Characteristics of pneumococcal pneumonia, how dangerous it is, who is more often affected, symptoms and treatment of pathology. X-ray sign of pneumococcal pneumonia Pneumococcal pneumonia symptoms

Pneumococcal pneumonia is an etiological type of bacterial inflammation of the lungs, which is provoked by pneumococci. The clinical picture of the disease is dominated by febrile-intoxication and bronchopulmonary syndrome. The defeat of the body with pneumococcal infection can provoke meningitis and inflammation in the ENT organs. Severe inflammation of the lungs is highly likely to lead to the development of dangerous diseases.

Pneumococcal inflammation is caused by Gram-positive pneumococci bacteria. Their sources are carriers or infected people. Carriage is typical for a quarter of the adult population and half of the children attending educational institutions.

In addition, a high percentage of carriers is noted among medical workers, large manufacturing enterprises, and people living in camps or barracks. Most often, the pathology caused by pneumococci affects children under five years of age and people of advanced age. In the elderly, this disease can be fatal. Patients with chronic diseases of the liver, heart, lungs, with immunodeficiency and after transplantation are at risk.

Infection occurs by contact or airborne droplets. In cold weather, the probability of the latter increases several times. Factors that worsen prognosis in the diagnosis of pneumococcal pneumonia include:

extensive damage to the lung;
smoking;
alcoholism;
work in hazardous production;
cardiovascular pathologies with stagnation in the pulmonary circulation;
chronic diseases of the respiratory system;
chronic fatigue;
weak immunity;
children's age up to 2 years.

Clinical course

Pneumococcal pneumonia progresses very quickly, incubation is only 1 to 3 days. The severity of symptoms depends on the size of the lesion and the form of inflammation:

affects a small area, is easily tolerated with timely organization of therapy;
affects a third of the organ - begins abruptly and is characterized by a severe course;
lobar pneumococcal pneumonia - affects a lobe or several lobes of the lung at once - the most dangerous form.
high body temperature up to 39 - 40 degrees;
weakness, headaches, sleep disturbance and lack of appetite;
shortness of breath, rapid pulse, profuse sweating and chills;
dry cough, which gradually turns into wet with an admixture of pus;
pain in the chest on the affected side.

The clinical picture develops in 4 stages:

1. Initial - characterized by the formation of edema and accumulation of exudate.

2. Red seal.

3. Brown seal.

4. Permissions.

Important! The child is characterized by a severe course of infection with severe intoxication, when it is impossible to do without hospitalization.

The initial stage of pneumonia

Pneumococcal pneumonia begins acutely, abruptly, accompanied by:

rise in temperature immediately to 38 - 40 degrees;
chest pain;
unproductive cough;
a single chill.

The time of the initial period of the disease is 12 - 72 hours.

Red seal stage

This stage lasts about the same: 12 - 72 hours. At the same time, many red blood cells enter the lumen of the alveoli filled with exudate. Because of this, the exudate becomes airless and dense. Symptoms of the previous stage are supplemented by the following:

quickening of breathing;
dyspnea;
productive cough;
discharge of mucopurulent sputum with blood streaks;
progressive symptoms of intoxication - weakness, muscle pain, aches all over the body and lack of appetite.

In addition to the alveoli, pathology affects the pleura, mediastinum, lymph nodes, and interstitial tissue.

brown compaction stage

This stage is the longest - it takes 2 - 7 days. It is characterized by the penetration of leukocytes into the exudate. There is a breakdown of red blood cells, the shade of sputum changes. Symptoms are the same as in the previous stage.

Permission

This stage lasts no longer than 3 days. There is a subsidence of pathological processes in the body, the exudate is gradually absorbed under the influence of macrophages, pain is reduced and shortness of breath is relieved.

Diagnostics

Diagnosis of pneumococcal pneumonia against the background of bacteria multiplication is difficult, requires a thorough examination. For this, laboratory, instrumental and clinical methods are organized.

Pneumococcal inflammation can only be detected by culture of sputum samples and subsequent accurate diagnosis of the pathogen.

Through auscultation, the doctor diagnoses wheezing, weakening and sometimes the complete absence of pulmonary respiration at the site of maximum inflammation. A characteristic feature of the pathology is crepitus.

The x-ray shows the darkening of the entire lobe in the lung. When diagnosing computed spiral tomography, atelectases of various sizes are visualized.

Treatment of pneumococcal pneumonia

The doctor, after identifying the disease and its etiology, determines the need for hospitalization. Inpatient treatment is carried out for children under 6 years of age and some other groups of patients with such pathological conditions:

concomitant chronic diseases;
immunodeficiency;
disturbances of consciousness;
suspected aspiration of vomit or other fluid;
severe tachycardia;
shock state;
damage to 2 or more lobes of the lung;
no result after antibiotic therapy for 3 days.

Therapy is organized in a complex, necessarily includes the following methods:

compliance with the treatment regimen;
diet;
taking antibiotics;
pathogenetic treatment;
relief of symptoms;
therapy of concomitant pathologies and complications;
phytotherapeutic procedures, exercise therapy and massages.

Mode and nutrition for pneumococcal pneumonia

With fever, the patient must observe strict bed rest. The room must be ventilated, wet cleaning and quartzing as necessary.

Particular attention should be paid to the drinking regime - the patient needs to consume at least 3 liters of fluid per day. This will prevent dehydration caused by severe intoxication.

The diet should include fresh fruits, vegetables, necessarily proteins and easily digestible fats.

Antibiotic therapy for pneumococcal pneumonia

The method of administration of antibacterial drugs, the exact dose and time of the course corresponds to the severity of the lesion. Pneumococci are especially sensitive to such drugs:

from penicillins - Oxacillin, Ampicillin;
from fluoroquinolones - Ciprofloxacin;
from cephalosporins - Cefazolin,;
from carbapenems - Meropenem.

