and sometimes the entire lung.

The pathological and anatomical picture in typical pneumococcal pneumonia (lobar) undergoes evolution with a successive change of four stages of development.

Stage of tide or hyperemia. At this stage, the capillaries are dilated and overflowing with blood, serous fluid begins to accumulate in the alveoli, a small amount of erythrocytes, leukocytes and cells of the desquamated alveolar epithelium. Due to an increase in the number of erythrocytes by diapedesis and loss of fibrin, this stage passes into the next one on the 2nd-3rd day of the disease.

Red hepatization stage. The cavities of the alveoli at this stage are filled with fibrin with a significant admixture of erythrocytes, a small amount of leukocytes and cells of the alveolar epithelium. The affected lobe is enlarged, dense, airless. Its color is red-brown. On the pleura, enveloping the affected lobe, there are fibrinous overlays; they are also visible inside the vessels and lymphatic slits. In the future, erythrocytes undergo hemolysis and decay. This stage lasts 2-3 days, after which it passes into the next one.

The stage of gray hepatization. The affected lobe still remains dense. Its color on the cut is grayish-yellowish. The alveoli contain fibrin with an admixture of leukocytes. Erythrocytes are absent. At the end of the gray hepatization stage, a crisis occurs in the development of the disease and the next stage begins.

Resolution stage. The released proteolytic enzymes cause liquefaction of fibrin, leukocytes and cells of the alveolar epithelium undergo lipid transformation and decay. The liquefying exudate is secreted through the bronchi and absorbed through the lymphatic tract.

In typical cases, the disease begins suddenly - with chills, often stunning, a rapid rise in temperature to 40 ° C, stabbing pains in the chest, aggravated by inhalation, due to the reaction of the pleura to the inflammatory process, headache, often vomiting. Less commonly, the disease is preceded by a premorbid state for several days: weakness, weakness, body aches, etc.

Already on the 1st-2nd day of the illness, a cough appears, at first painful, since a small amount of mucous sputum comes out with difficulty and each coughing shock exacerbates pleural pain. Sputum gradually acquires a mucopurulent character, and in some patients it is stained with blood and acquires a “rusty” shade, pathognomonic for pneumococcal lobar pneumonia. Croupous pneumonia usually develops in one lung, more often in the right, but bilateral lesions can also be observed. Often the process is localized in the lower lobe, but the upper lobes can also be involved in the inflammatory process. Sometimes the resulting pain syndrome simulates acute appendicitis or cholecystitis. Damage to the pleura can lead to pain in the heart, reminiscent of coronary disease.

Also characteristic are hyperemia of the face, a blush on the cheeks. At the height of intoxication, the visible mucous membranes may acquire a cyanotic hue, the sclera are often subicteric. Herpetic eruptions appear on the lips and wings of the nose. The body temperature remains high for several days with little fluctuation. Breathing is rapid, superficial - up to 40 per minute or more. The pulse is speeded up to 100-120 beats per minute.

Physical symptoms depend on the volume of lung damage, the extent and phase of the inflammatory process. In the first days of the disease, dullness on percussion arises and rapidly increases, corresponding to the affected area of ​​the lung. At the beginning of the hepatization phase, gentle crepitus may be heard - crepitatio indux. At this time, bronchial breathing can be heard. In the resolution phase, percussion dullness is replaced by a pulmonary sound, breathing loses its bronchial tone, becomes hard, and then vesicular. Final crepitus is heard - crepitatio redux.

X-ray examination is determined by intense homogeneous darkening with bulging outer contours. The development of destructive changes is uncharacteristic. Often there is a pleural effusion, which gives reason to designate the pathological process as pleuropneumonia.

The temperature decreases gradually, within 2-4 days (lytically), or suddenly, during the day (critically). The crisis is accompanied by profuse sweating. The beginning of the crisis usually falls on the 3rd, 5th, 7th, 11th day.

Recently, the clinical picture of typical pneumococcal pneumonia has noticeably smoothed out as a result of the use of antibiotic therapy.

The state of the cardiovascular system in elderly and senile patients determines the prognosis of the disease, which justifies the aphorism of the French clinician Corvisart (1807): "La maladie est au poumon, le danger au coeur" (the lungs hurt - the danger in the heart).

During a crisis, there may be sharp drop blood pressure with a small, frequent pulse and increased cyanosis - collapse phenomena, pulmonary edema may develop.

Of the laboratory parameters, a significant neutrophilic leukocytosis of 20-30 x 10 9 /l and above is characteristic. Shift of the leukocyte formula to the left to young forms of neutrophils; toxic granularity of neutrophils may be detected. At the height of the disease, aneosinophilia is characteristic. As the recovery decreases, the number of leukocytes decreases, while the ESR rises to 40 mm per hour and above (“crossover symptom”). Eosinophils appear in the blood (“eosinophilic dawn of recovery”), the number of neutrophils decreases and, conversely, the number of lymphocytes increases.

When sowing blood in 20-40% of cases, bacteremia is detected.

The reaction of the pleura is almost always determined, however, a significant pleural effusion is noted only in 10-15% of patients.

According to the summary data, there is a decrease in the frequency of lobar pneumococcal pneumonia and at the same time there is an increase in focal pneumonia of pneumococcal nature.

Staphylococcal pneumonia

It can be community-acquired, complicating viral infections, or hospital-acquired, developing in the elderly, with diabetes, traumatic brain injury, after mechanical ventilation. Prolonged hospital stay increases the risk of staph infections. Chronic obstructive bronchitis may also be a risk factor for the development of staphylococcal pneumonia.

In recent years, staphylococcal pneumonias are quite common, and in the structure of pneumonias they make up 5-10%. According to the peculiarities of pathogenesis, primary and secondary (septic) forms of staphylococcal pneumonia should be distinguished.

Primary staphylococcal pneumonia develops usually acutely among full health. However, it is often associated with the flu. Such staphylococcal pneumonia is difficult and is characterized by a tendency to rapid suppuration.

The acute onset of the disease is accompanied by a significant increase in temperature and chills. Expressed shortness of breath, chest pain, cough with the release of purulent or mucopurulent sputum, often containing an admixture of blood.

There are also marked general weakness, sweating, tachycardia. Dullness of percussion sound is also found, with auscultation - weakened breathing, often with a bronchial tinge, small bubbling wet rales. Typically, the rapid development of destructive changes in the lungs, usually multiple. Extensive areas of lung tissue can be involved in the pathological process, more often in both lungs. However, the severity of the patient's condition does not always correspond to the changes found in the lungs. Yu.M. Muromsky et al. (1982) found that destructive changes in the lung tissue cause strains of staphylococcus that produce lecithinase, phosphatase, and a-and β-hemolysins.

In some cases, the initial clinical manifestations are more blurred. The temperature is subfebrile, and the general condition of the patient is relatively satisfactory.

The X-ray picture differs in variety and considerable variability. Numerous macrofocal and focal shadows of polysegmental localization are revealed. Against the background of widespread infiltrative changes, cavities of various sizes are visible, some of which may contain a horizontal level of fluid. The described changes are located partly in the depth of the lung tissue, but some of them have subpleural localization. Their breakthrough into the pleural cavity is possible with the development of a picture of pyopneumothorax, which significantly worsens the patient's condition and the prognosis of the disease. In such cases, it is necessary to quickly drain the pleural cavity and transfer the patient to the intensive care unit.

Both variants of staphylococcal pneumonia described above are inherent in primary staphylococcal pneumonia, which is determined by I.P. Zamotaev (1993) as bronchogenic.

Along with primary staphylococcal pneumonia, I.P. Zamotaev identifies a hematogenous variant of staphylococcal pneumonia, which is characterized by a clinical picture of a septic process: tremendous chills, high fever, severe intoxication, severe respiratory complaints with chest pain, cough with bloody sputum, shortness of breath and increasing respiratory failure. The percussion picture is mosaic: areas of dullness alternate with tympanic ones. During auscultation, areas of weakened breathing are interspersed with amphoric breathing, sonorous moist rales are heard. In the blood test - pronounced leukocytosis, left stab shift, lymphopenia, a significant increase in ESR. Often there is a tendency to anemia.

The X-ray picture is characterized by the presence of multiple inflammatory foci, more often in both lungs, of medium and significant size. These focuses tend to merge and then fall apart. More often they have the correct rounded shape and may contain a horizontal level of liquid. In the process of dynamic observation, they can decrease in size and transform into a thin-walled cyst.

Often, in this variant, a picture of pyopneumothorax occurs.

Diagnosis of staphylococcal pneumonia should be based on the following data:

1) the presence of foci in the body staph infection;

2) severe clinical course of the disease;

3) features of the X-ray picture with the frequent presence of multiple destructive cavities;

4) detection of pathogenic Staphylococcus aureus in sputum;

5) absence positive effect when using unprotected β-lactam antibiotics. The diagnosis becomes even more substantiated when a picture of pyopneumothorax is revealed.

Staphylococcal pneumonia, as mentioned above, can be community-acquired, but often they are hospital-acquired (nosocomial). In such cases, they usually acquire a septic course.

Pneumonia due to Klebsiella (Fridlander's wand)

This type pneumonia is relatively rare. It is believed that in the structure of pneumonia its specific gravity ranges from 0.5-4.0%. However, among patients with the most severe forms of pneumonia, it increases to 8-9.8%. More often, the lesion is of a shared nature, often related to upper lobe. Similar localization of the process in pneumonia caused by Klebsiella is observed more often than in pneumococcal pneumonia. Accounting for this circumstance is of certain importance, firstly, when conducting a differential diagnosis with tuberculosis, and secondly, when choosing an approximate etiology of pneumonia. Men get sick 5-7 times more often than women, older people more often than young people.

Predisposing factors are alcoholism, malnutrition, diabetes mellitus, chronic obstructive bronchitis.

Due to the severe course and the possibility of an unfavorable outcome, early etiological diagnosis, timely hospitalization and adequate therapy are very relevant.

The disease usually begins acutely, often against the background of complete clinical well-being. At the same time, body temperature rarely reaches 39 ° C, but there are cases when it does not reach 38 ° C. Cough hacking, painful, unproductive. The sputum is usually viscous, jelly-like in consistency, may contain streaks of blood, and has the smell of burnt meat. Almost always there are pains in the chest of pleural origin. Perhaps the development of exudative pleurisy. At the same time, the exudate is cloudy, has a hemorrhagic hue, contains a large number of microorganisms of the Klebsiella genus. Cyanosis of visible mucous membranes is usually expressed. The discrepancy between the relatively low body temperature, the low severity of physical data and the general serious condition. Destructive cavities can quickly form, resulting in significant amounts of bloody sputum. Usually abscess formation occurs in the first 4 days of the disease. On percussion, there is a distinct dullness, and on auscultation, weakened bronchial breathing and a small number of wheezing. The latter is due to the filling of the lumen of the alveoli and small bronchi with mucus. Often, dyspeptic disorders, icterus of the sclera and mucous membranes are detected. A blood test reveals leukopenia with monocytosis and a shift of the leukocyte formula to the left. Leukocytosis is detected more often with purulent complications. X-ray examination reveals an area of ​​blackout, initially homogeneous. The affected proportion appears enlarged in volume. In the future, areas of destruction, pleural effusion are formed.

