Inflammation of the lungs is a very serious disease that is officially called pneumonia in medicine. The disease ranks 4th in mortality after strokes, heart attacks and oncology. The most pressing question today is what is pneumonia, is it possible to get infected from this disease and at what stage? To have an idea of the danger of the disease, you need to know about the causes of the pathological process and the nuances of its development.
Pneumonia - what is it
The main essence of the disease - lung tissue undergoes pathological changes. Respiratory function and, as a result, all organs and tissues suffer from inflammatory processes, since they receive less oxygen. Inflammation of the lungs is an infectious disease during which an attack of viruses and microbes on the alveoli occurs - the smallest parts of the respiratory system. Pneumonia can affect a small area of lung tissue or spread to the whole lung. The disease develops in a week, and a full recovery can take several months.
Inflammation of the lungs proceeds, depending on the pathogen that caused it. More often (up to 50%) pneumococcus causes pathology. This group includes over 100 species of bacteria. The most common are mycoplasma (mycoplasma pneumonia), legionella, chlamydia. In second place in frequency, lung tissue affects Hemophilus wand, Staphylococcus aureus, Klebsiella and other microbes. An epidemic outbreak is caused by aggressive pathogens spreading through airborne droplets. Epidemics of pneumococcal pneumonia are noted in crowded places.
Is pneumonia contagious?
Before finding out whether pneumonia is contagious, you should understand what the cause of the disease. If bacterial inflammation of the lungs occurs in a person against the background of an existing pathology, this is unlikely to cause an infection in a partner who has been in contact with the patient. However, if atypical microorganisms (chlamydia, mycoplasma, etc.) become causative agents, they are often transmitted by airborne droplets. If another person has lowered immunity, then the risk of infection is very high. For this reason, it is better to minimize contact with the patient.
What is pneumonia, it is not always possible to immediately understand, because the clinical symptoms of the disease are very diverse, and the manifestation of the pathology depends on many factors. The patient's initial complaints are similar to signs of many bacterial infections: weakness, fever, malaise, excessive sweating, high body temperature. Then there is a cough with a discharge of purulent sputum, pain in the chest cavity, respiratory failure. When the pathogen enters the lung tissue through the bloodstream, the doctor additionally identifies the following clinical symptoms:
- shortening percussion sound
- pleural friction noise
- moist fine wheezing,
- weakened bronchial breathing
- weakening of voice jitter.
Causes of pneumonia
Ill pneumonia can be in different ways, because the causes of what is pneumonia, very much. As already mentioned, in the first place is the pneumococcus bacterium. Often the causative agents are:
- gram-positive microorganisms: streptococci, staphylococci,
- Gram-negative microorganisms: hemophilic bacillus, enterobacteria, Friedlander bacillus, Legionella, Proteus, Escherichia coli,
- fungal infections,
- viral infections (adenoviruses, parainfluenza, influenza, herpes).
The disease provokes not only the infectious pathogen of pneumonia. Inflammation of the lung is often caused by non-infectious factors: allergic agents, toxic substances, ionizing radiation, injuries of the chest. The risk group includes patients with:
- chronic bronchitis,
- congestive heart failure
- congenital lung disease
- chronic nasopharyngeal infections,
- severe immunodeficiency states.
What is dangerous
What is pneumonia, have already figured out. However, not all patients treat the treatment with due attention, because they do not know what is dangerous pneumonia. Before the invention of antibiotics, the disease was fatal. The disease is still fatal in 5% of cases. Especially dangerous is pneumonia for children and elderly patients, since their immunity is weakened. Immediately after the defeat of the bronchi and lungs, there is a violation of oxygen exchange. The implications for adult patients may be as follows:
- respiratory failure
- bronchial asthma,
- heart failure,
- fibrosis or lung abscess.
Pneumonia viral etiology is dangerous for both mother and child. The problem is that in the early stages of the symptoms of alveolar lesions are similar to the clinical manifestations of a cold, so women do not go to the doctors, trying to be treated on their own. Such behavior only makes the pathology worse. If aspiration pneumonia was detected on time, then the prognosis is favorable. If home treatment has led to the accession of a secondary infection or to a purulent complication, then the risk of severe consequences is high. Inflammation of the lungs during pregnancy can lead to:
- myocarditis, endocarditis,
- infectious toxic shock,
- respiratory failure
- broncho-obstructive syndrome
- exudative pleurisy,
- edema, abscess, gangrene of the lung.
Among children, babies and schoolchildren are more likely to get pneumonia. With the late treatment of pathology, the consequences for the child's body can be very different: pleurisy, destructive pneumonitis, cardiopulmonary insufficiency. If the right therapy is carried out, then the consequences and complications should not be, and the prognosis of the disease in most cases is positive.