Pathogenetic therapy of pneumonia

Pathogenetic treatment corresponds to the severity of the course of inflammation and the severity of symptoms. It includes the following groups of drugs:

bronchodilators - Berodual, Atrovent;
expectorants - Lazolvan;
mucolytics - Mukaltin;
antioxidants - vitamin E, multivitamin complexes, rutin, vitamin C;
immunomodulators - Dekaris, Timalin;
bronchodilators - Eufillin.

The main goal of pathogenetic treatment is to restore the work of the bronchi, because without the removal of exudate, the recovery stage will not begin. With an unproductive cough, it must be converted into a wet one.

Important! Antioxidant therapy is equally important, as many free radicals that appear during inflammation damage the membrane of the alveoli and blood vessels.

Detoxification

Detoxification is the removal of various toxins from the body. It is carried out with the help of infusion of drugs - saline, gemodez, Ringer, lipoic acid, etc. Simultaneously, urination control is implemented. With severe intoxication, plasmapheresis and blood purification from toxins with the help of sorbents are required.

Symptomatic treatment

Symptomatic therapy involves the elimination of severe symptoms that provoke discomfort and pain. For this purpose:

antitussive drugs for severe dry cough - Libeksin, Kodterpin;
NSAIDs for pain in the chest, in order to reduce swelling of the interstitial tissue - Paracetamol, Aspirin;
cardiac preparations for the normalization of the contractile functions of the heart muscle - Cordiamin, Camphor oil.

Non-drug treatment

Methods of treatment with physiotherapy are prescribed at the stage of recovery. This helps to accelerate the resorption of exudate, restore microcirculation and activate immune functions. The most effective procedures include:

aeroionotherapy;
inhalation; with Bioparox;
electrophoresis with magnesium sulfate or calcium chloride;
UHF, microwave;
inductothermy;
mud, paraffin applications;
acupuncture.

Exercise therapy is allowed after 2 - 3 days from the moment of normalization of the temperature regime. Classes restore the vital capacity of the lungs, normalize ventilation and drainage of the bronchi, restore microcirculation.

Massage is allowed at any stage of the disease, but its techniques will differ. For this reason, only a professional should carry out manipulations. Massage restores bronchial drainage and microcirculation in the lung tissue.

Pneumococcal pneumonia is a dangerous disease that, if not properly treated, can be fatal. Children and the elderly with various chronic disorders in the body are susceptible to the development of pathology. Already at the first symptoms, you need to contact a specialist, delay provokes complications.

pneumococcal pneumonia- an etiological variety of bacterial pneumonia caused by Streptococcus pneumoniae (pneumococcus). The clinic of pneumococcal pneumonia is dominated by febrile-intoxication (severe weakness, anorexia, febrile temperature, chills) and bronchopulmonary (cough with sputum, shortness of breath, pain in the side) syndromes. Establishing the diagnosis is facilitated by a comprehensive assessment of physical, radiological, laboratory data. First-line antibiotics for the treatment of pneumococcal pneumonia are penicillins, cephalosporins, macrolides; additionally, detoxification, oxygen therapy, immunocorrection, physiotherapy are carried out.

pneumococcal pneumonia

Pneumococcal pneumonia is a form of pneumococcal infection that occurs in the form of focal bronchopneumonia or lobar pleuropneumonia. Pneumonias of pneumococcal etiology lead in the structure of bacterial pneumonias. S. pneumoniae is believed to cause about 30% of community-acquired and 5% of hospital-acquired pneumonias. The highest incidence is observed among children under 5 years of age and adults over 60 years of age. In about a quarter of cases, pneumococcal pneumonia occurs with severe pulmonary (pleurisy, lung abscess, pleural empyema) and extrapulmonary (pericarditis, arthritis, sepsis) complications.

Before the advent of the penicillin era, mortality from pneumococcal pneumonia exceeded 80%, now, thanks to vaccination and antibiotic therapy, this figure has dropped significantly. However, morbidity, morbidity, and mortality rates remain high, making pediatric and pulmonologists more alert to pneumococcal pneumonia.

Causes of pneumococcal pneumonia

Streptococcus pneumoniae, the causative agent of pneumococcal pneumonia, is a Gram-positive diplococcus. The bacterium is surrounded by a polysaccharide capsule, which serves as a factor determining the virulence and pathogenicity of pneumococcus, its ability to form antibiotic resistance. Given the structure and antigenic properties of the polysaccharide capsule, more than 90 serotypes of S.pneumoniae are isolated, 20 of which cause the most severe, invasive forms of pneumococcal infection (meningitis, pneumonia, septicemia).

Pneumococcus is a representative of the conditionally pathogenic human nasopharyngeal microflora. Bacteriocarrier S.pneumoniae occurs in 10-25% of healthy people. A bacteriocarrier or a patient with pneumococcal infection serves as a reservoir and distributor of the pathogen. Infection can occur in several ways:

airborne - by inhalation of mucus particles sprayed in the air containing the pathogen
aspiration - when the secretion of the nasopharynx enters the lower respiratory tract
hematogenous - from extrapulmonary foci of pneumococcal infection.

The risk category most susceptible to pneumococcal pneumonia is children under 2 years of age, the elderly over the age of 65, immunocompromised patients, people with asplenia, alcoholism and tobacco addiction. Factors that increase the likelihood of morbidity are hypothermia, nutritional deficiencies, hypovitaminosis, frequent acute respiratory viral infections, stay and close contacts in a team (in a kindergarten, hospital, nursing home, etc.). Up to 50% of pneumococcal pneumonias occur during an influenza pandemic because the influenza virus facilitates pneumococcal adhesion and colonization of the bronchial mucosa.