In the pre-antibacterial era, the prognosis was often unfavorable. However, at present, the mortality rate reaches 8%.

Pneumonia due to Haemophilus influenzae

Pneumonia caused by N. influenzae (Pfeiffer's wand) is relatively rare, although in recent years it has shown a tendency to increase. Often occurs in children. In adults, pneumonia caused by Haemophilus influenzae usually develops in areas of atelectasis due to obstruction of the small bronchi in patients with chronic obstructive bronchitis. Lung involvement is often focal in nature. In this case, focal changes can merge with the formation of focal shadows. Since the disease occurs against the background of purulent bronchitis, a mosaic of physical data is characteristic. Haemophilus influenzae can be the cause of the development of secondary pneumonia in influenza.

The clinical picture of pneumonia that developed against the background of an exacerbation of chronic obstructive bronchitis or influenza is characterized by the appearance of a second wave of fever, the appearance of areas of dullness on percussion and localized moist rales on auscultation. In the blood test, neutrophilic leukocytosis is simultaneously recorded. In some cases, pneumonia can be complicated by meningitis, pericarditis, pleurisy, arthritis, and an extended picture of sepsis. For culture, blood agar is used. Haemophilus influenzae, as a rule, does not grow on other media.

SARS

Mycoplasma pneumonia

Mycoplasma is a highly virulent pathogen transmitted by airborne droplets. Epidemic rises of the disease are often observed, which last for several months and are repeated every 4 years, mainly in the autumn-winter period. Hospital pneumonia is quite rare.

The onset of the disease is gradual, with the appearance of catarrhal phenomena and malaise. High or subfebrile temperature may be observed. Chills and shortness of breath are not typical. Pleural pain is absent. The cough is often unproductive or with scanty mucous expectoration.

On auscultation, dry or local moist rales are heard. Pleural effusion develops extremely rarely.

Extrapulmonary and general symptoms are characteristic - myalgia, more often in the back and hips; profuse sweating, conjunctivitis, myocardial damage, severe general weakness.

When examining blood, a slight leukocytosis or leukopenia is noted, the leukocyte formula is not changed, anemia is often detected.

An X-ray examination reveals a focal-spotted nature of the shadow, located mainly in the lower parts of the lungs.

Mycoplasmal pneumonia is characterized by dissociation of signs - a normal leukocyte formula and the release of mucous sputum at high temperature; pouring sweats and severe weakness with low subfebrile condition or normal temperature.

Chlamydial pneumonia

The disease begins with a dry cough, sore throat (pharyngitis, laryngitis), and malaise. There are chills, high fever. The cough is initially dry but quickly becomes productive with small amounts of purulent sputum.

On auscultation, crepitus is heard first, followed by local moist rales. Both lobar and focal pneumonia can occur in the volume of one or more lobes. Chlamydial pneumonia can be complicated by pleural effusion, which is manifested by characteristic chest pains.

Leukocyte formula usually unchanged, although neutrophilic leukocytosis may be noted.

An x-ray examination reveals local or fairly widespread large-focal shadows, sometimes with the formation of small foci.

legionella pneumonia

Legionella was first identified in 1976 during an outbreak among American Legionnaires' Convention participants.

Subsequently, it was found that clinically legionellosis can manifest itself in two main forms: legionnaires' disease - pneumonia caused by legionella, and Pontiac fever.

Pneumonia was severe and lethality reached 16-30% in the absence of treatment or the use of ineffective antibiotics.

Epidemic outbreaks usually occur in autumn. The pathogen is well preserved in water, so living near open water bodies can be considered a risk factor. Air conditioners can also serve as a source of infection.

The disease can occur as community-acquired and nosocomial pneumonia.

Nosocomial legionella pneumonia often develops in individuals receiving glucocorticoid hormones and cytotoxic agents. Mortality in this case can reach 50%.

The incubation period is 2-10 days. The disease begins with weakness, drowsiness, fever, cough with scanty sputum, which may contain an admixture of blood. Sputum is often purulent. Dyspeptic disorders may be detected.

Physical examination is determined by the shortening of percussion sound, crepitus, local moist rales. Bradycardia and hypotension are often observed. A third of patients have pleural effusion.

In a laboratory study, leukocytosis with a shift of the formula to the left, relative lymphopenia, increased ESR, and thrombocytopenia are detected. In the analysis of urine - hematuria, proteinuria. There is also a positive polymerase chain reaction.

X-ray examination shows macrofocal and focal shadows with a tendency to merge. With favorable dynamics, the normalization of the x-ray picture occurs within a month.

Extrapulmonary manifestations, which are rare, include endocartitis, pericarditis, myocarditis, pancreatitis, and pyelonephritis.

The most effective treatment with the use of macrolides, its duration is at least 2-3 weeks. The use of β-lactam antibiotics is ineffective.

It is widely believed that in at least 20-25% of patients with atypical pneumonia, only interstitial changes in the lungs are determined by X-ray examination. However, as V.E. Nonikov (2001), in such cases, computed tomography can reveal pneumonic infiltration of the lung tissue. Moreover, even linear tomography contributes to obtaining the same effect.

A quick tentative determination of the etiology of pneumonia can be facilitated by the data obtained by microscopy of a Gram-stained sputum smear, given below (Russian Consensus on Pneumonia):

To determine the tactics of managing patients with community-acquired pneumonia, the recommendations of S.N. Avdeeva (2002), who divides them into the following groups:

Pneumonia that does not require hospitalization; this group is the most numerous, its share is up to 80% of all patients with pneumonia; these patients suffer from mild pneumonia and can be treated on an outpatient basis; lethality does not exceed 1-5%;

Pneumonia requiring hospitalization of patients in a hospital; this group makes up about 20% of all pneumonias; patients have underlying chronic diseases and severe clinical symptoms; the risk of mortality in hospitalized patients reaches 12%;

Pneumonia requiring hospitalization of patients in departments intensive care; such patients are defined as suffering from severe community-acquired pneumonia; the lethality of this group is about 40%.

In this case, the assessment of the severity of pneumonia according to M.D. becomes essential. Niederman et al. (1993):

1. The frequency of respiratory movements is more than 30 per 1 min upon admission.

2. Severe respiratory failure.

3. The need for mechanical ventilation.

4. When conducting radiography of the lungs, the detection of bilateral lesions or lesions of several lobes; an increase in the size of the blackout by 50% or more within 48 hours after admission.

5. State of shock (systolic blood pressure less than 90 mm Hg or diastolic blood pressure less than 60 mm Hg).

6. The need to use vasopressors for more than 4 hours.

7. Diuresis less than 20 ml per hour (if there is no other explanation for this) or the need for hemodialysis.

Pneumonia in the elderly and senile

Pneumonia in elderly and senile patients is a serious problem due to significant difficulties in diagnosis and treatment, as well as high mortality.

So, according to V.E. Nonikova (1995), US National Center for Medical Statistics (1993,2001), as well as M. Wood-head et al. (2005), the incidence of community-acquired pneumonia in the elderly is twice as high as in individuals young age. The rate of hospitalization for this disease increases more than 10-fold with age.

According to N. Kolbe et al. (2008), with pneumonia in older people, the resistance of the pathogen to antibiotics is significantly higher, which significantly worsens the prognosis of the disease.

Opinion I.V. Davydovsky (1969) about the exceptional importance of pneumonia in the thanatogenesis of the gerontological population has not lost its relevance. Mortality among patients with pneumonia older than 60 years is 10 times higher than in other age groups, and reaches 10-15% in pneumococcal pneumonia and 30-50% in pneumonia caused by Gram-negative flora or complicated by bacteremia.

An assessment of the two-year survival rate of the elderly showed that after pneumonia, mortality from decompensation of underlying diseases significantly increases.

Pneumonia often develops in the terminal period serious illnesses often being the direct cause of death in old age. In the elderly and old age the role of Klebsiella pneumonia, as well as Pseudomonas aeruginosa and Escherichia coli, is especially great. In most elderly people, pneumonia is caused by a mixed infection, including both gram-negative and gram-positive flora. In the etiology of modern pneumonia in the elderly, along with the bacterial flora, fungi, rickettsia and viruses play an important role.

Multimorbidity is a characteristic feature of the elderly.

Pneumonia in persons over 60 years of age is never the only disease. They always develop against the background of previous diseases, some of which play the role of predisposing, while others are pathogenetically or etiologically important.

The high error rate in the diagnosis of pneumonia in the elderly shows that their recognition at this age is associated with difficulties both at the prehospital stage and in the hospital. In terms of the frequency of diagnostic errors, pneumonia leaves behind many diseases and can only be compared with neoplasms, the difficulties of detecting which are well known.

Overdiagnosis of pneumonia prevails. It is especially high among people over 60 years of age and is twice the frequency of diagnostic errors in young people. Most common causes clinical overdiagnosis are misinterpretation of febrile syndrome and erroneous interpretation of auscultation data. Overdiagnosis is also facilitated by the lack of X-ray examination and incorrect interpretation of its data.

On the contrary, a pronounced pain syndrome often leads away from the diagnosis of pneumonia, inclining the doctor to an erroneous diagnosis of myocardial infarction, renal colic, cholecystitis or intestinal obstruction.

According to V.E. Nonikova (2001), the situation when pneumonia is not diagnosed (that is, there is an underdiagnosis) is even more dangerous, since in these cases the start of adequate therapy is unreasonably delayed or the patient may be at risk of unnecessary surgery.

According to V.E. Nonikova, the most common clinical symptoms of pneumonia in the elderly are fever, cough, sputum. Approximately in 2/3 of patients of this age, the disease begins gradually. Chills are noted in 1/3 of patients (as in younger patients).

Shortening of the percussion sound is typical, as a rule, with lobar pneumonia and parapneumonic pleurisy. Auscultatory findings are presented in the lungs in the form of moist rales (77%), dry rales (44%), weakened breathing (34%), crepitus (18%) and bronchial breathing (6%).

Significantly more often with pneumonia in people over 60 years of age, shortness of breath, heart rhythm disturbances, peripheral edema, and confusion are noted.

Data from routine laboratory studies do not have significant features in pneumonia in the elderly. Prognostically unfavorable for massive pneumonia in these individuals is leukopenia with a neutrophilic shift and lymphopenia.