Depending on the severity of the disease and the characteristic symptoms, there are several types of pneumonia:
- Typical. The main cause is focal infectious inflammation.
- Atypical pathogen. It is the cause of a whole group of diseases, the symptoms of which in each case vary. With progressive development, lobar inflammation may be observed. On x-rays, this type of inflammation is not clear, therefore, is considered very insidious.
- Stagnant view. It is characterized by the appearance of stagnation in the bronchi. The accumulation of sputum causes the development of pathogenic microbes, which provokes first respiratory viral diseases, and then chronic infection (chlamydial pneumonia).
- Alien masses. More often we are talking about small objects or food particles that cause damage to the mucous membrane.
With the development of viral pneumonia, doctors distinguish several stages in the course of the disease:
- Tide stage Duration is about 80 hours. It is characterized by a sharp flow of blood into the lungs with the release of exudate. Edema of the organ occurs, leading to its inflammation.
- Stage of red hepatization. Duration is no more than 70 hours. Lung tissue compacted, increasing in volume, in the exudate increases the concentration of red blood cells.
- Stage of gray hepatization. Erythrocytes disappear in the exudate, leukocyte count increases. This leads to the fact that the lung tissue becomes gray tint. The period can last one week.
- Stage resolution. There is a resorption of fibrin, the breakdown of leukocytes, as a result, the lung takes on a healthy appearance. The recovery time is 10-12 days.
To confirm the possible pathology of the lungs, laboratory and instrumental diagnostic methods are used. The main method is radiological in direct and lateral projection. For a clearer definition of the source of inflammation (especially in segmental pneumonia), additional measures are applied:
- CT scan,
- lung biopsy (for interstitial pneumonia),
- study of respiratory function (if shortness of breath is observed).
Laboratory tests include complete blood count, sputum examination and bacterioscopy. In severe cases of disease with characteristic lung lesions, blood is drawn from a vein to determine the pathogen. If the pathology is accompanied by symptoms of influenza, a blood test for antibodies to viruses is taken. In severe focal pneumonia, for a timely start of artificial ventilation of the lungs, a complete study of blood gases is necessary.
Diagnosis of lobar pneumonia includes auscultation. The doctor carefully listens to the lungs, paying particular attention to the patient's breathing. Auscultative symptoms:
- Wet fine wheezing. Listened to inhale at the maximum speed of the air flow. The symptom occurs when a viscous exudate is formed in the bronchi, consisting of bubbles, which, passing through the air flow, burst and emit a characteristic sound.
- Crepitus. Pathological process in the alveoli, which occurs when wetting their walls with a viscous secret. This leads to a listened cod when inhaling. When the patient tries to cough, crepitus does not disappear, which distinguishes it from wheezing.
Therapeutic actions are aimed at suppressing acute bacterial infection, restoration of pulmonary resistance, elimination of prolonged intoxication. The main treatment for pneumonia is the prescription of antibacterial drugs. Do not prescribe antibiotics if the disease is caused by viruses. In this case, the treatment is carried out with anti-inflammatory and antiviral drugs. The presence of a fungal pneumonia in a patient requires taking antifungal drugs. To speed up the recovery of the patient, doctors additionally prescribe:
- physical therapy,
- physiological procedures.
In the vast majority of pneumonia treated with antibiotics. Penicillins can be distinguished among antibacterial agents. Their mechanism of action is aimed at suppressing cell wall biosynthesis, which protects the cell from the surrounding space. This group of antibiotics includes:
- Novocillin. Release form - bottles for intramuscular injection. On average, assigned to 1 million ED 4 times / day.
- Oxacillin. Available in 0.25 g, 0.5 g in vials, capsules and tablets. It is applied every 4-5 hours. The average daily dose - 6 g.
- Nafcillin. Assign intravenously or intramuscularly every 4-6 hours. Daily dose - from 6 to 12 g.
The course can range from 3 days to several weeks, depending on the severity of the disease. When nosocomial pneumonia in the hospital is a combined antibiotic treatment regimen to eliminate the risk of an epidemic. In hospital pneumonia, especially in case of a staphylococcal infection, the following antibacterial drugs are prescribed:
- 3-4 generations cephalosporins,
There are tips for treating pathology using traditional methods. This is dangerous, especially against the background of a chronic disease, because it can be fatal, so all therapeutic measures need to be discussed with a doctor. There is herbal medicine that helps with dry cough and reduces the appearance of sputum. One of the most effective recipes is a collection of marigold, hypericum and chamomile flowers. To prepare the decoction must be mixed for 1 tsp. each component, pour 2 cups boiling water, then 2 hours to insist. Take 3 times a day for 0, 3 cups to improve the condition.
Complications of pneumonia
Basically, all pulmonary complications are associated with inadequate treatment. The worst case scenario is fatal on the background of pleural effusion, when excess fluid seeps into space. There is a risk of infection to nearby tissues and organs, causing a pathological process in them. This may be the heart, brain, pulmonary arteries.