The development of pneumococcal pneumonia proceeds with the change of four pathomorphological phases. In the first (phase of microbial edema) lasting 12-72 hours, there is an increase in blood filling of the vessels with the release of exudate into the lumen of the alveoli. Pneumococci are detected in the serous fluid. The second phase of pneumonia (red hepatization) is characterized by the appearance of fibrinogen and erythrocytes in the exudate. The affected lung tissue becomes dense, airless, resembling liver tissue in consistency and color. This period lasts 1-3 days. The next phase (gray hepatization) lasting 2-6 days proceeds with a predominance of leukocytes in the exudate, due to which the lung acquires a grayish-yellow color. In the last period (resolution phase), the reverse development of changes begins: resorption of exudate, dissolution of fibrin, restoration of airiness of the lung. The duration of this period is determined by the severity of the inflammatory process, the reactivity of the macroorganism, the correctness of therapy.

Symptoms of pneumococcal pneumonia

The clinical picture of pneumococcal pneumonia consists of a number of syndromes inherent in acute pneumonia in general: intoxication, general inflammatory, bronchopulmonary and pleural. Inflammation of the lungs caused by pneumococcal infection usually occurs in one of two ways: in the form of lobar pneumonia (lobar pneumonia, pleuropneumonia) or focal pneumonia (lobular pneumonia, bronchopneumonia).

Croupous pneumonia manifests itself acutely, with a sudden rise in temperature to 38-40 ° C, a tremendous chill, a feverish blush on the cheeks. Signs of intoxication are significantly expressed: weakness, headache, myalgia, loss of appetite. Shortness of breath and tachycardia appear. Patients report chest pain on the side of the lesion when breathing and coughing. Dry, painful at first, the cough soon becomes loose, with brownish ("rusty") sputum. The course of croupous pneumococcal pneumonia is severe. Often there are complications in the form of acute respiratory failure, pleurisy, lung abscess, pleural empyema. Extrapulmonary and generalized complications develop less frequently: meningitis, endocarditis, nephritis, sepsis.

The onset of focal pneumococcal pneumonia is usually preceded by an episode of SARS. General weakness, high fatigue, severe sweating persist. Symptoms are generally similar to croupous pleuropneumonia, but less pronounced. The fever is less high and prolonged, the cough is moderate and not so painful. The course of focal pneumonia is usually moderate, complications are relatively rare. However, bronchopneumonia is more prone to a protracted course - often infiltrative changes in the lungs persist for more than one month.

Diagnosis of pneumococcal pneumonia

For pneumococcal pneumonia, certain physical data are characteristic, which change in accordance with the pathomorphological phase of the disease. At the stage of exudation, dullness of percussion sound, hard breathing, dry rales, and initial crepitus are determined. In the stage of hepatization, bronchophony appears, a pleural friction rub is heard. The stage of resolution is characterized by different-sized moist rales, sonorous crepitus, hard breathing, turning into vesicular.

X-ray examination (radiography of the lungs in two projections) allows visualizing pneumonic infiltration of the lung tissue (in the form of intense darkening of the lobe or focal shadow), determining the presence of pleural effusion. For the purpose of differential diagnosis with lung cancer, tuberculosis, atelectasis, linear and computed tomography (CT of the lungs) is used.

With pneumococcal pneumonia, changes in peripheral blood tests are pronounced. Typical neutrophilic leukocytosis, a sharp shift of the formula to the left, increased ESR. In a biochemical study of blood, the activity of the inflammatory reaction is indicated by a positive CRP, an increase in sialic acids, fibrinogen, haptoglobin, γ-globulins.

Etiological verification of pneumococcal pneumonia is carried out using a microscopic examination of sputum: accumulations of pneumococci are determined in Gram-stained preparations. Bacteriological sputum culture, serological reactions are also carried out (titers of antipneumococcal antibodies in paired blood sera increase on the 10-14th day of the disease).

Treatment of pneumococcal pneumonia

The modern approach to the treatment of pneumococcal pneumonia consists of basic, etiotropic, pathogenetic and symptomatic therapy. Hospitalization in a hospital is carried out according to clinical indications (children of the first year of life, elderly patients, persons with chronic concomitant diseases). For the period of fever, bed rest is prescribed, a full, calorie-balanced diet is recommended, drinking enough fluids.

Etiotropic therapy of pneumococcal pneumonia consists in the use of antibacterial drugs that have the greatest activity against S.pneumoniae. First of all, these are inhibitor-protected penicillins (amoxicillin, ampicillin), second-third generation cephalosporins (ceftriaxone, cefotaxime), macrolides (josamycin, spiramycin), carbapenems (imipenem, meropenem). Vancomycin is used to treat antibiotic-resistant strains of pneumococcus.

The pathogenetic approach to the treatment of pneumococcal pneumonia is based on detoxification therapy, the use of bronchodilators, cardioprotectors, anti-inflammatory and diuretics. Symptomatic therapy involves taking antipyretic, antitussive, expectorant drugs, conducting distraction and local therapy (inhalation, irrigation of the pharynx with antiseptic solutions). In the resolution phase, rehabilitation measures are added to drug treatment: breathing exercises, physiotherapy, chest massage, vitamin therapy. The total duration of treatment for pneumococcal pneumonia should be at least 3 weeks with dynamic x-ray control.

Forecast and prevention of pneumococcal pneumonia

Moderate pneumococcal pneumonia usually has a benign course and resolves within two to four weeks. Severe forms of infection are observed in young children, persons with severe intercurrent diseases and can be fatal due to the addition of various pulmonary and extrapulmonary complications.

In order to reduce the incidence rate and adverse outcomes, mandatory vaccination against pneumococcal infection has been included in the national preventive vaccination schedule since 2014. In addition to developing specific immunity, vaccination allows you to sanitize the upper respiratory tract from pneumococcal colonization and reduce the number of bacteria carriers. Nonspecific prevention of pneumococcal pneumonia consists of isolating patients, increasing overall resistance to infections, and timely treatment of acute respiratory viral infections.

Pneumonia pneumococcal

It remains the most common in children 6 months - 4 years old, occupying a significant place among pneumonias in older children. Of the 83 serotypes of pneumococcus, 20-25 cause more than 95% of all cases of pneumonia. Children lose a high level of maternal immunity to pneumococcus by the end of the first year of life, the increase in antibody titers (carriage, infection) accelerates after 3 years. A number of serotypes (3, 5, 9) are characterized by increased virulence; they, like other serotypes new to the patient, often cause complicated forms. According to cultures of pulmonary punctates, pneumococcus is often accompanied by Haemophilus influenzae in non-capsular form.