The clinical features of pneumonia in the elderly are:

Small physical symptoms, often the absence of local clinical and radiological signs of pulmonary inflammation, especially in dehydrated patients, which leads to disruption of exudation processes;

Ambiguous interpretation of the identified wheezing, which can be heard in the lower parts of the elderly and without the presence of pneumonia, as a manifestation of the phenomenon of airway obstruction. Areas of dullness can serve as a manifestation of not only pneumonia, but also atelectasis;

Frequent absence of acute onset and pain syndrome;

Frequent violations of the central nervous system (confusion, lethargy, disorientation), which occur acutely and do not correlate with the degree of hypoxia; these disorders may be the first clinical manifestations of pneumonia, but are often regarded as acute disorders cerebral circulation;

Shortness of breath as the main symptom of the disease, not explained by other causes, such as heart failure, anemia, etc.;

Isolated fever, without signs of pulmonary inflammation; in 75% of patients, the temperature is above 37.5 °C;

Deterioration of the general condition, decrease in physical activity, pronounced and not always explainable loss of the ability to self-service;

Unexplained falls, often preceded by signs of pneumonia however, it is not always clear whether a fall is one of the manifestations of pneumonia or whether pneumonia develops after a fall;

Exacerbation or decompensation of concomitant diseases - strengthening or appearance of signs of heart failure, cardiac arrhythmias, decompensation of diabetes mellitus, signs of respiratory failure. Often these symptoms appear in clinical picture to the fore;

Prolonged resorption of pulmonary infiltration (up to several months).

Nosocomial (hospital, nosocomial) pneumonia

This type of pneumonia ranks first among the causes of death from nosocomial infections.

Mortality from nosocomial pneumonia reaches 70%, but it is the direct cause of death of patients in 30-50%, when the infection is the main cause of death.

It is estimated that nosocomial pneumonia occurs in 5-10 cases per 1000 hospitalized.

When diagnosing nosocomial pneumonia, infections that were in the incubation period at the time the patient was admitted to the hospital should be excluded.

The etiology of nosocomial pneumonia is characterized by significant originality, which makes it difficult to plan etiotropic therapy.

Depending on the period of development of nosocomial (nosocomial) pneumonia, it is customary to distinguish:

. "early nosocomial pneumonia", which occurs within the first 5 days after hospitalization, which is characterized by pathogens that are sensitive to traditionally used antibiotics;

. "late nosocomial pneumonia", which develops no earlier than the 5th day after hospitalization, which is characterized by a high risk of the presence of multidrug-resistant bacteria and a less favorable prognosis.

The risk of nosocomial pneumonia is especially high in patients with COPD.

Consequently, early nosocomial pneumonia in patients who did not receive antibiotic therapy is most likely due to the normal microflora of the upper respiratory tract with a natural level of antibiotic resistance. However, in domestic intensive care units and intensive care units, the practice of using antibiotics for prophylactic purposes is widespread. Under these conditions, the etiological structure and phenotype of resistance of bacteria-causative agents of "early nosocomial pneumonia" approaches "late nosocomial pneumonia". In nosocomial pneumonia that developed during or after antibiotic treatment, the leading role can be played primarily by representatives of the Enterobacteriaceae family:

Klebsiella and Enterobacter spp.

Pseudomonas aeruginosa;

Staphylococcus spp.

In a significant proportion of cases, these pathogens of nosocomial pneumonia are characterized by the presence of resistance to antibiotics of different classes.

Risk factors for detection in nosocomial pneumonia of multidrug resistance are the following factors:

Use of antibiotics in the previous 90 days;

Nosocomial pneumonia that developed 5 days later or later from the moment of hospitalization;

High prevalence of resistance of the main pathogens in the hospital;

Acute respiratory distress syndrome;

Chronic hemodialysis;

The presence of a family member with a disease caused by a multidrug-resistant pathogen.

Among nosocomial pneumonias, a special place is occupied by ventilator-associated pneumonia (VAP), that is, pulmonary inflammation that develops in people who are on artificial lung ventilation (ALV). Most important factors to predict the probable etiology of VAP are previous antibiotic therapy and the duration of mechanical ventilation. So, in patients with early VAP (i.e. pneumonia that developed during mechanical ventilation for 5-7 days) who did not receive antibiotics, the leading etiological agents are:

S. pneumoniae;

Enterobacteriaceae spp. (including Klebsiella pneumoniae),

H. influenzae;

In the etiology of "late" VAP, the leading role is played by:

Pseudomonas aeruginosa,

Enterobacteriaceae;

Acinetobacter spp:,

Staphylococcus aureus.

Almost all pathogens of "late" VAP have a pronounced drug resistance to antibiotics, since such pneumonia, as a rule, occurs against the background of long-term antibiotic therapy or prophylaxis.

In total, up to 30-100 pneumonias occur per 1000 patients during mechanical ventilation. Each day of a patient's stay in the intensive care unit or intensive care unit during ventilation assistance increases the risk of developing pneumonia by 1-3%.

The complexity of the problem is reflected in the classification of pneumonia, when one of the leading pathogenetic mechanisms - aspiration, which is considered in both hospital and community-acquired pneumonia, is placed in the name of a separate heading "aspiration pneumonia". A special place is occupied by the most severe variant of this pneumonia - Mendelssohn's syndrome.

The etiology of aspiration pneumonia (both community-acquired and hospital-acquired) is characterized by the participation of anaerobes in a "pure form" or in combination with aerobic gram-negative flora. These microorganisms often cause severe and early destruction of lung tissue in the form of abscess pneumonia or gangrene of the lungs.

Aspiration pneumonia

Aspiration pneumonias (AP) are commonly referred to as pneumonias in patients after a documented episode of massive aspiration or in patients with risk factors for the development of aspiration.

For the development of AP, two conditions must be present:

Violation of local respiratory protection factors in the form of pharyngeal closure, cough reflex, active mucociliary clearance, etc .;

The pathological nature of the aspiration material is high acidity, a large number of microorganisms, a large volume of material, etc.

The main risk factors for the development of aspiration pneumonia according to N.A. Cassire and M.S. Niederman (1998):

Patient related risk factors

- Impaired consciousness

- Severe underlying diseases

- Stroke

– Epilepsy

— Alcoholism

- Dysphagia

– Gastroesophageal reflux

- Condition after gastrectomy

- Enteral feeding tube

- Diseases of the teeth and gums

Risk factors associated with the properties of the aspirated material

– material pH below 2.5

— Large particles in the aspirate

— Large volume of aspirate (more than 25 ml)

— Hypertonic nature of the aspirate

– High bacterial contamination

AP can also develop as community-acquired pneumonia, but, apparently, it occurs more often as nosocomial pneumonia.

AP occupies a fairly large proportion among all forms of pneumonia - about 25% of severe forms of pneumonia in intensive care units are accounted for by it.

AP is caused by microorganisms that normally colonize the upper respiratory tract, that is, low-virulence bacteria, in most cases anaerobes, and can be considered as a pleuropulmonary infection that goes through the following stages of development: pneumonitis, necrotizing pneumonia, lung abscess, pleural empyema.

The distribution of aspirated material, therefore, the localization of infectious foci in the lungs depends on the position of the patient's body at the time of aspiration. Most often, AP develops in the posterior segments of the upper lobes and the upper segments of the lower lobes if aspiration occurred while the patient was in a horizontal position, and in the lower lobes (more often on the right) if the patient was in a vertical position.

The disease develops gradually without a clearly defined acute onset. Many patients develop an abscess or empyema 8 to 14 days after aspiration.

When foci of destruction appear in about half of the patients, sputum production with a fetid putrefactive odor is noted, and hemoptysis may develop.

At the same time, the absence of a putrid odor during the formation of an abscess does not exclude the role of anaerobic microorganisms in the occurrence of AP, since many anaerobes do not lead to the formation of metabolic products with a putrid odor.

Other symptoms that are quite characteristic of pneumonia are cough, shortness of breath, pleural pain, leukocytosis.

However, in many patients their development is preceded by several days and sometimes weeks of less pronounced clinical signs: weakness, subfebrile temperature, cough, in some patients - weight loss and anemia.

With AP caused by anaerobes, chills are almost never observed in patients.

So the characteristic clinical features are:

gradual onset;

Documented aspiration or factors predisposing to the development of aspiration;

Fetid odor of sputum, pleural fluid;

Localization of pneumonia in dependent segments;

Necrotizing pneumonia, abscess, empyema;

The presence of gas above the exudate in the pleural cavity (pyopneumothorax);

Lack of growth of microorganisms under aerobic conditions.

Prevention

Do not smoke.

People at high risk of developing pneumonia should be vaccinated against pneumococcal pneumonia. The risk group includes people over the age of 65, with heart, lung or kidney disease, diabetes or a weak immune system, and alcoholics. The vaccine is required only once; it provides long-term protection and is 60-80 percent more effective in those whose immune systems function normally.

Treatment

Antibiotics are prescribed to treat a bacterial infection; they must be taken within the prescribed period. Interruption of treatment may cause a recurrence of the disease.

Antifungals, such as amphotericin B, are prescribed to treat a fungal infection.

Antiviral drugs such as neuraminidase inhibitors, ribavirin, acyclovir, and ganciclovir sodium may be effective against some types of viral infection.

Take over-the-counter cough medicines containing dextromethorphan if you have a persistent dry cough. However, if you are coughing up phlegm, suppressing the cough completely can cause mucus to accumulate in your lungs and lead to serious complications.

Your doctor can instruct you on how to clear mucus from your lungs by assuming various postures with your head lower than your torso.

Patients who do not have heart or kidney failure should drink at least eight glasses of water a day to reduce lung secretions and make them easier to remove.

Bed rest until fever subsides.

Oxygen can be given through a mask to make breathing easier. In severe cases, a respirator may be required.

Excess fluid in the space around the lungs can be removed with a syringe and a needle inserted through the chest wall.

Call your doctor if you have symptoms of pneumonia, especially fever above 38°C, shortness of breath when lying down, or bloody sputum when you cough.

. Attention! Call " ambulance” if you have trouble breathing or have a blue tint on your lips, nose, or nails.

The incidence of pneumonia in children of the first year of life is 15-20 per 1000 children, older than 3 years 5-6 per 1000, in adults 10-13 per 1000 of the adult population. The high frequency of pneumonia in young children is associated with the anatomical and physiological characteristics of the respiratory system.

Anatomy and physiology of the lungs

Pneumonia is a very serious disease, and in order to better understand what happens in the lungs and in the body as a whole, let's turn to the anatomy and physiology of the lungs.

The lungs are in the chest cavity. Each lung is divided into parts (segments), the right lung consists of three segments, the left lung of two, as it is adjacent to the heart, therefore the volume of the left lung is less than that of the right by about 10%.

The lung consists of the bronchial tree and alveoli. The bronchial tree, in turn, consists of the bronchi. Bronchi are of various sizes (caliber). The branching of the bronchi from a large caliber to smaller bronchi, up to the terminal bronchioles, is the so-called bronchial tree. It serves to conduct air during inhalation and exhalation.

Bronchioles decrease in diameter, pass into respiratory bronchioles and eventually end in alveolar sacs. The walls of the alveoli are very well supplied with blood, which allows gas exchange.

The alveoli are covered from the inside with a special substance (surfactant). It serves to protect against microbes, prevents the collapse of the lung, is involved in the removal of microbes and microscopic dust.

Features of the respiratory system in young children

1. The larynx, trachea and bronchi in infants are narrow. This leads to the retention of sputum in the respiratory tract and the multiplication of microorganisms in them.

