Medicine inflammation of the lungs. Pneumonia - symptoms in adults. By what signs can you determine pneumonia at home. Diagnostic criteria for determining pneumonia in the elderly

Content

Infectious inflammation of the lungs is a dangerous disease that often progresses in patients under 2 years of age and over 65 years of age. People with a weakened immune system are at risk. If you find out how pneumonia develops, then a person will become afraid for his health, and he will definitely take care of timely prevention, prevent the disease.

The first symptoms of pneumonia in an adult

The main task of the doctor is to timely differentiate the characteristic ailment, since its symptoms are similar to those of the flu and the common cold. At first, the patient does not pay attention to changes in general well-being, referring to a cold. The first signs of pneumonia characterize the stage of the tide, which is represented by migraine attacks and severe chills. Additional symptoms are listed below:

• weakness of the limbs (feeling when "cotton legs");
• minor violations of the temperature regime;
• dry cough;
• dyspnea;
• periodic flushes, which are replaced by a state of cold sweat.

Specific symptoms of pneumonia

When a patient does not react in any way to changes in the general condition for a long time, the course of the pathology only intensifies. If the first signs of pneumonia in adults reduce performance, but allow you to carry the disease on your feet, then the specific symptoms of the disease become a strong argument for the immediate hospitalization of a clinical patient. It:

• high fever, fever with possible hallucinations;
• cough with streaks of blood in the separation of sputum;
• accumulation of carbon dioxide in the blood, impaired gas exchange of lung tissue;
• prolonged sneezing;
• increasing pain in the head;
• decreased physical activity, constant fatigue.

Extrapulmonary syndromes in pneumonia

It is important to note that this is an infectious disease that is caused by increased activity of the pathogenic flora. This may be a fungal, bacterial, mixed and mycoplasmal nature of the pathology, but doctors do not exclude the increased activity of other dangerous pathogens that have not been studied clinically. Having noticed the first signs of pneumonia, the patient can prevent the development in the near future of such extrapulmonary complications as:

• heart failure;
• myocarditis, endocarditis;
• infectious-toxic shock;
• symptoms of iron deficiency anemia;
• meningoencephalitis and meningitis.

How pneumonia manifests itself with bilateral inflammation

Not all patients know how to determine pneumonia at home, so you should not experiment with your health and start the pathological process. Otherwise, doctors do not exclude inflammation of the vital organ on both sides. If bilateral pneumonia progresses, the symptoms are atypical, detailed below:

• blue lips, fingertips;
• heavy, confused breathing;
• continuous dry cough with sputum;
• shortness of breath, weakness in the whole body;
• lack of appetite.

If bilateral pneumonia progresses, symptoms in adults begin with a high temperature that exceeds 38.5 degrees. The patient begins to have a fever, the disease progresses, and requires immediate resuscitation. The clinical outcome depends entirely on how soon the patient and his immediate environment respond to signs of pneumonia in an adult.

Syndromes with pneumonia of various types

If the signs of lung disease are obvious, it is problematic to determine the nature of the pathogenic infection in community settings. The sluggish pathological process only complicates the clinical picture, and the disease may soon acquire an already incurable chronic form. To avoid complications, it is important to know the manifestation of pneumonia for a particular nature of the pathological process.

Symptoms in adults of viral pneumonia are as follows:

• heat;
• progressive rhinitis, conjunctivitis;
• dry cough;
• nausea, lack of appetite, less often - vomiting.

Symptoms of bacterial pneumonia in adults are:

• fever;
• cough with yellow mucus;
• chest pain;
• symptoms of arterial hypertension in adults;
• lack of appetite, weight loss.

Symptoms of fungal pneumonia in adulthood are as follows:

• dry cough, myalgia;
• the presence of streaks of blood in the sputum;
• opening of the abscess, the spread of pus into the pleura;
• soreness of the lymph nodes;
• cardiovascular failure.

Signs of pneumonia in an adult of mycoplasmal nature are similar to the fungal form, require immediate medical attention, diagnosis. A mixed variety of the disease is characterized by symptoms of acute respiratory viral infections, flu and colds, but occurring in a complicated form. The disease must first be identified, and then transgressed to immediate antibiotics.

What are the symptoms of pneumonia of various forms

If a disease is suspected, differential diagnosis is required first. If we classify the main symptoms of pneumonia in adults, we can distinguish atypical, interstitial, croupous and focal (bronchopneumonia) forms of this disease. The clinical outcome depends entirely on the precise definition of the clinical picture. Below is a detailed description of the symptoms of inflammation of the lungs in adults with one form or another of the disease.

With an atypical form of pneumonia in an adult, the following signs of pathology take place:

• manifestations of a cold, SARS, flu, familiar to patients;
• other symptoms depend on the nature and activity of the pathogen.