Clinical picture. Pneumococcal pneumonia occurs in different forms. "Classic" are croupous (lobar) and similar to it large-focal, in which a homogeneous shadow occupies 1-2 segments or has a spherical appearance. The onset is acute, with a temperature of up to 40-41 ° C, dry cough, sometimes with brown sputum, leukocytosis with a shift to the left, and an increase in ESR. Often there are herpes, redness of the cheek on the side of the lesion, pain (groaning) when breathing (dry pleurisy), often radiating to the stomach, which can divert the attention of the doctor from changes in the lungs.

In less reactive forms, the onset is not so violent, the physical picture corresponds to that of bronchopneumonia, on the radiograph there are inhomogeneous shadows in the zone of 1-2 segments with fuzzy boundaries. Blood changes are insignificant or absent.

Bilateral localization of the process is rare; usually this is a serious disease that occurs with complications.

Complications. Pneumococcus is the most common causative agent of pleurisy, pulmonary suppuration and pyopneumothorax. The presence of exudate in the pleura at the beginning of the disease (synpneumonic pleurisy) increases the likelihood of destruction. Pleurisy responds well to therapy without drainage, as evidenced by a decrease in cytosis and other signs of suppuration during repeated puncture. In many cases, however, it is “replaced” by the formation of a metapneumonic effusion with a cytosis below 1000 in 1 μl and an abundance of fibrin. Clinically, this is manifested by a rise in body temperature after 1-2 days of its decrease and the accumulation of exudate; ESR rises sharply, although the number of leukocytes in the absence of destruction decreases. Fever of a constant type or hectic, its duration is on average 7 days, but in the next 2-3 weeks there may be rises in body temperature, inferior to treatment with anti-inflammatory drugs (steroids, indomethacin); in adolescents, they may be a symptom of a tuberculosis outbreak. Echographic often reveal pericardial effusion that does not require special treatment.

In the presence of a focus of destruction, fever also persists against the background of effective therapy, leukocytosis (often against the background of metapneumonic pleurisy) until the abscess is emptied through the bronchus or into the pleural cavity. The cavity formed in the lung, most often thin-walled (bulla), in the first days with a fluid level, often tense due to the valve mechanism in the bronchus, gradually decreases and disappears after 2-4 weeks. Abscess with a dense wall is rarely formed, usually with superinfection (pseudomonas, anaerobes).

Small, non-tense pyopneumothorax can be treated without drainage; in many cases, however, drainage is unavoidable, often lasting up to 3 weeks.

Treatment. The drugs of choice are penicillin, ampicillin, chloramphenicol, lincomycin, first-generation cephalosporins (the last 3 drugs are used for intravenous therapy and penicillin intolerance), biseptol, macrolides; with metapneumonic pleurisy - non-steroidal anti-inflammatory drugs. Drainage of the pleural cavity with pleurisy does not accelerate recovery and does not reduce the frequency of destruction. The repeated puncture of a pleura is shown at increase in volume of an exudate. Puncture of the lung cavities or their bronchoscopic drainage is indicated only in rare cases after unsuccessful conservative treatment (antibiotics, mucolytics, drainage position).

Signs, diagnosis and treatment of pneumococcal pneumonia

Pneumococcal pneumonia is most often lobar pneumonia or focal bronchopneumonia. In the greatest number of cases, the disease occurs as a "home" or community-acquired infection. It is caused by a rather virulent and common pathogen - Streptococcus pneumoniae - pneumococcus.

Pneumococcal bacterium under a microscope.

Etiology and clinical picture of croupous inflammation

Pneumococci are representatives of the microflora of the human upper respiratory tract. When it enters the underlying respiratory sections, they cause inflammation even with the slightest decrease in protective mechanisms.

Microorganisms are immobile anaerobic rounded cells, diplococci, allowing growth in short chains. Resistant to some types of antibiotics. They are the source of pneumonia in more than 30% of detected cases.

Pneumococcal pneumonia - predominantly inflammation of one or two segments, less often - lobar. The upper lobe of the right lung and the lower lobe of the left lung are more commonly affected.

The two most common ways of infection are characteristic: endogenous - pneumonia often occurs as a secondary infection against the background of acute respiratory viral infections, bronchitis and airborne - mass transmission of the pathogen during an epidemic. There have been cases of intrauterine infection of the fetus.

General signs of the disease

Pneumonia begins acutely with symptoms of increasing weakness and intoxication up to depression of consciousness.

General condition: chills, severe weakness;
From the nervous system: headaches, insomnia;
On the part of the gastrointestinal tract: no appetite, flatulence, vomiting is possible, the tongue is covered with a white coating;
Skin: hyperemia of the face on the side of inflammation, the skin is moist. Herpetic eruptions in the lips, nose. During the development of pneumonia - acrocyanosis.
Breathing is frequent, shallow. Dyspnea. The affected side lags behind when breathing, the intercostal spaces are smoothed. In children, exhalation is accompanied by a groan.
From the side of the cardiovascular system: tachycardia up to 125 beats per minute, the pulse is not even, weak filling, pressure is reduced.

A fever develops rapidly up to 39-40 degrees C. The decrease in temperature occurs critically during the day with the development of hypotension, up to collapse and pulmonary edema. A pseudo-crisis is characteristic. With the timely start of treatment, the condition is more favorable, lytic, the temperature decreases within 1-2 days.

Involvement of the pleura - pain.

Pain in the chest makes the patient spare his breath, take a forced position lying on the healthy side, raising his torso. Localization depends on the focus of the inflammatory process. Possible pseudo-abdominal or meningeal syndromes, irradiation of pain. Lower lobe pneumonia mimics an "acute abdomen" and appendicitis.