2. In newborns, the horizontal position of the ribs and the intercostal muscles are underdeveloped. Children at this age are in a horizontal position for a long time, which leads to stagnation of blood circulation.

3. Imperfect nervous regulation of the respiratory muscles, which leads to respiratory failure.

The main forms of pneumonia

Also, depending on the involvement of the lungs, one-sided (when one lung is inflamed) and two-sided (when both lungs are involved in the process) are distinguished.

Causes of pneumonia

Pneumonia is an infectious disease caused by various microorganisms.

According to many scientists, in 50% of all patients with pneumonia, the cause remains unknown.

The causative agents of pneumonia in early childhood are most often staphylococcus aureus, mycoplasma, microviruses, adenoviruses.

The most dangerous is a mixed viral-microbial infection. Viruses infect the respiratory mucosa and open access to the microbial flora, which aggravates the manifestations of pneumonia.
I would like to note other causes of pneumonia

Risk factorsto develop pneumoniaamong adults:

1. Constant stress that exhausts the body. 2. Malnutrition. Insufficient consumption of fruits, vegetables, fresh fish, lean meats. 3. Weakened immunity. It leads to a decrease in the barrier functions of the body. 4. Frequent colds leading to the formation of a chronic focus of infection. 5. Smoking. When smoking, the walls of the bronchi and alveoli are covered with various harmful substances, preventing the surfactant and other structures of the lung from working normally. 6. Abuse of alcoholic beverages. 7. Chronic diseases. Especially pyelonephritis, heart failure, coronary heart disease.

Symptoms of pneumonia (manifestations)

Symptoms of pneumonia consist of "lung complaints", symptoms of intoxication, signs of respiratory failure.

The onset of the disease can be either gradual or sudden.

Signs of intoxication.
1. An increase in body temperature from 37.5 to 39.5 degrees Celsius.
2. Headache of varying intensity.
3. Deterioration of well-being in the form of lethargy or anxiety, decreased interest in the environment, sleep disturbances, night sweats.

From " pulmonary symptoms» Cough may be noted. His character is dry at the beginning, and after a while (3-4 days) becomes wet with copious sputum. Usually the sputum is rusty in color due to the presence of red blood cells in it.

In children, cough with rusty sputum occurs mainly at an older age. Cough occurs as a result of inflammation of the bronchial and tracheal mucosa under the action of inflammatory mediators, or mechanical (phlegm) irritation.
Edema interferes normal operation lung and therefore, with the help of coughing, the body tries to clear it. When the cough lasts 3-4 days, there is a persistent increase in pressure in all structures of the lung, so red blood cells pass from the vessels into the lumen of the bronchi, forming, together with mucus, rusty sputum.

In addition to coughing, chest pain appears on the side of the damaged lung. The pain usually worsens with inspiration.

To signs of pulmonary insufficiency includes such symptoms as: shortness of breath, cyanosis (blue) of the skin, especially the nasolabial triangle.
Shortness of breath appears more often with extensive pneumonia (bilateral), breathing is especially difficult. This symptom appears due to the shutdown of the affected part of the lung from the function, which leads to insufficient saturation of the tissues with oxygen. The larger the focus of inflammation, the stronger the shortness of breath.

Rapid breathing, for example, in children older than a year (more than 40 per minute) is one of the main signs of pneumonia. The blueness of the nasolabial triangle is especially noticeable in young children (during breastfeeding), but adults are no exception. The cause of cyanosis is again a lack of oxygen.

Course of pneumonia: the duration of the disease depends on the effectiveness of the prescribed treatment and the reactivity of the organism. Before the advent of antibiotics, the high temperature dropped by 7-9 days.

When treated with antibiotics, the drop in temperature can be early dates. Gradually, the patient's condition improves, the cough becomes wetter.
If the infection is mixed (viral-microbial), the disease is accompanied by damage to the cardiovascular system, liver, kidneys.

Diagnosis of pneumonia

If you suspect that you have pneumonia, you should definitely consult a doctor (physician or pediatrician).Without medical examination it is impossible to make a diagnosis of pneumonia.

What is waiting for you at the doctor?

1.	Conversation with a doctor	At the appointment, the doctor will ask you about complaints and various factors that could cause the disease.
2.	Chest examination	To do this, you will be asked to undress to the waist. The doctor will examine the chest, especially the uniformity of its participation in breathing. In pneumonia, the affected side often lags behind the healthy side when breathing.
3.	tapping lungs	Percussion necessary for the diagnosis of pneumonia and the localization of the affected areas. With percussion, finger tapping of the chest is performed in the projection of the lung. Normally, when tapping, the sound is voiced like a box-shaped one (due to the presence of air); in case of pneumonia, the sound is dulled and shortened, since instead of air, a pathological fluid called exudate accumulates in the lung.
4.	Listening to the lungs	Auscultation(listening to the lung) is performed using a special device called a stethophonedoscope. This simple device consists of a system of plastic tubes and a membrane that amplifies the sound. Normally, a clear lung sound is heard, that is, the sound of normal breathing. If there is an inflammatory process in the lungs, then exudate interferes with breathing and the sound of labored, weakened breathing and various kinds of wheezing appears.
5.	Laboratory research	General blood analysis: where there will be an increase in the number of leukocytes - cells responsible for the presence of inflammation, and an increased ESR is the same as an indicator of inflammation. General urine analysis: carried out to exclude an infectious process at the level of the kidneys. Sputum analysis during coughing: to determine which microbe caused the disease, as well as adjust the treatment.
6.	Instrumental Research	X-ray examination In order to understand in which area of ​​the lung the inflammation focus is located, what size it is, as well as the presence or absence of possible complications (abscess). On the x-ray, the doctor sees a bright spot against the background of the dark color of the lungs, called enlightenment in radiology. This enlightenment is the focus of inflammation. Bronchoscopy Bronchoscopy is also sometimes performed - this is an examination of the bronchi using a flexible tube with a camera and a light source at the end. This tube is passed through the nose into the lumen of the bronchi to examine the contents. This study is done with complicated forms of pneumonia.

There are diseases similar in symptoms to pneumonia. These are diseases such as acute bronchitis, pleurisy, tuberculosis, and in order to correctly diagnose and then cure, the doctor prescribes a chest x-ray for all patients with suspected pneumonia.

In children, radiological changes characteristic of pneumonia may develop before the onset of symptoms of pneumonia (wheezing, decreased breathing). In children with damage to the lower lobe of the lung, it is necessary to differentiate pneumonia even with appendicitis (children complain of pain in the abdomen).

picture of pneumonia

Effective treatmentpneumonia

Hygiene, regimen and nutrition for pneumonia

1. Bed rest is recommended during the entire acute period.
Children of the first months of life are laid in a half-turn position to prevent choking with vomit. Swaddling of the chest is not allowed. When shortness of breath should be provided correct position baby in bed with a raised upper torso.
When the child's condition improves, you should change the position of the child in bed more often and take him in your arms.

2. Balanced diet: increase in fluid intake 1.5-2.0 liters per day, preferably warm. You can use fruit drinks, juices, tea with lemon. Do not eat fatty foods (pork, goose, duck), confectionery (cakes, pastries). Sweet enhances inflammatory and allergic processes.

3. Clearing the respiratory tract of phlegm by expectoration.
In children under one year old, the airways are cleansed of mucus and sputum at home by the mother (the oral cavity is cleaned with a napkin). The department produces suction of mucus and sputum with an electric suction from the oral cavity and nasopharynx.

4. Regular ventilation and wet cleaning in the room when there is no patient in the room.
When the air temperature outside is more than 20 degrees in the room, the window should always be open. At a lower temperature outside, the room is ventilated at least 4 times a day, so that in 20-30 minutes the temperature in the room drops by 2 degrees.
In winter, in order to avoid rapid cooling of the room, the window is covered with gauze.

What medicines are used for pneumonia?

The main type of treatment for pneumonia is medication. It is designed to fight infection.
In the acute period of pneumonia, this is antibiotic treatment.

Broad-spectrum antibiotics are more commonly used. The choice of a group of antibiotics and the route of their administration (by mouth, intramuscularly, intravenously) depends on the severity of pneumonia.

In a mild form of pneumonia, as a rule, antibiotics are used in tablet form and in the form of intramuscular injections. Such drugs are used as: Amoxicillin 1.0-3.0 grams per day in 3 divided doses (orally), cefotaxime 1-2 grams every 6 hours intramuscularly.

Treatment of pneumonia in mild form possible at home, but under the obligatory supervision of a doctor.

Severe forms of pneumonia are treated in the hospital in the pulmonology department. Antibiotics in the hospital are administered either intramuscularly or intravenously.

The duration of antibiotic use should be at least 7 days (at the discretion of the attending physician)
The frequency of administration and dosage are also selected individually. As an example, we give standard schemes for the use of drugs.

Cefazolin 0.5-1.0 grams intravenously 3-4 times a day.

Cefepime 0.5-1.0 grams intravenously 2 times a day.

On the 3-4th day of taking antibiotics (or simultaneously with the start of taking antibacterial drugs), an antifungal drug (fluconazole 150 milligrams 1 tablet) is prescribed to prevent a fungal infection.

The antibiotic destroys not only the pathogenic (disease-causing) flora, but also the natural (protective) flora of the body. Therefore, a fungal infection, or intestinal dysbacteriosis, may occur. Therefore, the manifestation of intestinal dysbacteriosis can manifest itself liquid stool, bloating. This condition is treated with drugs such as bifiform, subtil after the end of the course of antibiotics.

When using antibiotics, it is also necessary to take vitamins C and group B in therapeutic doses. Expectorant and sputum thinning drugs are also prescribed.

When the temperature is normalized, physiotherapy (UHF) is prescribed to improve the resorption of the focus of inflammation. After the end of UHF, 10-15 sessions of electrophoresis with potassium iodide, platifilin, lidase are carried out.

Phytotherapy for pneumonia

Herbal treatment is used in the acute period. They use preparations with an expectorant effect (elecampane root, licorice root, sage, coltsfoot, thyme, wild rosemary) and anti-inflammatory action ( icelandic moss, birch leaves, St. John's wort).

These plants are mixed in equal parts, rubbed and 1 tablespoon of the collection is poured with 1 glass of boiling water, simmered for 10-20 minutes (boiling bath), insisted for 1 hour, drink 1 tablespoon 4-5 times a day.

Physiotherapy an obligatory part of the treatment of patients with acute pneumonia. After normalization of body temperature, short-wave diathermy, UHF electric field can be prescribed. After the end of the UHF course, 10-15 sessions of electrophoresis with potassium iodine and lidase are carried out.

Adequate treatment of pneumonia is possible only under the supervision of the attending physician!

Therapeutic exercise for pneumonia

Usually, chest massage and gymnastics begin immediately after the temperature returns to normal. The tasks of exercise therapy for pneumonia are:

1. Strengthening the general condition of the patient
2. Improvement of lymph and blood circulation
3. Prevention of the formation of pleural adhesions
4. Strengthening the heart muscle

In the initial position, lying 2-3 times a day, breathing exercises are performed with the simplest movements of the limbs. Then they include slow turns of the torso and inclinations of the torso. The duration of classes is no more than 12-15 minutes.