How not to get pneumonia from a patient
In order not to catch the infection, you should know what pneumonia is and how to avoid infection. To reduce the risk of disease, several rules should be followed to increase the overall immunity of the body:
- time to treat viral infections,
- do not supercool
- get a flu shot every year
- to refuse from bad habits.
The main advice that can be given in order to prevent pneumonia is to consult a doctor when the first cold symptoms appear. People who suffer from chronic broncho-pulmonary diseases should be vaccinated with PNEUMO-23 in order not to become infected. In addition, the basic recommendations include:
- maintaining a positive attitude
- active lifestyle
- varied nutrition.
Pneumonia is an inflammation of the lower respiratory tract of various etiologies that occurs with intra-alveolar exudation and is accompanied by characteristic clinical and radiological signs. Acute pneumonia occurs in 10-14 people out of 1000, in the age group over 50 years old - in 17 people out of 1000. The urgency of the problem of the incidence of acute pneumonia persists despite the introduction of new antimicrobial drugs, as well as a high percentage of complications and mortality (up to 9%) ) from pneumonia.
Among the causes of mortality of the population, pneumonia is on the 4th place after heart and vascular diseases, malignant neoplasms, injuries and poisoning. Pneumonia can develop in debilitated patients, joining the course of heart failure, cancer, impaired cerebral circulation, and complicates the outcome of the latter. In patients with AIDS, pneumonia is the main immediate cause of death.
Causes and mechanism of pneumonia
Among the etiofactors that cause pneumonia, in the first place is a bacterial infection. The most common pathogens of pneumonia are:
- Gram-positive microorganisms: pneumococci (from 40 to 60%), staphylococci (from 2 to 5%), streptococci (2.5%),
- Gram-negative microorganisms: Friedlender bacillus (from 3 to 8%), Hemophilus bacillus (7%), enterobacteria (6%), Proteus, Escherichia coli, Legionella, etc. (from 1.5 to 4.5%),
- mycoplasmas (6%),
- viral infections (herpes, influenza and parainfluenza viruses, adenoviruses, etc.),
- fungal infections.
Pneumonia can also develop as a result of exposure to non-infectious factors: chest injuries, ionizing radiation, toxic substances, allergic agents.
The risk group for the development of pneumonia includes patients with congestive heart failure, chronic bronchitis, chronic nasopharyngeal infection, congenital lung malformations, severe immunodeficiency conditions, debilitated and exhausted patients, patients who are on bed rest for a long time, and elderly and senile patients .
Particularly susceptible to the development of pneumonia are people who smoke and abuse alcohol. Nicotine and alcohol vapors damage the bronchial mucosa and inhibit the protective factors of the bronchopulmonary system, creating a favorable environment for the introduction and reproduction of the infection.
Infectious pathogens of pneumonia penetrate into the lungs by bronchogenic, hematogenous or lymphogenous pathways. With the existing reduction of the protective bronchopulmonary barrier in the alveoli, infectious inflammation develops, which through the permeable interalveolar septa spreads to other parts of the lung tissue.In the alveoli, the formation of exudate, which prevents the gas exchange of oxygen between the lung tissue and blood vessels. Oxygen and respiratory failure develops, and in case of a complicated course of pneumonia, heart failure occurs.
In the development of pneumonia, 4 stages are distinguished:
- tide stage (from 12 hours to 3 days) - characterized by abrupt blood circulation of the pulmonary vessels and fibrinous exudation in the alveoli,
- stage of red warming (from 1 to 3 days) - the lung tissue is compacted, the structure resembles the liver. In the alveolar exudate erythrocytes are found in large quantities,
- the stage of gray hepatization - (from 2 to 6 days) - is characterized by the breakdown of red blood cells and massive leukocyte output to the alveoli,
- resolution stage - normal lung tissue structure is restored.
3. According to the development mechanism, pneumonia is isolated:
- primary, developing as an independent pathology
- secondary, developing as a complication of associated diseases (for example, congestive pneumonia)
- aspiration, developing when foreign bodies get into bronchi (food particles, vomit, etc.)
- infarction pneumonia, developing as a result of thromboembolism of small vascular branches of the pulmonary artery.
9. Depending on the severity of pneumonia is divided into:
- mild - it is characterized by mild intoxication (clear consciousness, body temperature up to 38 ° C, blood pressure is normal, tachycardia is not more than 90 beats per minute), dyspnea at rest is absent, a small inflammatory focus is determined radiographically.
- moderate - signs of moderately severe intoxication (clear consciousness, sweating, severe weakness, body temperature up to 39 ° C, blood pressure moderately reduced, tachycardia about 100 beats per minute), respiratory rate - up to 30 per minute. at rest, a pronounced infiltration is determined radiographically.