At the beginning of pneumococcal pneumonia, cough with a small amount of expectorated sputum. The discharge is viscous, mucous, gray in color with an admixture of blood. The red-brown hue of the discharge increases with the development of the disease. On the second day, "rusty" sputum appears.

In the resolution phase of pneumonia, the sputum is mucopurulent and comes off easily.

Diagnostic picture

The beginning of the development of pneumonia is characterized by a dull-tympanic sound over the affected area. With the development of the process - a dull sound, without femoral (absolute) dullness.

In the resolution phase, a dull tympanic sound is determined. In the central and upper lobe forms of pneumonia, diagnosis based on physical signs is difficult due to the depth of the infiltration focus.

In the stage of hyperemia at the height of inspiration, wheezing is heard. Voice trembling and bronchophony are not expressed. Breathing is weakened. The most distinct auscultation in the phase of gray and red hepatization: bronchial breathing, vocal trembling and bronchophony are increased, scattered dry rales, crepitus is absent.

In the phase of resorption of the exudate, different-sized moist rales are determined, there is no crepitus, bronchial breathing weakens.

Laboratory indicators

Signs of inflammation and intoxication: leukocytosis, an increase in the number of segmented and stab cells with a decrease in lymphocytes, toxigenic granularity of neutrophils. The number of monocytes is increased. Eosinopenia. ESR is accelerated. thrombocytopenia. Atypical forms of croupous pneumonia occur with leukopenia.

The content of total protein in the blood serum decreases, mainly due to albumin. A sharp shift in the albumin-globulin ratio. Significantly increased fibrinogen. The content of urea and glucose at the peak of pneumonia is increased.

The specific gravity of urine increases. Protein, cylindruria, hematuria appear. Perhaps the appearance of bile pigments.

The X-ray picture of the onset of pneumonia is not expressed, an increase in the lung pattern is determined, diffuse darkening without clear boundaries. In the development of pneumonia - homogeneous infiltration without foci of destruction in the projection of the affected area. The root of the lung is expanded, not structured.

The stage of regression is radiographically determined by a decrease in the intensity of the shadow, which indicates the resorption of the infiltrate. Strengthening of the lung pattern and signs of compaction of the pleura are preserved. Normalization of the picture occurs approximately after 30 days.

Who is at risk

Risk groups for pneumococcal pneumonia:

Persons over the age of 65, a special risk group - living in nursing homes, located in departments of round-the-clock stay, having diseases of the cardiovascular system;
Children, a special risk group - organized children attending preschool institutions prone to frequent acute respiratory infections;
All immunocompromised;
Persons with asplenia;
Subjected to systematic hypothermia, mental overstrain, experiencing nutritional deficiencies;
Persons who are constantly in a close team: military personnel, prisoners.

Prevention and treatment of pneumococcal pneumonia

Non-specific prophylaxis:

compliance with the rules of a healthy lifestyle;
rejection of bad habits;
compliance with the rules of rational nutrition;
hardening;
adequate and timely treatment of viral infections;
sanitation of carriers of pneumococcal infection.

Specific prophylaxis: vaccination with pneumococcal vaccine, which has shown good clinical results. The vaccine is administered once. High-risk groups are being revaccinated.

Timely antibacterial treatment with drugs with anti-pneumococcal activity. Depending on the severity of the course, the reception is prescribed periorally, intramuscularly, intravenously. It is possible to carry out stepwise therapy.
Detoxification therapy;
Mucolytics;
Bronchodilators;
Analgesics;
oxygen therapy;
Immunocorrectors;
Physical treatment UHF, exercise therapy, inhalation.

Possible complications and prognosis

A protracted course of pneumonia is observed in 40% of patients, which depends on age, body condition, pathogenicity of the pathogen, localization of the process, and the success of therapy. With adequate treatment, the onset of resorption of the exudate occurs on the 7-8th day.

Scientific classification of staphylococcus:
Domain:
Type of: Firmicutes (firmicutes)
Class: bacilli
Order: Lactobacillales (Lactobacilli)
Family: Streptococcaceae (Streptococcal)
View: Pneumococcus (Streptococcus pneumoniae)
International scientific name: Streptococcus pneumoniae

Pneumococcus (lat. Streptococcus pneumoniae) is a spherical or egg-shaped bacterium belonging to the Streptococcal family (Streptococcaceae).

Other names for pneumococcus: Weikselbaum's diplococcus, Frenkel's diplococcus.

Pneumococcus is the most common causative agent of a disease such as -. Mortality of pneumonia is up to 5% of cases. Other diseases of pneumococcal etiology include otitis, sinusitis, laryngitis, tracheitis, bronchitis, meningitis, sepsis and others. Especially pneumococcal infection often causes exacerbation of broncho-pulmonary diseases in children.

Characteristics of streptococci

Like other types of streptococci, pneumococci most often exist in pairs, sometimes lining up in chains. The size of the bacterium is 0.5-1.25 microns. Behaviorally, pneumococcal infection is non-motile, anaerobic, Gram-positive. Rapid reproduction occurs with an increase in carbon dioxide. The basis of pneumococcus is peptidoglycan, together with surface proteins, carbohydrates, lipoproteins and teichoic acids, and all this is in a protective powerful polysaccharide capsule that prevents opsonization.

The classification of pneumococci includes up to 100 strains of these bacteria.

Diseases that can cause pneumococci

The most common diseases of pneumococcal nature are:

Septic arthritis;
otitis media;
(rhinitis (runny nose), sinusitis, ethmoiditis, sphenoiditis and frontal sinusitis);
Pneumonia (community-acquired);

The most popular pneumococcal diseases are pneumonia (about 70%), otitis media (about 25%), meningitis (from 5 to 15%) and endocarditis (about 3%).

In addition, pneumococcal infection can join existing diseases of other types of infection -, etc.

How to inactivate pneumococcus?

The bacterium pneumococcus dies when:

their treatment with solutions of antiseptics and disinfectants;
exposure to antibacterial agents.