For children preschool age gymnastics is used partly according to the game method. For example, walking in various ways. Using the story "a walk in the forest" - a hunter, a bunny, a clubfoot bear. Breathing exercises (porridge boils, woodcutter, the ball burst). Drainage exercises - from a position, standing on all fours and lying on its side (the cat is angry and kind). Exercises for the muscles of the chest (mill, wings). Ends with walking with a gradual deceleration.

To finally convince you that treatment should be carried out under the supervision of a doctor, I will give several possible complications pneumonia.

Abscess (accumulation of pus in the lung), which, by the way, is treated with surgery.

Pulmonary edema - which, if not dealt with in time, can lead to death.

Sepsis (the entry of microbes into the blood) and, accordingly, the spread of infection throughout the body.

Prevention of pneumonia

The most the best prevention is leading a rational lifestyle:

• Proper nutrition (fruits, vegetables, juices), outdoor walks, avoiding stress.
• In winter and spring, to avoid a decrease in immunity, you can take a multivitamin complex, for example, Vitrum.
• To give up smoking .
• Treatment of chronic diseases, moderate alcohol consumption.
• For children, it is important to exclude passive smoking, consult an otolaryngologist if the child is often sick colds, timely treatment of rickets , anemia .

Here are some recommendations with breathing exercises, useful for people who often suffer from colds. This breathing exercise should be done every day. It helps not only to improve oxygenation (saturation of cells with oxygen) of tissues, but also has a relaxing and sedative effect. Especially when during the exercise you think only about the good.

Yoga breathing exercises for the prevention of diseases of the respiratory system

1. Stand up straight. Stretch your arms forward. Take a deep breath and hold your arms to the sides and forward several times. Lower your hands, exhale vigorously with an open mouth.

2. Stand up straight. Hands forward. Inhale: at exposure, wave your arms like a windmill. Energetic exhalation with an open mouth.

3. Stand up straight. Grab your shoulders with your fingertips. While holding the breath, connect the elbows on the chest and spread widely several times. Exhale forcefully with your mouth wide open.

4. Stand up straight. Inhale in three vigorous gradual breaths - steps. In the first third, stretch your arms forward, in the second to the sides, at shoulder level, in the third, up. Exhale forcefully, opening your mouth wide.

5. Stand up straight. Inhale as you rise up on your toes. Hold your breath while standing on your toes. Slowly exhale through the nose, lowering onto the heels.

6. Stand up straight. On an inhale, rise up on your toes. Exhaling, sit down. Then get up.

How does pneumonia manifest itself in children?

Pneumonia in children manifests itself in different ways, depending on the area of ​​the inflammatory process and the infectious agent ( microorganism that causes inflammation).
Usually the development of pneumonia occurs against the background of acute respiratory infections such as bronchitis inflammation of the bronchial mucosa), laryngotracheitis ( inflammation of the mucous membrane of the larynx and trachea), angina . In this case, the symptoms of pneumonia are superimposed on the picture of the primary disease.

In most cases, pneumonia in children manifests itself in the form of three main syndromes.

The main syndromes of pneumonia in children are:

• general intoxication syndrome;
• syndrome specific inflammation lung tissue;
• respiratory distress syndrome.

General intoxication syndrome
Inflammation of the lung tissue in a small area rarely causes severe symptoms of intoxication syndrome. However, when several segments of the lungs or whole lobes are involved in the process, signs of intoxication come to the fore.
Young children who cannot express their complaints become capricious or lethargic.

Signs of a general intoxication syndrome are:

• increased body temperature;
• rapid pulse ( more than 110 - 120 beats per minute for preschool children, more than 90 beats per minute for children over 7 years old);
• fatigue;
• fast fatiguability;
• drowsiness;
• pallor of the skin;
• decreased appetite up to refusal to eat;
• rarely sweating ;
• rarely vomiting.

With the defeat of small areas of the lungs, the body temperature is kept within 37 - 37.5 degrees. When the inflammatory process covers several segments or a lobe of the lung, the body temperature rises sharply to 38.5 - 39.5 degrees or more. At the same time, it is difficult to knock down antipyretic drugs and quickly rises again. Fever may persist will remain) 3-4 days or more without adequate treatment.

Syndrome of specific inflammation of the lung tissue
The most characteristic signs of pneumonia in children are signs indicating organic lung damage, infection and inflammation.

Signs of specific inflammation of the lung tissue in pneumonia are:

• cough;
• pain syndrome;
• auscultatory changes;
• radiological signs;
• abnormalities in the hemoleukogram ( general blood test).

A feature of cough in pneumonia in children is its constant presence, regardless of the time of day. The cough is paroxysmal in nature. Any attempt to take a deep breath leads to another attack. Cough is constantly accompanied by phlegm. In preschool children, parents may not notice phlegm when they cough because children often swallow it. In children aged 7-8 years and older, there is a discharge of mucopurulent sputum in varying amounts. The shade of sputum with pneumonia is reddish or rusty.

Pneumonia in children usually resolves without pain. Pain in the form of aching pain in the abdomen may appear when the lower segments of the lungs are affected.
When the inflammatory process from the lungs passes to the pleura ( the lining of the lungs), children complain of chest pains when breathing. The pain is especially aggravated when trying to take a deep breath and when coughing.

On radiographs with pneumonia in children, darker areas of the lung tissue are noted, which correspond to the affected areas of the lungs. Plots can cover several segments or entire shares. In the general blood test for pneumonia, an increased level of leukocytes due to neutrophils is observed ( leukocytes with granules) and an increase in ESR ( erythrocyte sedimentation rate).

Respiratory failure syndrome
As a result of damage to the lung tissue in pneumonia, the area of ​​\u200b\u200bthe "breathing" surface of the lungs decreases. As a result, children develop respiratory failure syndrome. The smaller the child, the faster he develops respiratory failure. The severity of this syndrome is also affected by comorbidities. So, if the child is weak and often sick, then the symptoms of respiratory failure will increase rapidly.

Signs of respiratory failure in pneumonia are:

• dyspnea;
• tachypnea ( increase in breathing);
• difficult breathing;
• mobility of the wings of the nose during breathing;
• cyanosis ( bluish coloration) of the nasolabial triangle.

From the first days of the disease, pneumonia in children is characterized by the appearance of shortness of breath both against the background of elevated body temperature and with subfebrile condition ( long-term retention of temperature in the region of 37 - 37.5 degrees). Shortness of breath can be observed even at rest. Tachypnea or rapid shallow breathing is a mandatory symptom of pneumonia in children. At the same time, there is an increase in respiratory movements at rest up to 40 or more. Respiratory movements become superficial and incomplete. As a result, a much smaller amount of oxygen penetrates the body, which, in turn, leads to disruption of gas exchange in tissues.

With pneumonia in children, difficult, irregular breathing is noted. Attempts to take a deep breath are accompanied by great efforts involving all chest muscle groups. During breathing in children, you can see the retraction of the skin in the hypochondrium or supraclavicular region, as well as in the spaces between the ribs.
During inhalation, the wings of the nose move. The child seems to be trying to inhale more air by inflating the wings of the nose. This is another hallmark that indicates respiratory failure.

What are the features of pneumonia in newborns?

Pneumonia in newborns is characterized by a number of features. First of all, this is a very rapidly growing symptomatology. If in adults in the clinic of the disease it is possible to conditionally distinguish stages, then pneumonia of newborns is characterized by an almost fulminant course. The disease progresses by leaps and bounds, respiratory failure is rapidly increasing.

Another feature of pneumonia in newborns is the predominance of symptoms of general intoxication. So, if in adults pneumonia is more manifested by pulmonary symptoms ( cough, shortness of breath), then newborns are dominated by intoxication syndrome ( refusal to feed, convulsions, vomiting).

Pneumonia in newborns may have the following manifestations:

• refusal to breastfeed;
• frequent regurgitation and vomiting;
• shortness of breath or groaning breath;
• convulsions;
• loss of consciousness.

The first thing the mother pays attention to is that the child refuses to eat. He whimpers, restless, throws up his chest. In this case, a high temperature may not be observed, which will make it difficult to diagnose the disease. A slight increase in temperature or its decrease, as a rule, is observed in premature babies. High temperature is typical for children born in normal terms.

Newborns immediately show signs of respiratory failure. In this condition, an insufficient amount of oxygen enters the child's body, and the tissues of the body begin to experience oxygen starvation. Therefore, the skin of the child becomes bluish. The skin of the face begins to turn blue first. Breathing becomes shallow, intermittent and frequent. The frequency of respiratory excursions reaches 80 - 100 per minute at a rate of 40 - 60 per minute. At the same time, the children seem to groan. The rhythm of breathing is also interrupted, and foamy saliva often appears on the lips of children. Against the background of temperature, convulsions occur in more than half of the cases. The so-called febrile convulsions occur at high temperatures and are clonic or tonic in nature. The consciousness of children at such moments is rarely preserved. Often it is confused, while the children are sleepy and lethargic.

Another difference between pneumonia in newborns is the presence of so-called intrauterine pneumonia. Intrauterine pneumonia is the one that developed in a child when he was still in the womb. The reason for this may be various infections that a woman suffered during pregnancy. Also intrauterine pneumonia is typical for premature babies. This pneumonia appears immediately after the birth of the child and is characterized by a number of symptoms.

Intrauterine pneumonia in a newborn baby may have the following features:

• the first cry of the child is weak or completely absent;
• the skin of the baby is bluish;
• breathing is noisy, with multiple moist rales;
• decrease in all reflexes, the child reacts poorly to stimuli;
• the child does not take the breast;
• possible swelling of the extremities.

Also, this type of pneumonia can develop when the child passes through the birth canal, that is, during the birth itself. This happens due to aspiration of amniotic fluid.

Intrauterine pneumonia in newborns is most often caused by bacterial flora. These can be peptostreptococci, bacteroids, E. coli, but most often they are group B streptococci. In children after six months, pneumonia develops against a background of a viral infection. So, first a viral infection develops ( like the flu), to which bacteria subsequently attach.

The most common causative agents of pneumonia in children of the first year of life

For children of the first month of life ( i.e. for newborns) is characterized by the development of small-focal pneumonia or bronchopneumonia. On x-ray, such pneumonia looks like small foci, which can be within one lung or two. Unilateral small-focal pneumonia is typical for full-term children and is characterized by a relatively benign course. Bilateral bronchopneumonia is characterized by a malignant course and is mainly found in prematurely born children.

For newborns, the following forms of pneumonia are characteristic:

• small focal pneumonia- on x-ray images, small areas of darkening ( looks white on film.);
• segmental pneumonia- the focus of inflammation occupies one or more segments of the lung;
• interstitial pneumonia- not the alveoli themselves are affected, but the interstitial tissue between them.

What temperature can be with pneumonia?

Given that pneumonia is acute inflammation lung tissue, then it is characterized by an increase in temperature. Elevated temperature (above 36.6 degrees) - is a manifestation of the syndrome of general intoxication. The cause of high temperature is the action of antipyretic substances ( pyrogens). These substances are synthesized either by pathogenic bacteria or by the body itself.