- severe - characterized by severe intoxication (fever of 39-40 ° C, clouding of the creation, adynamia, delirium, tachycardia over 100 beats per minute, collapse), shortness of breath up to 40 per minute. at rest, cyanosis, radiographically determined extensive infiltration, the development of complications of pneumonia.
Characteristic acute onset with fever over 39 ° C, chills, chest pain, shortness of breath, weakness. Cough worries: first dry, unproductive, then for 3-4 days - with “rusty” sputum. Body temperature is constantly high. With lobar pneumonia, fever, cough and sputum discharge persist for up to 10 days.
In severe cases of lobar pneumonia, the hyperemia of the skin and cyanosis of the nasolabial triangle is determined. Herpes sores can be seen on the lips, cheeks, chin, and wings of the nose. The patient's condition is severe. Breathing is shallow, rapid, with swelling of the wings of the nose. Auscultation is followed by crepitus and moist fine bubbling rales. Pulse, frequent, often arrhythmic, blood pressure low, heart tone deaf.
It is characterized by a gradual, hardly noticeable onset, more often after acute respiratory viral infections or acute tracheobronchitis. The body temperature is febrile (38-38.5 ° C) with daily fluctuations, the cough is accompanied by discharge of mucopurulent sputum, sweating, weakness are noted, and when breathing there is chest pain during inhalation and coughing, acrocyanosis. With focal drain pneumonia, the patient's condition worsens: severe shortness of breath, cyanosis appear. During auscultation, hard breathing is heard, exhalation is extended, dry small- and medium-bubbling wheezing, crepitus over the focus of inflammation.
Patients with pneumonia, as a rule, are hospitalized in the general therapeutic department or pulmonology department. For the period of fever and intoxication, bed rest is prescribed, plentiful warm drink, high-calorie, vitamin-rich food. In cases of respiratory failure, patients with pneumonia are prescribed inhaled oxygen. The main directions of therapy:
- Antibiotic therapy. The main treatment for pneumonia is antibiotic therapy. Appoint antibiotics should be as early as possible, without waiting for the determination of the pathogen. Selection of antibiotic carries a doctor, no self-treatment is unacceptable! For community-acquired pneumonia, penicillins are more often prescribed (amoxicillin with clavulanic acid, ampicillin, etc.), macrolides, cephalosporins. The choice of the method of administration of the antibiotic is determined by the severity of pneumonia. Penicillins, cephalosporins, fluoroquinolones (ciprofloxacin, ofloxacin, etc.), carbapenems, aminoglycosides are used to treat nosocomial pneumonia. If the pathogen is unknown, a combination antibiotic therapy of 2-3 drugs is prescribed. The course of treatment can last from 7-10 to 14 days, it is possible to change the antibiotic.
- Symptomatic therapy. In pneumonia, detoxification therapy, immunostimulation, administration of antipyretic, expectorant and mucolytic, antihistamine drugs are indicated.
- Physiotherapy After the cessation of fever and intoxication, the regime is expanded and physiotherapy is prescribed (electrophoresis with calcium chloride, potassium iodide, hyaluronidase, UHF, massage, inhalation) and exercise therapy to stimulate the resolution of the inflammatory focus.
Treatment of pneumonia is carried out until complete recovery of the patient, which is determined by the normalization of the state and well-being, physical, radiological and laboratory parameters. With frequent re-pneumonia of the same localization, the issue of surgery is resolved.
In pneumonia, the prognosis is determined by a number of factors: virulence of the pathogen, patient age, background diseases, immune reactivity, treatment adequacy. Complicated variants of the course of pneumonia, and immunodeficiency states, resistance of pathogens to antibiotic therapy are unfavorable with respect to the prognosis. Particularly dangerous are pneumonia in children under 1 year old, caused by staphylococcus, Pseudomonas aeruginosa, Klebsiella: the mortality rate for them is from 10 to 30%.
With timely and adequate therapeutic measures, pneumonia ends with recovery. The following outcomes of pneumonia can be observed for variants of changes in the lung tissue:
- full restoration of the lung tissue structure - 70%,
- the formation of a local pneumosclerosis site - 20%,
- the formation of the site of local carnification - 7%,
- reduction of a segment or share in size - 2%,
- wrinkling of a segment or share - 1%.
Description of the disease
Signs of pneumonia described in his treatises the legendary Hippocrates, but the real breakthrough in the treatment of this infection occurred only at the beginning of the 20th century, after the discovery of penicillin by Alexander Fleming. A pulmonary disease is very insidious: it is rapidly developing, while successfully disguised as a flu or a classic cold, which is why it is not always easy to recognize it.