How is pneumococcus transmitted? The conditions under which a person begins to get pneumococcal disease usually consist of two parts - exposure to infection and weakened immunity. However, a person can become seriously ill with ordinary contact with this type of bacteria, when its amount in the air is at a high concentration.

Consider the most popular ways of contracting pneumococcal infection:

How can pneumococcus enter the body?

Airborne route. The main route of infection with pneumococcal infection is airborne. Cough and a nearby person is the root cause of the majority. The insidiousness of pneumococcal infection lies in the fact that its carrier is often unaware of his own role, because. it may not cause any symptoms in its carrier. It is also worth noting that during the period, in the air, especially indoors, the concentration of, and other species increases. That is why the first victims are people who often stay or work in crowded places.

Air-dust path. Dust, including house dust, consists of many particles - plant pollen, animal hair, particles of peeled skin and paper, as well as viruses, bacteria, fungi and other infections. The presence of a person in rooms where little or rarely is cleaned is another factor contributing to infection.

Contact-household way. Most types of infection do not die on their own, therefore, sharing the same kitchen utensils and personal hygiene items with a sick person increases the risk of getting sick.

hematogenous route. Infection occurs when a person's blood comes into contact with an infected object. Frequent patients are people who inject drugs.

medical path. Infection occurs when using, for example during a routine examination, contaminated medical equipment/instruments.

How can pneumococcus seriously harm a person's health, or what weakens the immune system?

As we said, the second factor that contributes to the development of pneumococcal disease is a weakened immune system, which performs the protective function of the body. So, when an infection enters the body, the immune system produces special antibodies that, reaching the source of infection or settling the infection, stop it and destroy it. If the immune system is weakened, there is no one to fight the infection, except medicines.

Consider the main causes of weakened immunity:

The presence of chronic diseases - any disease in the body of a chronic form indicates that the immune system cannot cope with it on its own, while the disease gradually continues to harm health;
The presence of other infectious diseases - sinusitis, broncho-pulmonary diseases,;
Insufficient amount of vitamins and minerals in the body ();
Bad habits - smoking, drugs;
Sedentary lifestyle;
Lack of healthy sleep, chronic fatigue;
Abuse of certain drugs, especially antibiotics;
Very often pneumococcal infection is brought into the house by children - from school and kindergarten. This is facilitated by close contact between children, as well as not fully developed immunity. Further, if certain preventive measures are not observed in the house, the disease develops in adults.

At-risk groups

Consider a group of people who are at increased risk of contracting pneumococcal disease:

Elderly people, from 60 years old and children;
Persons working in crowded places - office workers, drivers and conductors of public transport, employees of large enterprises, employees of medical institutions, employees of nursing homes and educational institutions, military personnel.
People who have chronic diseases and systems, as well as diseases such as diabetes, emphysema, kidney disease, HIV.
Persons who consume alcoholic beverages, smokers.
Persons who like to walk in frosty and/or cool damp weather without a hat, in short jackets, thin trousers and other clothes due to which the body is exposed to hypothermia.
Persons who have had other infectious diseases - SARS, acute respiratory infections, influenza, and others.

Symptoms of pneumococcus

The symptoms (clinical picture) of pneumococcal diseases are very extensive, and largely depend on the place (organ) in which the infection settled, the strain of pneumococcus, human health and the state of his immunity.

Common symptoms of pneumococcus may include:

, malaise, and ;
Difficulty breathing, sneezing, ;
Elevated and high body temperature,;
, sometimes strong;
, violation of consciousness;
Photophobia;
Violation of the sense of smell;
, sometimes with ;
All types -, and;
Diseases of the respiratory system: pharyngitis, laryngitis, tracheitis, bronchitis and pneumonia;

Complications of pneumococcus:

Inflammation of the heart muscle -, endocarditis,;
Purulent otitis;
Decrease or loss of voice or hearing;
lung abscess;
Sepsis;
mental retardation;
Stiffness of movements;
Epilepsy;
Fatal outcome.

Important! Some clinical complications can sometimes accompany a person for the rest of his life.

Diagnosis of pneumococcus

Testing for pneumococcus is usually taken from swabs taken from the oropharynx (for diseases of the upper respiratory tract), sputum from the nose and blood.

Thus, the following tests and methods for examining the body with pneumococcal infection are distinguished:

Bacteriological culture of sputum and swabs taken from the nasal cavity and oropharynx;
internal organs;
lungs;

How to treat pneumococcus? Treatment of pneumococcus usually consists of several points:

1. Antibacterial therapy;
2. Strengthening the immune system;
3. Restoration of normal intestinal microflora, which is usually disturbed by the use of antibacterial drugs;
4. Detoxification of the body;
5. Antihistamines - prescribed for children with allergies to antibiotics;
6. Symptomatic therapy;
7. With a simultaneous illness and other diseases, their treatment is also carried out.

Treatment of pneumococcal diseases in any case begins with a visit to the doctor and the patient undergoing diagnostics. This must be done to exclude other types of infection, as well as to check the resistance (susceptibility) of the infection to a particular antibacterial drug.

Before considering antibiotics for pneumococcal disease, consider their interaction (resistance).

Antibiotic resistance

Doctors note a not very favorable trend in the treatment of pneumococcal infection. Thus, from year to year, all over the world, resistance (resistance) of pneumococci to antibacterial drugs of the penicillin and tetracycline series, as well as macrolides, has been noticed, and resistance to antibiotics is gradually increasing. The most resistant pneumococci are in America, Western Europe, Asia, the least in Germany, the Netherlands. If we talk about superficial reasons, then this was largely facilitated by the availability of antibiotics to any person, even without prescriptions. The fact is that incorrectly selected antibiotics, or a course of therapy with this group of drugs, contribute to the development of an infection of a certain immunity to these drugs in the future, the bacteria mutate, their new strains develop. In some countries, such as Germany, it is just impossible to buy antibiotics without a doctor's prescription, and therefore, many infectious diseases of a bacterial nature are more easily treatable, and the number of complications, and, accordingly, deaths is much less.