The nature of the temperature depends on the form of pneumonia, on the degree of reactivity of the body and, of course, on the age of the patient.

Type of pneumonia	The nature of the temperature
Croupous pneumonia	39 - 40 degrees, accompanied by chills, wet sweat. Lasts 7-10 days.
Segmental pneumonia	39 degrees if pneumonia is caused by bacterial flora; 38 degrees if pneumonia is of viral origin.
Interstitial pneumonia	within the normal range ( i.e. 36.6 degrees) - in patients older than 50 years, as well as in cases where pneumonia develops against the background of systemic diseases; 37.5 - 38 degrees, with acute interstitial pneumonia in middle-aged people; above 38 degrees - in newborns.
Pneumonia of viral origin	37 - 38 degrees, and when the bacterial flora is attached, it rises above 38.
Pneumonia in HIV -infected people	37 - 37.2 degrees. The so-called low-grade fever can last throughout the entire period of illness, only in rare cases does the temperature become febrile ( over 37.5 degrees).
hospital pneumonia (one that develops within 48 hours of hospitalization)	38 - 39.5 degrees, does not respond well to taking antipyretics, lasts more than a week.
Pneumonia in people with diabetes mellitus.	37 - 37.5 degrees, with severe decompensated forms of diabetes; above 37.5 degrees - with pneumonia caused by Staphylococcus aureus and microbial associations.
Intrauterine pneumonia of premature babies	less than 36 degrees with a pronounced lack of mass; 36 - 36.6 degrees with pneumocystis pneumonia; in other forms of pneumonia, the temperature is either within the normal range or reduced.
Early neonatal pneumonia (those that develop during the first weeks of life)	35 - 36 degrees, accompanied by respiratory disorders ( respiratory arrest).

Temperature is a mirror of the human immune system. The weaker a person's immunity, the more atypical his temperature. The nature of the temperature is affected by concomitant diseases, as well as medication. It happens that with viral pneumonia, a person begins to take antibiotics on his own. Because the antibacterial drugs ineffective in this case, the temperature continues to hold for a long time.

How does pneumonia caused by Klebsiella proceed?

Pneumonia caused by Klebsiella is much more severe than other types of bacterial pneumonia. Its symptoms are similar to those of pneumonia caused by pneumococci, however, it is more pronounced.

The main syndromes that dominate the clinical picture of pneumonia caused by Klebsiella are intoxication syndrome and lung tissue damage syndrome.

Intoxication syndrome
One of the important features of Klebsiella pneumonia is an acute, sudden onset due to the action of microbial toxins on the human body.

The main manifestations of intoxication syndrome are:

• temperature;
• chills;
• general weakness;
• increased sweating;
• dizziness;
• headache;
• delirium;
• prostration.

In the first 24 hours, the patient has a body temperature of 37.5 - 38 degrees. At the same time, the first signs of the disease appear - chills, general fatigue and malaise. As Klebsiella toxins accumulate in the body, the fever rises to 39 - 39.5 degrees. The general condition is deteriorating sharply. Appear single vomiting and diarrhea. Hyperthermia ( heat) negatively affects the functioning of the brain. Headache is replaced by prostration and delirium, appetite decreases. Some patients experience hallucinations.

Lung Tissue Syndrome
Klebsiella are quite aggressive towards lung tissue, causing destruction ( destruction) lung parenchyma. For this reason, the course of Klebsiella pneumonia is especially severe.

Symptoms of lung tissue damage in pneumonia caused by Klebsiella are:

• cough;
• sputum;
• pain syndrome;
• dyspnea;
• cyanosis ( bluish coloration).

Cough
In the initial stages of the disease, patients complain of a constant dry cough. After 2-3 days, against the background of high temperature, a persistent productive cough appears. Due to the high viscosity, sputum is difficult to separate, and the cough becomes excruciatingly painful.

Sputum
Sputum with Klebsiella pneumonia contains particles of destroyed lung tissue, so it has a reddish color. It can be compared with currant jelly. Sometimes there are streaks of blood in the sputum. Also, sputum has a sharp specific smell, reminiscent of burnt meat. On the 5th - 6th day from the onset of the disease, bloody sputum is released in large quantities.

Pain syndrome
First, there are constant pains in the throat and in the retrosternal region due to a persistent cough. Secondly, there are pleural pains. The inflammatory process from the lungs quickly spreads to the pleural sheets ( membranes of the lungs), which have a large number of nerve endings. Any irritation of the pleura causes severe pain in the chest area, especially in the lower sections. The pain is aggravated by coughing, walking, bending over.

Dyspnea
Due to the destruction of lung tissue by Klebsiella, the area of ​​\u200b\u200bthe alveoli involved in the breathing process decreases. For this reason, shortness of breath appears. With the defeat of several lobes of the lungs, shortness of breath becomes pronounced even at rest.

Cyanosis
Severe respiratory failure leads to the appearance of a cyanotic color of the nasolabial triangle ( area covering the nose and lips). This is especially pronounced on the lips and tongue. The rest of the face becomes paler with a grayish tint. There is also a bluish discoloration of the skin under the nails.

In a particularly severe course of Klebsiella pneumonia with a pronounced intoxication syndrome, other organs and systems are often affected. With untimely treatment in 30 - 35 percent of cases, the disease ends in death.

What are the features of the course of croupous pneumonia?

Due to the particular severity of the course of croupous pneumonia and the peculiarities of its development, this form is usually considered as a separate disease. In lobar pneumonia, an entire lobe of the lung is affected, and in extreme cases, several lobes. The causative agent is pneumococcus. Pneumococcus is particularly pathogenic, which is why the pneumonia caused by it is extremely difficult.

The main features of the course of croupous pneumonia

Main characteristics	Croupous pneumonia
The debut of the disease	The onset of the disease begins with chills and a sharp rise in temperature to 39 degrees. Croupous pneumonia has the sharpest onset of the disease. Gradual development is excluded.
Main symptoms	Cough accompanied by stabbing pain in the chest. The first two days it is dry. The fever lasts 7-11 days. Sputum appears on the 3rd day. The sputum contains streaks of blood, due to which it acquires a rusty tint ( "rusty phlegm" is specific symptom lobar pneumonia). Frequent, shallow and labored breathing. Pain in the chest, especially when breathing. The development of pain syndrome is due to damage to the pleura ( croupous pneumonia always occurs with damage to the pleura). If pneumonia affects the lower segments of the lungs, then the pain is localized in different segments abdominal cavity. This often mimics a picture of acute appendicitis, pancreatitis, biliary colic.
Changes in the internal organs	Most often, the nervous system, liver, heart suffer. The gas composition of the blood is disturbed - hypoxemia and hypocapnia develop. Dystrophic change in the liver - it increases, becomes painful, and bilirubin appears in the blood. The skin and sclera become icteric. Frequent dystrophic changes in the heart muscle.
Disease staging	The pathological process of croupous pneumonia takes place in several stages: high tide- the lung tissue is filled with blood, stagnation of blood in the capillaries is noted. Lasts the first 2-3 days. Red hepatization stage The alveoli of the lungs are filled with effusion. From the bloodstream, erythrocytes and fibrin penetrate into the lungs, which makes the lung tissue dense. In fact, this section of the lungs ( where effusion accumulates) becomes non-functional, as it ceases to take part in gas exchange. Lasts from 4 to 7 days. Gray hepatization stage- leukocytes join the effusion, which give the lung a gray tint. It lasts from the 8th to the 14th day. Resolution stage- effusion begins to leave the lungs. Lasts several weeks.
Changes in the blood, urine, in cardiac activity	In the general blood test, leukocytosis 20 x 10 9 is noted, a decrease in the number of eosinophils and an increase in neutrophils, an erythrocyte sedimentation rate ( COE) rises to 30 - 40 mm per hour or more. A biochemical blood test reveals an increase in the level of residual nitrogen. Pulse 120 beats per minute or more, signs of ischemia on the cardiogram, lowering blood pressure. In the urine protein, erythrocytes. All these changes are due to the high toxicity of pneumococcus and its destructive effect on body tissues.

It should be noted that classic croupous pneumonia is becoming less common these days.

What is the difference between viral pneumonia and bacterial pneumonia?

Viral pneumonia has a number of features that distinguish it from bacterial pneumonia. However, often viral pneumonia is complicated by a bacterial infection. In such cases, diagnosis becomes difficult. "Pure" viral pneumonia in more than 85 percent of cases is observed in children. In adults, pneumonia of a mixed type is most often diagnosed - viral-bacterial.

Differences between viral and bacterial pneumonia

Criterion	Viral pneumonia	bacterial pneumonia
contagiousness (infectiousness)	It is contagious, like any acute respiratory viral disease ( ORZ).	In epidemiological terms, it is not considered contagious.
Incubation period	Short incubation period - from 2 to 5 days.	Long incubation period - from 3 days to 2 weeks.
Previous disease	Pneumonia always appears as a complication of an acute respiratory viral illness, most often as a result of influenza.	No previous illness is typical.
prodromal period	Lasts about 24 hours. Particularly pronounced. The main symptoms are : severe muscle pain; aches in the bones;	Virtually invisible.
The onset of the disease	A pronounced debut of the disease, in which the body temperature quickly rises to 39 - 39.5 degrees.	Usually begins gradually, with a temperature not exceeding 37.5 - 38 degrees.
Intoxication syndrome	Weakly expressed. Most frequent symptoms general intoxication syndrome are: fever; chills; muscle and headaches; general fatigue; dyspeptic disorders in the form of nausea, vomiting, diarrhea.	Expressed. The most common symptoms of intoxication syndrome are: heat; chills; headache; general weakness; loss of appetite; cardiopalmus ( over 90 beats per minute).
Signs of damage to the lung tissue	Symptoms of lung damage are mild at the onset of the disease. The symptoms of general malaise of the body come to the fore.	Pulmonary symptoms are expressed from the first days of the disease.
Cough	A moderate unproductive cough has been noted for a long time. Gradually, a small amount of mucous sputum begins to stand out. Sputum is clear or whitish in color, odorless. Sometimes streaks of blood appear in the sputum. If the sputum becomes purulent, then a bacterial infection has joined.	Dry cough quickly becomes wet. Initially, a small amount of mucous sputum is secreted. The volume of sputum increases, and it becomes mucopurulent. The color of sputum can be different - greenish, yellowish or rusty with an admixture of blood.
Signs of respiratory failure	In the advanced stages of the disease, acute respiratory failure appears with severe shortness of breath and cyanosis of the lips, nose and nails.	The main symptoms of respiratory failure are: severe shortness of breath, even at rest; cyanosis of the lips, nose and fingers; rapid breathing - more than 40 respiratory movements per minute.
Pain syndrome	Moderate chest pains are noted. The pain is aggravated by coughing and taking a deep breath.	In the chest appear pronounced pain when coughing and taking a deep breath.
auscultatory data (listening)	Throughout the disease, hard breathing with occasional single wheezing is heard.	Many wet rales of various sizes and intensity are heard. Inflammation of the pleura is heard in the form of crepitus.
X-ray data	There is a pattern of interstitial ( intercellular) pneumonia. The main characteristics of a viral pneumonia x-ray are: thickening of the interlobar septa, which gives the lung tissue the appearance of a honeycomb; moderate compaction and darkening of the tissue around the bronchi; increase in peribronchial nodes; emphasizing the vessels in the region of the roots of the lungs.	There are no highly specific signs of bacterial pneumonia. The main characteristics of an x-ray are: dark areas of the lung of various sizes ( focal or diffuse); the contours of the focus are blurred; light shading lung tissue ( decrease in airiness); determination of the level of fluid in the pleural cavity.
General blood analysis	There is a decrease in the number of leukocytes ( white blood cells). Sometimes there is lymphocytosis ( an increase in the number of lymphocytes) and/or monocytosis ( increase in the number of monocytes).	A pronounced leukocytosis and an increase in the erythrocyte sedimentation rate are detected ( ESR).
Response to antibiotic therapy	Negative reaction to antibiotics. Effective is antiviral therapy during the first days of illness.	A positive reaction to antibiotics is visible from the first days of treatment.