Scientists distinguish 2 main types of pneumonia - the primary one, which begins as an independent disease, and the secondary one - develops against the background of acute respiratory viral infections or other ailments, most often with reduced immunity. The disease can be transmitted in three ways, the most common - the classic airborne, when the infection gets into the lungs of a healthy child or adult from the patient.
Another way is hematogenous, the pathogen penetrates along with the blood (when infected with blood and other serious infections). The third method is endogenous, when the bacteria that live in the nose and throat are activated and become a source of infection. Thus, the question of whether pneumonia is contagious is unequivocal: yes, it is contagious.
Features of pneumonia in both adults and children often depend on the type of infection:
- Focal (a small portion of the lung suffers - one or more alveoli).
- Segmental (affected one or more pulmonary segments).
- Lobar (inflammation in the whole pulmonary lobe).
- Total (infection captures the respiratory organ completely).
One type of pulmonary lobe lesion is dangerous lobar pneumonia, which, without proper treatment, often becomes bilateral pneumonia.
The causes of pneumonia in children and adults are the same - directly the causative agent of infection and reduced immunity.
The main causative agents of pulmonary infection are:
- Hemophilic wand.
The first three pathogens cause typical pneumonia, the last 4 groups of microorganisms cause atypical pulmonary inflammation.
The most popular pathogen is streptococcus. It is usually present on the skin and in the respiratory tract, and when weakened by immunity, against the background of other diseases, it can penetrate into the lungs and provoke their inflammation. Enterobacteria usually cause pneumonia in people with chronic pathologies of the kidneys, staphylococcal infection is mainly diagnosed in elderly patients.
Chlamydial pneumonia can often be found in a child after 5 years. The most effective method of treatment is antibiotics, a minimum period of 3 weeks. Mycoplasma usually causes pulmonary inflammation in young people, and the hemophilus bacillus traditionally affects smokers. Legionella infection is less common, but such a pathology can cause serious consequences.
There are additional risk factors that can trigger symptoms of pneumonia:
- Chronic pulmonary diseases
- Chronic infections of the nasopharynx (eg, sinusitis),
- Permanent bronchitis and tonsillitis,
- Immunity deficiency,
- Birth injuries,
- Heart defects.
The first and most characteristic symptoms of pneumonia are coughing, shortness of breath, chest pain, fever, which is accompanied by sweating, and later signs of intoxication. A dry cough appears when the body tries to get rid of dangerous bacteria, then shortness of breath occurs. Especially pronounced shortness of breath in elderly patients against the background of chronic cardiovascular ailments.
Temperature fluctuations are one of the main signs of infection in the lungs. Before the first increase in temperature, a long-lasting chill may appear, then the numbers on the thermometer soar to 38–39 degrees. Temperature fluctuations of 1.15 degrees during the day usually last about 10 days, with complete inpatient treatment, this period can be reduced to 3-4 days.
Intoxication with pneumonia is the poisoning of the body with the decay products of infectious pathogens and toxins after the breakdown of tissues. To identify intoxication in a child and an adult can be based on the following symptoms: headache, feeling unwell, confusion, and later - disturbances in the work of other organs (bad stool, abdominal pain, flatulence and poor appetite).
Symptoms of lobar pneumonia
Croupous pneumonia is one of the most dangerous varieties of this disease, in which a whole lobe of the lung is affected up to single and bilateral inflammation.
Symptoms of pneumonia of this type include:
- A sharp increase in body temperature
- Pain in the side on one side, when coughing and on inhaling intensify,
- Shortness of breath and dry cough develops, first rare, then increasing,
- The neck is covered with red spots on the part of the patient's lung or reddens completely,
- A little blue lips, swelling nasolabial triangle,
- A few days later a brownish sputum with streaks of blood may appear in the cough,
- With severe intoxication, the patient periodically loses consciousness and delirious.
Symptoms of atypical pneumonia
If pneumonia is caused by atypical pathogens, the signs of pneumonia in adults and children may differ somewhat from the classic picture.
When mycoplasma infection, the first symptoms of pneumonia are rhinitis, sore throat, fever, dry cough. Later, muscle and joint pain, nosebleeds, inflammation of lymph nodes are added. More often such a disease is diagnosed in a child, for example, during an outbreak in kindergarten.
The first signs of chlamydial pulmonary inflammation in a child and in an adult are rhinitis, a temperature jump of up to 38–39 degrees, an increase in lymph nodes, later allergic reactions, dermatitis, and bronchitis may appear on the background of the disease.
Obvious symptoms in inflammation of the lungs of the legionella type can be called a strong fever up to 40 degrees with chills and severe headaches and dry cough. This form of pneumonia most often leads to death (50–60%), usually elderly people suffer.
Symptoms of chronic pneumonia
Chronic, or recurrent, inflammation of the lungs begins against a background of an acutely cured acute illness, if a small inflammatory focus remains in the lungs, or is a complication of severe pneumonia.