The focal form of the disease has the following symptoms in the body of an adult patient:

• separate sections of the alveoli and neighboring bronchi are involved;
• sluggish pathological process at an early stage, resembling the symptoms of SARS;
• high temperature from 38 degrees;
• separation of sputum with impurities of bile, pus, mucus;
• acrocyanosis, cyanosis;
• paroxysmal chest pains;
• pronounced shortness of breath.

The croupous form of pneumonia in adults is manifested in the body by the following symptoms:

• body temperature up to 40 degrees;
• cutting pain behind the sternum;
• general weakness, aches all over the body;
• unproductive cough with rusty sputum;
• fine bubbling rales;
• persistent fever;
• hyperemia of the skin of the fingers, lips, cheeks.

The interstitial (hidden) form of a characteristic ailment is manifested by the following changes in general well-being:

• increasing shortness of breath and cough;
• pain in the joints and muscle tissues;
• absence of bronchial obstruction;
• pulmonary hypertension;
• sharp weight loss;
• lack of temperature and sputum with blood.

How to identify pneumonia

At the first signs of the disease, it is important to urgently undergo a complete diagnosis in a hospital setting. This is a really working method, how to recognize inflammation of the lungs in adults and proceed to intensive care in a timely manner. Differentiating the diagnosis is very problematic, so doctors resort to a comprehensive clinical examination, which includes a number of laboratory blood tests. Mandatory medical measures necessary for the patient are presented below:

1. Palpation method at the doctor's appointment for probing compacted lung tissue. On the side of the lesion, the patient's voice will begin to tremble, somewhat changing its usual tone.
2. X-ray examination. The method helps to determine the lesions of the lung tissue, their number, specificity, structure and prevalence in the broncho-pulmonary system.
3. Fibrobronchoscopy. An invasive diagnostic method in complicated clinical pictures, which studies the composition of the secret taken from the patient's respiratory tract.
4. Ultrasound of the pleural cavity, echocardiography. The method helps to identify pleural effusion.
5. General blood and urine tests. Additionally, it does not hurt to perform a laboratory test for HIV.
6. Sputum backtest. This method determines individual antibiotic susceptibility to accurately determine a safe intensive care regimen.

Pneumonia is an acute infectious and inflammatory disease with focal lesions of the respiratory sections of the lungs, intraalveolar exudation, severe febrile reaction and intoxication.

Classification of pneumonia

1. Community-Acquired Pneumonia Develops at home and is the most common form of pneumonia. Its causative agents are often pneumococci, streptococci, Haemophilus influenzae and other gram-positive microorganisms.
2. Nosocomial pneumonia (synonyms: hospital-acquired, nosocomial). It develops during the patient's stay in the hospital for another disease, but not earlier than 48-72 hours after hospitalization or 48 hours after discharge from the hospital.
3. Aspiration pneumonia occurs in patients with impaired consciousness (stroke, eclampsia attack, traumatic brain injury), as well as in the aspiration of food, vomit, foreign bodies, in violation of the cough reflex.
4. Pneumonia in persons with severe immunity defects (congenital immunodeficiency, HIV infection).

By clinical and morphological course of pneumonia:

1. Lobar (croupous) pneumonia is characterized by damage to an entire lobe (less often a segment) of the lung with involvement of the pleura in the inflammatory process;

1. acute onset with severe clinical manifestations
2. fibrinous nature of the exudate
3. damage to the alveolar tissue and respiratory bronchioles with preservation of airway patency
4. staging in the development of inflammation

2. Focal pneumonia (bronchopneumonia) is characterized by damage to the lobule or segment of the lung;

1. gradual onset and less pronounced clinical manifestations;
2. serous or mucopurulent nature of the exudate;
3. violation of the patency of the respiratory tract;
4. there is no staging in the development of inflammation.
   

The severity of pneumonia is determined by the severity of clinical manifestations, and according to this, they distinguish:

1.Mild severity

Body temperature up to 38°C, respiratory rate (RR) up to 25 per minute, heart rate (HR) up to 90 per minute, mild intoxication and cyanosis, no complications and decompensation of concomitant diseases.

2.Medium severity

Body temperature - 38-39 ° C, respiratory rate 25-30 per minute, heart rate 90-100 per minute, tendency to arterial hypotension, moderate intoxication and cyanosis, complications (pleurisy), decompensation of concomitant diseases unexpressed.

3. Severe severity

Body temperature above 39°C, respiratory rate> 30 per minute, heart rate> 100 per minute, pronounced intoxication and cyanosis, blood pressure system.<90 мм рт. ст, АД диаст. <60 мм рт.ст., наличие осложнений (эмпиема, инфекционно-токсический шок, токсический отек легких и др.), выраженная деком-пенсация сопутствующих заболеваний.

community-acquired pneumonia

Etiology (causes of pneumonia)

The etiology of pneumonia is associated with the typical microflora that colonizes the upper respiratory tract, but only some of them, which have an increased virulence, are capable of causing an inflammatory response when they enter the lower respiratory tract.