What is nosocomial pneumonia?

Intrahospital ( synonyms nosocomial or hospital) pneumonia - this is the pneumonia that develops within 48 - 72 hours ( 2 or 3 days) after the patient is admitted to the hospital. This type of pneumonia is singled out in a separate form, due to the peculiarities of development and extremely severe course.

The term "hospitalized" means that pneumonia is caused by bacteria living within the walls of hospitals. These bacteria are particularly resistant and have multiresistance ( resistant to several drugs at once). Also, nosocomial pneumonia in most cases is caused not by a single microbe, but by a microbial association ( multiple pathogens). Conditionally allocate early nosocomial pneumonia and late. Early pneumonia develops within the first 5 days from the moment of hospitalization. Late nosocomial pneumonia develops no earlier than the sixth day from the moment the patient enters the hospital.

Thus, the course of nosocomial pneumonia is complicated by the polymorphism of bacteria and their particular resistance to medications.

The most common causative agents of nosocomial pneumonia

Exciter name	Characteristic
Pseudomonas aeruginosa	It is the most aggressive source of infection, has polyresistance.
Enterobacteriaceae	It occurs very often, also quickly forms resistance. Often found in combination with P.aeruginosa.
Acinetobacter	As a rule, it is a source of infection along with other types of bacteria. It has a natural resistance to many antibacterial drugs.
S.Maltophilia	It is also naturally resistant to most antibiotics. At the same time, this type of bacteria is able to develop resistance to administered drugs.
S.Aureus	It has the ability to mutate, as a result of which new strains of this type of staphylococcus constantly appear. Various strains occur with a frequency of 30 to 85 percent.
Aspergillus Fumigatus	Causes fungal pneumonia. It is much less common than the above pathogens, but in recent decades there has been an increase in fungal pneumonia.

Nosocomial pneumonia is an infection with a high risk of mortality. Also, due to resistance to treatment, it is often complicated by the development of respiratory failure.

Risk factors for the development of nosocomial pneumonia are:

• advanced age ( over 60 years);
• smoking;
• previous infections, including those of the respiratory system;
• chronic diseases ( chronic obstructive pulmonary disease is of particular importance);
• unconsciousness with a high risk of aspiration;
• food through a probe;
• long horizontal position when the patient is in a supine position for a long time);
• connecting the patient to the ventilator.

Clinically, nosocomial pneumonia is very difficult and with numerous consequences.

Symptoms of nosocomial pneumonia are:

• temperature over 38.5 degrees;
• cough with phlegm;
• purulent sputum;
• frequent shallow breathing;
• interruptions in breathing;
• changes in the blood - can be observed as an increase in the number of leukocytes ( over 9x 10 9) and their decrease ( less than 4x 10 9);
• decrease in oxygen levels in the blood oxygenation) less than 97 percent;
• new foci of inflammation are visible on the x-ray.

Also, nosocomial pneumonia is often complicated by the development of bacteremia ( a condition in which bacteria and their toxins enter the bloodstream). This in turn leads to toxic shock. The lethality of this condition is very high.

What is SARS?

SARS is pneumonia that is caused by atypical pathogens and presents with atypical symptoms.
If typical pneumonia is most often caused by pneumococcus and its strains, then the causative agents of atypical pneumonia can be viruses, protozoa, fungi.

Symptoms of SARS are:

• high fever - more than 38 degrees, and with pneumonia caused by legionella - 40 degrees;
• symptoms of general intoxication predominate, such as excruciating headaches, muscle pains;
• erased pulmonary symptoms - moderate, unproductive ( no sputum) cough, and if sputum appears, then its amount is insignificant;
• the presence of extrapulmonary symptoms characteristic of the pathogen ( e.g. rashes);
• mild changes in the blood - there is no leukocytosis, which is characteristic of pneumococcal pneumonia.
• on the radiograph, an atypical picture - there are no pronounced foci of blackout;
• there is no reaction to sulfa drugs.

Severe acute respiratory syndrome is a special form of SARS. This syndrome in the English literature is called SARS ( severe acute respiratory syndrome). It is caused by mutated strains from the coronavirus family. An epidemic of this form of pneumonia was registered in 2000-2003 in the countries of Southeast Asia. The carriers of this virus, as it turned out later, were bats.

A feature of this atypical pneumonia is also erased pulmonary symptoms and a pronounced intoxication syndrome. Also, with pneumonia caused by a coronavirus, multiple changes in the internal organs are noted. This happens because, penetrating the body, the virus spreads very quickly to the kidneys, lungs, and liver.

The features of SARS or SARS are:

• adults from 25 to 65 years old are predominantly ill, isolated cases were noted among children;
• the incubation period lasts from 2 to 10 days;
• the route of infection transmission is airborne and fecal-oral;
• pulmonary symptoms appear on day 5, and before that symptoms of viral intoxication appear - chills, muscle pain, nausea, vomiting, and sometimes diarrhea ( such a course of the disease can mimic an intestinal infection);
• on the part of the blood, there is a decrease in the number of both lymphocytes and platelets ( which often provokes hemorrhagic syndrome);
• in a biochemical blood test, an increase in liver enzymes is noted, which reflects the damage to the liver by the virus.
• complications such as distress syndrome, toxic shock, acute respiratory failure develop rapidly.

Extremely high mortality in SARS is due to the constant mutation of the virus. As a result, finding a drug that would kill this virus is very difficult.

What are the stages of development of pneumonia?

There are three stages in the development of pneumonia, through which all patients pass. Each stage has its own characteristic symptoms and clinical manifestations.

The stages of development of pneumonia are:

• start stage;
• heat stage;
• permission stage.

These stages correspond to pathological changes in the lungs caused by the inflammatory process at the tissue and cellular level.

Stage of onset of pneumonia
The beginning of the inflammatory process in the lungs is characterized by a sharp, sudden deterioration in the general condition of the patient against the background of complete health. Sudden changes in the body are explained by its hyperergic ( excessive) reaction to the causative agent of pneumonia and its toxins.

The first symptom of the disease is subfebrile body temperature ( 37 - 37.5 degrees). In the first 24 hours, it quickly increases to levels of 38 - 39 degrees and more. High body temperature is accompanied by a number of symptoms caused by general intoxication of the body with toxins of the pathogen.

Symptoms of general intoxication of the body are:

• headaches and dizziness;
• general fatigue;
• fast fatiguability;
• rapid heartbeat ( more than 90 - 95 beats per minute);
• a sharp decline working capacity;
• loss of appetite;
• the appearance of a blush on the cheeks;
• cyanosis of the nose and lips;
• herpetic eruptions on the mucous membranes of the lips and nose;
• increased sweating.

In some cases, the disease begins with signs of indigestion - nausea, vomiting, rarely diarrhea. Also important symptoms the onset of the disease are cough and chest pain. Cough appears from the first days of the disease. Initially, it is dry, but permanent. Due to constant irritation and tension of the chest, characteristic pains appear in the retrosternal region.

stage of pneumonia
In the stage of peak, there is an increase in the symptoms of general intoxication of the body, and signs of inflammation of the lung tissue also appear. The body temperature is kept at a high level and is difficult to treat with antipyretic drugs.

Symptoms of pneumonia in the stage of peak are:

• severe chest pain;
• quickening of breathing;
• cough;
• expectoration;
• dyspnea.

Severe chest pains are caused by inflammation of the pleural sheets ( membranes of the lungs), which contain a large number of nerve receptors. Pain sensations have precise localization. The greatest intensity of pain sensations is noted with deep breaths, coughing, and when the torso is tilted to the affected side. The patient's body tries to adapt and reduce pain by reducing the mobility of the affected side. Become noticeable lagging half of the chest in the process of breathing. Severe chest pains lead to the appearance of "gentle" breathing. Breathing in a patient with pneumonia becomes superficial and rapid ( more than 25 - 30 breaths per minute). The patient tries to avoid taking deep breaths.

In the stage of heat, a constant cough persists. Due to the constant irritation of the pleural sheets, the cough intensifies and becomes painful. At the height of the disease with a cough, thick mucopurulent sputum begins to stand out. Initially, the color of sputum is gray-yellow or yellow-green. Gradually, streaks of blood and particles of destroyed lungs appear in the secretions. This gives the sputum a bloody-rusty color. During the peak of the disease, sputum is excreted in large quantities.

As a result of inflammation of the respiratory surface of the lungs, respiratory failure occurs, which is characterized by severe shortness of breath. In the first two days of the peak of the disease, shortness of breath appears during movement and normal physical exertion. Gradually, shortness of breath appears when performing minimal physical exertion and even at rest. Sometimes it can be accompanied by dizziness and severe fatigue.

Resolution stage
In the stage of resolution of the disease, all the symptoms of pneumonia go into decline.
Signs of general intoxication of the body disappear, and body temperature returns to normal.
The cough gradually subsides, and the sputum becomes less viscous, as a result of which it is easily separated. Its volume is decreasing. Pain in the chest occurs only with sudden movements or strong cough. Breathing gradually normalizes, but shortness of breath persists with normal physical activity. Visually, there is a slight lag of half of the chest.

What complications can pneumonia cause?

Pneumonia can occur with various pulmonary and extrapulmonary complications. Pulmonary complications are those that affect the lung tissue, bronchi, and pleura. Extrapulmonary complications are complications from the internal organs.

Pulmonary complications of pneumonia are:

• development of an obstructive syndrome;

Pleurisy
Pleurisy is an inflammation of the pleura that covers the lungs. Pleurisy can be dry and wet. With dry pleurisy, fibrin clots accumulate in the pleural cavity, which subsequently glue the pleural sheets together. The main symptom of dry pleurisy is very intense pain in the chest. Pain is associated with breathing and appears at the height of inspiration. To ease the pain a little, the patient tries to breathe less often and not so deeply. With wet or exudative pleurisy, the main symptom is shortness of breath and a feeling of heaviness in the chest. The reason for this is the accumulating inflammatory fluid in the pleural cavity. This fluid presses on the lung, compressing it and thus reducing the respiratory surface area.