How does chronic lung inflammation manifest itself? The main features are:
- Hard breath,
- Periodic wet cough, sometimes with purulent discharge,
- Heart palpitations and shortness of breath,
- Inflammation of the nasopharynx and oral cavity,
- Weak immunity and polyhypovitaminosis,
- General weakness and signs of intoxication,
- Night sweats,
- Poor appetite and weight loss,
- In the period of exacerbation - exhausting cough and temperature.
In the chronic form of a pulmonary infection, the respiratory organs do not cope with their work and cannot fully provide the tissues with oxygen, so the heart has to work in a doubled mode. As a result, the most frequent complication of chronic pneumonia is cardiovascular failure.
Symptoms in adults
To determine pneumonia in adults can be primarily on the classic dry cough. Other typical signs of pneumonia in such patients include:
- Chills, then a rapid rise in temperature,
- Shortness of breath even with minimal exertion,
- Tachycardia (more than 100 heartbeats per minute),
- Chest pain (pleural effusion);
- Severe headaches, dizziness,
- Rash of herpes due to weakened immunity,
- Stool problems (diarrhea or increased bowel movements).
Other symptoms of pneumonia depend on the type of pathogen, immunity and degree of pulmonary lesions. In severe forms of pulmonary disease, complications can occur:
- Pulmonary edema,
- Abscess (formation of cavities with pus),
- Psychoses, delusions and hallucinations,
- Pneumothorax (accumulation of air in the pleural region).
Symptoms in children
In children, inflammation of the lungs is rarely the primary disease, most often pneumonia develops against the background of severe colds, ill flu, bronchitis, etc. During this period, it is especially important for parents to distinguish the symptoms of pneumonia and start active treatment.
Typical pneumonia in a child begins with the usual indisposition, then weakness, fever, sweating, and later - dizziness and appetite disorders. In addition to temperature, rapid breathing is observed (more than 50 breaths per minute at a rate of 20–40).
Determination of pulmonary inflammation in a small child can be on the whole complex of symptoms:
- After the flu or cold, there is no improvement, or after a short glimpse temperature surges and severe weakness reappear,
- The child suffers from shortness of breath, regardless of whether there is a fever or cough,
- In addition to the classic signs of ARVI - cough, fever, runny nose, - there is a strong pallor of the skin,
- When the child's temperature rises, antipyretic drugs do not work,
- In infants, behavior changes: they are naughty, poorly or, on the contrary, sleep too much, refuse to eat or become lethargic and apathetic.
Pneumonia caused by various pathogens Edit
This group includes pneumonia caused by various pathogens that have different epidemiological, clinical and anatomical manifestations, need different therapy and methods of prevention, pneumonia for HIV infection and hospital pneumonia.
More than 17 million people are diagnosed with pneumonia per year, while men are sick 30% more often than women. Special risk groups include children under 5 years of age and the elderly over the age of 65 years. It is worth noting the relatively high mortality relative to other diseases: 8.04% in men and 9.07% in women.
The incidence of pneumonia depends on many factors: the standard of living, social and family status, working conditions, contact with animals, travel, the presence of bad habits, contact with sick people, individual human characteristics, the geographical prevalence of a particular pathogen. In 2017, in Russia, the excess of figures for community-acquired pneumonia was observed in 44 regions of the country. An unusually large number of epidemic foci were also recorded: in 2017, 52 outbreaks of community-acquired pneumonia, while in the previous 5 years only 16.
Pneumonia remains one of the most frequent causes of death of children and the elderly in our time, especially in social institutions (children. Houses, boarding schools, places of detention). The frequency of pneumonia in elderly patients increases dramatically while they are being treated in hospital for another disease. There are also sharp differences in the etiology of hospital and community-acquired pneumonia.
The most frequent way of penetration of microorganisms into the lung tissue is bronchogenic - and this is facilitated by: aspiration, inhalation of microbes from the environment, relocation of pathogenic flora from the upper respiratory system (nose, pharynx) to the lower, medical manipulations - bronchoscopy, tracheal intubation, artificial ventilation of the lungs , inhalation of medicinal substances from inseminated inhalers, etc. The hematogenous route of infection (with blood flow) is less common - with intrauterine infection, septic processes and drug addiction with intravenous drug administration. Lymphogenous pathway is very rare. Then, in pneumonia of any etiology, the infectious agent fixes and multiplies in the epithelium of the respiratory bronchioles - acute bronchitis or bronchiolitis of various types develops - from catarrhal lung to necrotic. The spread of microorganisms beyond the respiratory bronchioles causes inflammation of the lung tissue - pneumonia. Due to the violation of bronchial patency, atelectasis foci appear. Reflexively, with the help of coughing and sneezing, the body tries to restore the bronchial patency, but as a result, the infection spreads to healthy tissues, and new pneumonia centers are formed. Oxygen deficiency, respiratory failure, and in severe cases heart failure develop. Most affected are the II, VI, X segments of the right lung and the VI, VIII, IX, X segments of the left lung. Often regional lymph nodes are involved in the process - bronchopulmonary, paratracheal, bifurcation.