The highest resistance of pneumococci in the territories of Russia and Ukraine is observed in relation to tetracycline (40%) and co-trimoxazole (50%).

1. Antibacterial therapy

Important! Before using antibiotics, be sure to consult your doctor.

In brackets, after the name of the antibiotic, the percentage of resistance of the bacterium to the drug is indicated (in Russia, as of 2002-2012).

Antibiotics against pneumococci for internal use: Amoxicillin and Amoxicillin-Clavulanate (0.5%), Vancomycin (1%), Levofloxacin (1%), Rifampicin (1%), Clindamycin (2%), Cefotaxime "(2%), "Cefepim" (2%), "Ciprofloxacin" (2%), macrolides (from 7 to 26% - "", "Claritomycin", "Midecamycin", "Spiramycin", ""), Chloramphenicol (5%), "Penicillin" (29%), "" (40%), "Co-trimoxazole" (50%).

The course of antibiotic therapy is prescribed individually by the attending physician. Usually it is 5-10 days.

Antibiotics against pneumococci for topical use: Bioparox, Hexoral.

Important! Often, a doctor for the treatment of a disease selects a combination of 2 antibacterial drugs that must be taken at the same time.

2. Strengthening the immune system

To strengthen the immune system and stimulate its work, in combination with antibiotics, a reception is prescribed - immunostimulants: Immunal, IRS-19, Imudon.

A natural immunostimulant is, which is present in large quantities in the composition, cranberries, and sea buckthorn.

3. Restoration of normal intestinal microflora

While taking antibacterial drugs, they also get inside the intestines, destroy the beneficial microflora that contributes to the normal absorption of food and participates in other important processes of the body's life. Therefore, when taking antibacterial drugs, the use of probiotics, which restore the normal intestinal microflora, has recently become increasingly popular.

Among the probiotics can be identified: "Acipol", "Bifiform", "Linex".

4. Detoxify the body

Pneumococcal infection, while inside the body, poisons it with the products of its vital activity. Intoxication with infectious enzymes contributes to the deterioration of the course of the disease, causing symptoms such as nausea, vomiting, loss of strength, hallucinations and delirium.

To remove the waste products of the infection from the body, detoxification therapy is prescribed, which includes:

drinking plenty of fluids (up to 3 liters of fluid per day, preferably with the addition of vitamin C);
rinsing the nose and oropharynx with a weak saline solution or furacillin solution;
taking detoxification drugs: "Atoxil", "Albumin", "Enterosgel".

5. Antihistamines

Antihistamines are prescribed if, when taking antibiotics, a person has an allergic reaction - itching of the skin, rash, redness and other manifestations.

Among antihistamines, one can distinguish: "", "", "Cetrin".

6. Symptomatic therapy

To stop the symptoms of pneumococcal diseases and alleviate their course, symptomatic therapy is prescribed.

At high body temperature: cool compresses on the forehead, neck, wrists, armpits. Among the drugs can be identified - "", "".

For nasal congestion- vasoconstrictor drugs: Knoxprey, Farmazolin.

Important! Before using folk remedies, be sure to consult your doctor.

Pneumococcus is a representative of the flora of the upper respiratory tract, causes pneumococcal pneumonia. The disease often occurs after damage to the lungs by influenza, tonsillitis. This allows pneumococci to infect the lungs. Pneumococcal pneumonia can also enter the bloodstream, the middle ear, the lungs, and the nervous system. Healthy people can carry pneumococcus. Pneumococcus most often causes inflammation of the entire lobe of the lung or most of it. Pneumococcus is the most common causative agent of pneumonia.

Pneumococcal pneumonia usually manifests itself in two forms: croupous and focal pneumococcal pneumonia. Croupous pneumonia is lobar and pleuropneumonia. Focal pneumonia is lobular and bronchopneumonia.

Risk group

The disease usually affects young children under 5 years of age and older adults 65 years of age and older. In older people, the disease can be very severe and lead to death.

The risk group consists of people with chronic diseases of the heart, liver, lungs, HIV and AIDS infected or people who have undergone organ transplantation.

Clinical features and diseases of pneumococcal pneumonia

Croupous pneumonia. This form of the disease usually begins suddenly, acutely. The temperature rises quickly, the patients feel chills, and there are sharp pains in the chest during breathing. Initially, the cough is dry and painful. Then brown viscous sputum with blood streaks begins to appear. An asymmetric blush appears on the patient's cheeks. The patient has rapid breathing. This form of the disease is usually severe. But modern drugs can reduce the duration of the fever and speed up recovery. Complications after the disease can lead to the development of purulent processes, pleurisy, abscesses. Less rare complications of the disease are meningitis, hepatitis, endocarditis, nephritis, peritonitis.

Focal pneumonia. Usually appears on the background of acute respiratory infections, which causes bronchitis. The clinical picture has the same syndromes as in the lobar form of pneumonia, but they are much less pronounced. The patient's body temperature is not very high, the fever is short-lived. The patient is more concerned about general weakness. Sweating, high fatigue, shortness of breath are also observed. The disease is accompanied by a dry moderate cough. However, it may contain mucopurulent sputum. The skin is pale. Focal pneumonia usually occurs in mild or moderate forms. Complications of the disease are less common than with the croupous form of pneumonia.

Diagnosis of the disease

Diagnosis of pneumococcal pneumonia is based on the detection of pneumococcus in sputum. With this disease, the following diagnostic methods are carried out: laboratory tests, bacteriological culture, chest x-ray and physical examination.

The doctor asks the patient about age, the presence of concomitant diseases that can cause the development of pneumococcal pneumonia. When examining a patient, the respiratory rate is determined.

Laboratory data

With the disease, changes in the general blood test are observed. There is usually marked leukocytosis. The number of neutrophils also increases significantly. The leukocyte formula shifts to the left. During the peak period, eosinophils disappear, the number of platelets and lymphocytes decreases markedly. With recovery, all indicators are normalized.