With pleurisy, symptoms of respiratory failure quickly increase. Skin at the same time they quickly become cyanotic, there are interruptions in the work of the heart.

empyema
Empyema, or purulent pleurisy, is also a formidable complication of pneumonia. With empyema, pus does not accumulate in the pleural cavity. The symptoms of empyema are similar. exudative pleurisy, but are much more pronounced. The main symptom is a high temperature ( 39 - 40 degrees) of a hectic nature. This type of fever is characterized by daily temperature fluctuations from 2 to 3 degrees. So, the temperature from 40 degrees can drop sharply to 36.6. Sharp rises and falls in temperature are accompanied by chills and cold sweat. Also affected by empyema the cardiovascular system. The heart rate rises to 120 beats per minute or more.

lung abscess
An abscess forms a cavity in the lung or multiple cavities) in which purulent contents accumulate. An abscess is a destructive process, therefore, in its place, the lung tissue is destroyed. The symptomatology of this condition is characterized by severe intoxication. Until a certain time, the abscess remains closed. But then he breaks out. It can break through into the bronchial cavity or into the pleural cavity. In the first case, there is a copious discharge of purulent contents. Pus from the lung cavity exits through the bronchus to the outside. The patient has offensive, copious sputum. At the same time, the patient's condition improves with the breakthrough of the abscess, the temperature drops.
If the abscess breaks into the pleural cavity, then pleural empyema develops.

The development of obstructive syndrome
Symptoms of obstructive syndrome are shortness of breath and periodic attacks of suffocation. This is due to the fact that the lung tissue at the site of the former pneumonia loses its functionality. In its place develops connective tissue, which replaces not only lung tissue, but also its vessels.

Pulmonary edema
Edema is the most formidable complication of pneumonia, the lethality of which is very high. In this case, water from the vessels penetrates first into the interstitium of the lungs, and then into the alveoli themselves. Thus, the alveoli, which are normally filled with air, are filled with water.

In this state, a person begins to quickly suffocate and becomes agitated. A cough appears, which is accompanied by the release of foamy sputum. The pulse rises to 200 beats per minute, the skin is covered with a cold sticky sweat. This condition requires resuscitation.

Extrapulmonary complications of pneumonia are:

• toxic shock;
• toxic myocarditis;

Extrapulmonary complications of pneumonia are due to the specific action of bacteria. Some pathogenic bacteria have tropism ( similarity) to the liver tissue, others easily penetrate the blood-brain barrier and enter the nervous system.

toxic shock
Toxic shock is a condition in which toxins from bacteria and viruses enter the patient's bloodstream. This is an emergency condition in which multiple organ failure is observed. Multiple organ failure means that more than 3 organs and systems are involved in the pathological process. Most often, the cardiovascular, renal, digestive and nervous systems suffer. The main symptoms are fever, low blood pressure and a polymorphic rash on the body.

Toxic myocarditis
Myocarditis is a lesion of the heart muscle, as a result of which its function is lost. The highest cardiotropism ( selectivity for the heart muscle) have viruses. Therefore, viral pneumonia is most often complicated by toxic myocarditis. Bacteria such as mycoplasma and chlamydia also specifically affect the heart tissue.
The main symptoms are disorders heart rate, weakness of cardiac activity, shortness of breath.

Pericarditis
Pericarditis is an inflammation of the serous membrane that surrounds the heart. Pericarditis may develop on its own or precede myocarditis. At the same time, inflammatory fluid accumulates in the pericardial cavity, which subsequently presses on the heart and compresses it. As a result, the main symptom of pericarditis develops - shortness of breath. In addition to shortness of breath, a patient suffering from pericarditis complains of weakness, pain in the heart, dry cough.

Meningitis
Meningitis ( inflammation of the meningeal membranes of the brain) develops due to the penetration of pathogenic microorganisms into the central nervous system. Meningitis can also be bacterial or viral, depending on the etiology of the pneumonia.
The main symptoms of meningitis are nausea, vomiting, photophobia, and stiff neck.

Hepatitis
It is a very common complication of atypical pneumonia. With hepatitis, the liver tissue is affected, as a result of which the liver ceases to perform its functions. Since the liver plays the role of a filter in the body, when it is damaged, all metabolic products are not excreted from the body, but remain in it. With hepatitis, a large amount of bilirubin enters the blood from destroyed liver cells, which leads to the development of jaundice. The patient also complains of nausea, vomiting, dull pain in the right hypochondrium.

What antibiotics are used in the treatment of pneumonia?

The choice of this or that drug depends on the form of pneumonia and the individual tolerability of the drug.

Drugs that are used in the treatment of typical pneumonia

Pathogen	First line drugs	Alternative drug
Staphylococcus aureus	oxacillin;	clindamycin; cephalosporins I-II generation ( cephalexin, cefuroxime).
Streptococcus group A	penicillin G; penicillin V.	clindamycin; 3rd generation cephalosporins ceftriaxone).
Str.pneumoniae	penicillin G and amoxicillin in cases of penicillin-sensitive pneumococcus; ceftriaxone and levofloxacin in the case of penicillin-resistant pneumococcus.	macrolides ( erythromycin, clarithromycin); respiratory fluoroquinolones ( levofloxacin, moxifloxacin).
Enterobacteriaceae	3rd generation cephalosporins cefotaxime, ceftazidime).	carbapenems ( imipenem, meropenem).

Of course, it takes time to determine which microorganism caused pneumonia. To do this, it is necessary to isolate the pathogen from the pathological material, in this case sputum. All this takes time, which is often not available. Therefore, the doctor empirically approaches this issue. He chooses the antibiotic with the most a wide range actions. He also takes into account the nature of the disease, and if there are signs of an anaerobic infection, he will give preference to beta-lactam antibiotics or carbapenems.

Also, having studied in detail the patient's medical history, he can assume what kind of disease this is. If the patient has recently been hospitalized, then most likely it is nosocomial ( hospital) pneumonia. If the clinical picture is dominated by symptoms of general intoxication, and pneumonia is more like measles or mumps, then most likely it is atypical pneumonia. If it is intrauterine pneumonia of a newborn child, then perhaps its cause is gram-negative bacilli or Staphylococcus aureus.

Once pneumonia has been diagnosed, antibiotics are prescribed ( if it's bacterial pneumonia).

Drugs used in the treatment of SARS

Source of infection).
Klebsiella pneumoniae	cephalosporins II - IV generation ( cefotaxime, ceftazidime, cefepime); respiratory fluoroquinolones.	aminoglycosides ( kanamycin, gentamicin); carbapenems ( imipenem, meropenem).
Legionella	macrolides; respiratory fluoroquinolones.	doxycycline; rifampicin.
Mycoplasma	macrolides.	respiratory fluoroquinolones.
Pseudomonas aeruginosa	antipseudomonas cephalosporins ( ceftazidime, cefepime).	aminoglycosides ( amikacin).

In the treatment of pneumonia, various combinations of antibiotics are often used. Although monotherapy ( single drug treatment) is the gold standard, it is often inefficient. Poorly treated pneumonia is a major risk factor for subsequent relapse ( re-exacerbation).

It is important to note that although antibiotic therapy is the mainstay of treatment, other drugs are used in the treatment of pneumonia. Without fail, antibiotic therapy is carried out in parallel with the appointment of antifungal drugs ( for the prevention of candidiasis) and other drugs, in order to eliminate the main symptoms of pneumonia ( for example, antipyretics to lower the temperature).

Is there a vaccine for pneumonia?

There is no universal vaccine against pneumonia. There are some vaccines that only work against certain microorganisms. For example, the best known vaccine is the pneumococcal vaccine. Because pneumococcus is one of the most common causes of pneumonia, this vaccine prevents pneumococcal pneumonia. The best known are the Prevenar vaccines ( USA), Synflorix ( Belgium) and Pneumo-23 ( France).

The Prevenar vaccine is one of the most modern and most expensive. The vaccine is given in three doses one month apart. It is believed that immunity after vaccination is developed after a month. The Synflorix vaccine is given on the same schedule as Prevenar. Pneumo-23 is the oldest vaccine currently in existence. It is set once, and its validity period is about 5 years. A significant disadvantage of this vaccination is that it can be given only after reaching the age of two. It is known that newborn children are the most vulnerable category in terms of the development of pneumonia.

It should be noted right away that vaccination against pneumonia does not mean at all that a child or an adult will not get sick again. Firstly, you can get pneumonia of another origin, for example, staphylococcal. And secondly, even from pneumococcal pneumonia, immunity is not formed for life. Vaccine manufacturers warn that it is possible to get sick again after vaccination, but the patient will endure the disease much more easily.

In addition to the pneumococcal vaccine, there is a vaccine against Haemophilus influenzae. Haemophilus influenzae, or influenza bacillus, is also a common causative agent of pneumonia. The following three vaccines are registered in Russia - Act-HIB, Hiberix and Pentaxim. They are given at the same time as the polio and hepatitis B vaccines.

With regard to vaccination against viral pneumonia, it is a little more complicated. It is known that viruses are able to mutate, that is, to change. Therefore, it is very difficult to model a vaccine against a particular virus. As soon as science invents one vaccine against a known virus, it changes and the vaccine becomes ineffective.

How does aspiration pneumonia develop?

Aspiration pneumonia is a pneumonia that develops as a result of the penetration of foreign substances into the lungs. Foreign substances can be vomit, food particles and other foreign bodies.
Normally, the airways with the help of special mechanisms prevent foreign bodies from entering the lungs. One such mechanism is coughing. So, when a foreign object gets into the bronchial tree ( e.g. saliva), he starts coughing it up. However, there are situations when these mechanisms are defective, and foreign particles still reach the lungs, where they settle and cause inflammation.

Aspiration pneumonia can develop under the following conditions:

• alcohol intoxication;
• drug intoxication;
• the use of certain drugs;
• unconscious state;
• severe, uncontrollable vomiting;
• early childhood.

The most common cases are alcohol and drug intoxication. Alcohol, like some drugs, weakens all reflexes, including defense mechanisms. Very often, such conditions are accompanied by vomiting. At the same time, a person is not able to control this process. Vomit can easily enter the respiratory tract. It should be noted that even in a healthy person, vomit with strong and indomitable vomiting can enter the lungs.

In children, aspiration pneumonia can develop when food particles enter the bronchi. This happens when complementary foods are introduced into the baby's diet. Porridge, for example, buckwheat, has the greatest danger. Even one grain of buckwheat, once in the lungs, causes local inflammation.

Another risk group is people taking psychotropic drugs, such as antidepressants or hypnotics ( sleeping pills). These drugs weaken all the reactions of the body, including reflexes. People, especially those who take sleeping pills, are in a sleepy, somewhat slowed down state. Therefore, the obstruction in their airways is weakened, and food ( or drinks) easily enters the lungs.

Getting into the lung tissue, foreign bodies ( vomit, food) cause inflammation and pneumonia.