In the 2013-2016 survey studies. revealed a relationship between the incidence of bacterial pneumonia and dental health. 441 people out of more than 26,000 patients had bacterial pneumonia at least once. People who had never attended preventive examinations of the dentist had a 86% higher risk of pneumonia than those who underwent oral rehabilitation regularly 2 times a year.
"Typical" pneumonia is characterized by a sharp rise in temperature, cough with copious purulent sputum and, in some cases, pleural pain. In the study: shortening of percussion sound, harsh breathing, enhanced bronchophony, enhanced voice tremor, first dry and then wet crepitus rales, darkening on the X-ray. This pneumonia is caused Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae.
"Atypical" pneumonia is characterized by a gradual onset, dry, unproductive cough, the prevalence in the clinical picture of secondary symptoms - headache, myalgia, pain and sore throat, weakness and indisposition with minimal changes on the radiograph. This type of pneumonia is usually caused Mycoplasma pneumoniae (mycoplasma pneumonia), Legionella pneumophila (legionella pneumonia), Chlamydia pneumoniae (chlamydia pneumonia), Pneumocystis jirovecii (pneumocystic pneumonia).
"Secondary": aspiration, septic, on the background of immunodeficiency, hypostatic, post-traumatic and others.
Aspiration pneumonia - develops after inhalation into the lungs of a foreign mass (vomit during the operation, loss of consciousness, trauma, neonatal aspiration of amniotic fluid during childbirth), while microbes - the causative agents of pneumonia - enter the lungs as part of this foreign mass. Aspiration pneumonia develops as a focal pneumonia.
- Computed tomography of the chest
- Paracentesis of the pleural cavity and pleural biopsy
- Bronchoscopy with biopsy
- Blood culture on nutrient media
- Detection of specific antibodies
- Lung biopsy
- Lung biopsy after diagnostic thoracotomy
- Analysis of urine
Antibiotics are the cornerstone of pneumonia treatment. The choice of antibiotic is carried out depending on the microorganism that caused pneumonia. Also used drugs that expand the bronchi and thinning sputum - inside or in the form of inhalation, corticosteroids, intravenous saline, oxygen. Sometimes pleural puncture and bronchoscopy are performed. Often used physiotherapy: ultraviolet radiation, vibration massage, therapeutic exercise, paraffin, ozokerite.
In case of an undetermined type of pathogen, antibiotic treatment of community-acquired pneumonia uses a combination of protected penicillins and cephalosporins (i.e., broad spectrum antibiotics), macrolides, and also carbapenems (thienes, meropenem), respiratory fluoroquinolones. With the ineffectiveness of therapy replace the antibiotic. The criterion of success of therapy is the normalization of body temperature on the third day from the start of antibiotic use, as well as data from an objective study and chest X-ray.
Vaccine prevention of pneumococcal infections Edit
According to the position of the WHO and the Russian Respiratory Society, "Vaccination is the only way to prevent the development of pneumococcal infection." In the Russian Federation, 94% of all etiologically decoded cases of complicated pneumococcal infection in children occur in pneumococcal community-acquired pneumonia. Pneumococcus causes up to 76% of community-acquired pneumonia in adult Russians. For vaccination against pneumococcal infection of persons older than 2 years in the United States since 1983, and in the Russian Federation since 1999, polysaccharide polyvalent vaccines containing 23 serotype antigens that cause up to 90% of invasive pneumococcal etiology have been successfully used. Vaccination is carried out once, followed by revaccination of patients from high-risk groups (over 65 and immunocompromised persons) after 5 years. The effectiveness of polysaccharide vaccines reaches 80%, but may be lower in the elderly, patients with immunodeficiency states, as well as in children under 2 years of age. These vaccines cause the formation of T-independent B-cell immunity.
Indications for use of the pneumococcal polysaccharide vaccine are as follows:
- all persons 65 years and older
- persons from 2 to 64 years old with chronic heart disease, lung, sickle cell anemia, diabetes mellitus, cirrhosis of the liver, suffering from alcoholism,
- persons from 2 to 64 years old with immunodeficiency diseases, such as: lymphogranulomatosis, lymphoma and leukemia, chronic renal failure, nephrotic syndrome, multiple myeloma, HIV infection, diseases of the spleen or asplenia, during organ transplantation,
- persons from 2 to 64 years old who receive immunosuppressive therapy (radiation therapy, a long course of corticosteroids or cytotoxic drugs),
- adults from 19 to 64 years old, suffering from bronchial asthma, and smokers,
- Persons staying in children's groups for a long time.