Signs of the disease reveals a biochemical blood test: increased levels of globulins, fibrin, seromucoid, haptoglobin, sialic acids.

Physical examination data

Typical physical manifestations of lobar pneumococcal pneumonia depend on the form of the disease.

The initial stage is the phase of exudate accumulation. There is a dull sound over the affected focus. The patient's breathing is hard, elongated breath, dry, wet rales are sometimes heard.

Resolution stage. Voice trembling gradually normalizes, bronchophony disappears. Loud wheezing is heard. Bronchial breathing will be replaced at first by hard, and then by vesicular breathing. However, this pattern of phases of pneumococcal pneumonia may not always be observed.

In the focal form of the disease, physical data are less demonstrative.

X-ray studies

In the initial period of pneumococcal pneumonia, radiographic changes are very weakly expressed or may be absent altogether. The most characteristic changes appear in the phase of compaction of the lung tissue. With a lobar form of pneumonia, a strong darkening of the lobe of the lung is clearly visible on the radiograph.

The focal form of pneumococcal pneumonia is characterized by a focal shadow of local compaction.

X-ray of the lungs is carried out in two projections to identify the presence of pneumonia and severity.

Treatment of pneumococcal pneumonia

mild form of the disease. Use oral bactericidal antibiotics such as ampicillin, phenoxymethylpenicillin, 1st generation cephalosporins. If the patient has intolerance to the above drugs, then prescribe erythromycin, biseptol.

The average form of the disease. For treatment, intramuscular administration is prescribed every 4 hours.

Complicated form of the disease. In these cases, the dose of penicillin is doubled to improve drug penetration.

With a mild form of focal pneumonia, patients can be treated at home. The local therapist constantly monitors the patient.

However, a patient with lobar or focal pneumonia, in moderate or severe forms, needs urgent hospitalization. Elderly people, patients who do not have the opportunity to be treated at home, are also subject to hospitalization.

Patients need to provide high-calorie nutrition. Recommended: easily digestible food rich in vitamins; breathing exercises, vitamin therapy are rehabilitation measures. It is also useful to take infusions of medicinal herbs with expectorant capabilities. An important stage for rehabilitation will be treatment in sanatoriums and resorts.

Prognosis of pneumococcal pneumonia disease

Usually, with primary pneumonia, the prognosis of the disease is favorable. The patient usually recovers in 15-25 days. Croupous, focal pneumonia of moderate or severe forms can be fatal.

Ways to prevent the disease

An important tool in the prevention of the disease is the final treatment of tonsillitis and acute respiratory diseases. Also, for the prevention of pneumonia helps playing sports, proper nutrition, rich in vitamins. It is necessary to stop the abuse of alcohol and smoking.

Modern medicine has created a vaccine to prevent pneumococcal pneumonia. Vaccination protects people at risk from pneumonia.

Pneumococcal bacterium under a microscope.

Etiology and clinical picture of croupous inflammation

Pneumococcal pneumonia - predominantly inflammation of one or two segments, less often - lobar. The upper lobe of the right lung and the lower lobe of the left lung are more commonly affected.

Pneumonia begins acutely with symptoms of increasing weakness and intoxication up to depression of consciousness.

General condition: chills, severe weakness;
From the nervous system: headaches, insomnia;
On the part of the gastrointestinal tract: no appetite, flatulence, vomiting is possible, the tongue is covered with a white coating;
Skin: hyperemia of the face on the side of inflammation, the skin is moist. Herpetic eruptions in the lips, nose. During the development of pneumonia - acrocyanosis.
Breathing is frequent, shallow. Dyspnea. The affected side lags behind when breathing, the intercostal spaces are smoothed. In children, exhalation is accompanied by a groan.
From the side of the cardiovascular system: tachycardia up to 125 beats per minute, the pulse is not even, weak filling, pressure is reduced.

Body temperature.

Involvement of the pleura - pain.

In the resolution phase of pneumonia, the sputum is mucopurulent and comes off easily.

Percussion.

auscultatory.

In the phase of resorption of the exudate, different-sized moist rales are determined, there is no crepitus, bronchial breathing weakens.

Laboratory indicators

The specific gravity of urine increases. Protein, cylindruria, hematuria appear. Perhaps the appearance of bile pigments.

X-ray study.

Who is at risk

Risk groups for pneumococcal pneumonia:

Persons over the age of 65, a special risk group - living in nursing homes, located in departments of round-the-clock stay, having diseases of the cardiovascular system;
Children, a special risk group - organized children attending preschool institutions prone to frequent acute respiratory infections;
All immunocompromised;
Persons with asplenia;
Subjected to systematic hypothermia, mental overstrain, experiencing nutritional deficiencies;
Persons who are constantly in a close team: military personnel, prisoners.

Prevention and treatment of pneumococcal pneumonia

Non-specific prophylaxis:

compliance with the rules of a healthy lifestyle;
rejection of bad habits;
compliance with the rules of rational nutrition;
hardening;
adequate and timely treatment of viral infections;
sanitation of carriers of pneumococcal infection.

Specific prophylaxis: vaccination with pneumococcal vaccine, which has shown good clinical results. The vaccine is administered once. High-risk groups are being revaccinated.

Methods of treatment.

Timely antibacterial treatment with drugs with anti-pneumococcal activity. Depending on the severity of the course, the reception is prescribed periorally, intramuscularly, intravenously. It is possible to carry out stepwise therapy.
Detoxification therapy;
Mucolytics;
Bronchodilators;
Analgesics;
oxygen therapy;
Immunocorrectors;
Physical treatment UHF, exercise therapy, inhalation.

Possible complications and prognosis

Possible complications: pleurisy, abscess formation. Meningitis, bacteremia, pericarditis occur much less frequently.

In young people, competent treatment ensures a positive outcome of the disease. A high degree of risk persists in the elderly, burdened with concomitant pathologies, as well as in the development of an atypical course of pneumonia.