Currently, the Pneumo 23 polysaccharide vaccine (Sanofi Pasteur) is registered in the Russian Federation, and the Pnevmovaks 23 vaccine, which is popular in the US, is being registered. source not specified 3234 days
For children under 2 years of age, a 7, 10, or 13-valent pneumococcal vaccine conjugated with protein is used. It contains antigens of 7, 10 or 13 invasive pneumococci, respectively, causing 80% of all pneumococcal infections in children in developed countries. The vaccine forms a T-cell response and is highly immunogenic. In most developed countries, this vaccine is massively applied on national calendars from 2 months of age to 2 years, and also to children up to 5 years of age from risk groups. source not specified 3234 days
Currently, a registered conjugated pneumococcal vaccine “Prevenar” manufactured by Wyeth (USA) and Synflorix (manufactured by GlaxoSmithKline, Belgium) is used in the RF. Unlike the USA, where serotypes 14, 6B, 19F are included in Prevenar vaccine 18C, 23F, 4, and 9V cover 87% of isolates from sick children, serotypes 1 and 5 are very relevant in Asian countries, and in Russia - serotypes 1 and 3. Therefore, in the Russian Federation, children over 2 years old and adults in risk groups are most appropriate to use polysaccharide vaccine including these deficiencies Suitable serotypes. source not specified 3234 days
Vaccine prophylaxis for hemophilic pneumonia Edit
Haemophilus influenzae type B (CIB) is a widespread causative agent of severe infections, mainly in children under 6 years of age. Among the complicated pneumonia in developed countries, the proportion of CIB infection is 10-24%. source not specified 3234 days
Mass vaccination of children against CIB infection has reduced the incidence of hemophilic infections from 40-100 per 100 thousand in 1980 to 1.3 per 100 thousand in 1990. In developed and in many developing countries, mass CIB vaccination has reduced the incidence complicated pneumonia by 20% (for example, in Chile from 5.0 to 3.9 per 1000). Considering the fact that antibiotic resistance is growing among the CIB strains, the CIB vaccine is becoming ever more relevant. WHO recommends the inclusion of CIB vaccines in national calendars in all countries, noting that “a lack of data on morbidity should not prevent the introduction of CIB vaccines.” The CIB vaccine is recommended by the Ministry of Health of the Russian Federation for use where there are opportunities for this. Several foreign CIB vaccines have been registered in the Russian Federation (“Act-Hib” of the Aventis Pasteur company, HIBERIX of the Glaxo SmithKline company, etc.). source not specified 3234 days
The effectiveness of vaccination with polysaccharide vaccines in the Russian Federation is shown both in organized teams (in army teams, the incidence of pneumonia decreased 3 times, acute bronchitis - 2 times, acute otitis media and sinusitis - 4 times), and for risk groups. Thus, the incidence of respiratory diseases in frequently ill children after vaccination with 23-valent pneumococcal vaccine decreased from 6.54 to 0.67 cases per year per child, in children infected with mycobacteria of tuberculosis, the frequency of pneumonia and bronchitis decreased 7 times compared with with a control group receiving non-specific prophylaxis of respiratory infections.
In bronchial asthma in children, vaccination with 23-valent pneumococcal vaccine reduced the frequency of exacerbations of the underlying disease and the addition of respiratory infections (trigger of bronchial asthma) in 60% of children.
The high efficacy of pneumococcal vaccination in patients with COPD has been shown by both international and Russian studies (in Chelyabinsk, the vaccine efficacy index for patients with COPD was 4.6). The frequency of exacerbations (including pneumonia) in these patients decreased 2.4 times during the first year after vaccination.
Protein-conjugated pneumococcal vaccines significantly reduce the risk of invasive pneumococcal infections in children (under the age of 1 year by 82%), and, in addition, they form general population immunity, since young children are the main reservoir of invading pneumococci. Thus, in populations where, according to national calendars, children are grafted on a massive scale, adults are ill much less often.
In 2018, Pfizer published the results of KI vaccination of conjugated pneumococcal thirteen vaccine vaccine (PCV13). The study was conducted in Louisville in the format of a population-based observational prospective case-control study with negative control of adult patients. As part of the CI, patients with pneumonia were analyzed in order to identify vaccine-specific serotypes. The duration of hospitalization of patients with community-acquired pneumonia averaged 6 days. Studies have shown that immunization with pneumococcal vaccine PCV13 adults 65 years and older reduced the risk of their hospitalization caused by pneumonia by 73%.
Also, after pneumonia, almost every patient has scars on the lungs.
With the use of antibiotics, the prognosis is usually favorable. Intestinal flora after taking antibiotics, in most cases, is restored independently and does not require the use of drugs. In case of inadequate therapy or immunodeficiency, pneumonia can be fatal.