Typical bacterial pathogens of pneumonia:

• pneumococcus Streptococcus pneumoniae
• hemophilic bacillus Haemophilus influenzae.

Rare bacterial pathogens

• Staphylococcus aureus aureus;
• Klebsiella and E. coli Klebsiella pneumoniae, Escherichiacoli and other members of the Enterobacteriaceae family;
• Pseudomonas aeruginosa Pseudomonas aeruginosa.

Atypical bacterial pathogens:

• mycoplasma Mycoplasma pneumoniae;
• chlamydia Chlamydia pneumoniae;
• Legionella Legionella pneumophila.
  

Thus, the cause of the development of pneumonia is associated with the microflora of the upper respiratory tract, the composition of which depends on the environment in which the person is located, his age and general health. Predisposing factors for the disease of pneumonia are childhood, elderly and senile age, background bronchopulmonary diseases (bronchitis, bronchial asthma, COPD, etc.), pathology of the ENT organs, previous pneumonia, smoking, etc. Contributing factors to the disease of pneumonia include Xia exposure to cold, chest trauma, anesthesia, alcohol intoxication, drug addiction, surgery, etc.

The pathogenesis of pneumonia

There are four pathogenetic mechanisms that cause the development of pneumonia:

1. Aspiration of the contents of the oropharynx is the main route of infection of the respiratory sections of the lungs, and hence the main pathogenetic mechanism for the development of pneumonia.
2. Inhalation of microbial aerosol
3. Hematogenous spread of the pathogen from the extrapulmonarysource of infection (tricuspid valve endocarditis, septicpelvic endocarditis)
4. Direct spread of the pathogen from neighboring affectedorgans (liver abscess, mediastinitis) or as a result of infectionfor penetrating chest wounds.

Symptoms of Community Acquired Pneumonia

Symptoms of community-acquired pneumonia depend on the etiology of the process, the age of the patient, the severity of the disease, and the presence of concomitant pathology. The most significant causative agents of pneumonia are:

• pneumococcal pneumonia

The most common causative agent of community-acquired pneumonia for all age groups is pneumococcus (30-50% of cases). Pneumococcal pneumonia usually manifests itself in two classical variants: lobar (croupous) pneumonia and focal (bronchopneumonia).

The disease usually begins acutely with fever, chills, cough with scanty sputum, often with severe pleural pain. The cough is unproductive at first, however, soon a typical “rusty” sputum appears, sometimes with an admixture of blood.

On physical examination, there is dullness of the lung sound, bronchial breathing, crepitus, moist fine bubbling rales, pleural friction noise.

The most common complications are parapneumonic pleurisy, acute respiratory and vascular insufficiency.

• streptococcal pneumonia

The causative agent is β-hemolytic streptococcus, and the disease often develops after a viral infection (measles, influenza, etc.), has a severe course and is often complicated by sepsis. It is characterized by high fever with large daily fluctuations, repeated chills and sweats, stabbing pain in the side on the side of the lesion, streaks of blood appear in the sputum. In the feverish period, polyarthralgia is often noted.

Typical complications of this pneumonia are exudative pleurisy (70% of patients) and abscess formation. Lethality reaches 54%.

• Staphylococcal pneumonia

It is caused by Staphylococcus aureus and is often associated with influenza A and B epidemics and other respiratory viral infections.

This pathogen is characterized by peribronchial lesions with the development of single or multiple lung abscesses.

The disease begins acutely, proceeds with severe symptoms of intoxication, fever, repeated chills, shortness of breath, cough with purulent sputum. Pneumonia is usually multifocal, the development of new foci, as a rule, is accompanied by another rise in temperature and chills. With subpleural localization of the abscess, it can drain into the pleural cavity with the formation of pyopneumothorax.

• Viral pneumonia

It is most often caused by influenza viruses A and B, parainfluenza, adenoviruses. Pneumonia is distinguished by pathogenetic features - the inflammatory process begins with a pronounced edema of the bronchial mucosa, peribronchial space and alveoli, and is also complicated by the development of thrombosis, necrosis and bleeding. The disease begins with fever, chills, myalgia, conjunctivitis, sore throat and dry cough. With the development of pneumonia, shortness of breath, separation of purulent-hemorrhagic sputum, are added to the usual symptoms of influenza. Confusion of consciousness up to delirium often develops. Primary viral pneumonia from the 3-5th day from the onset of the disease becomes viral-bacterial. Auscultation in the lungs is characterized by alternating foci of hard or weakened breathing, dry rales with foci of crepitus, moist rales.

Also observed:

Pneumonia caused by Haemophilus influenzae

Klebsiella pneumonia (Friedlander's pneumonia)

Mycoplasma pneumonia

Hemorrhagic pneumonia.

Physical methods for diagnosing pneumonia

Pneumonia should be suspected if the patient has a fever associated with cough, dyspnoea, sputum production, and/or chest pain. At the same time, an atypical onset of pneumonia is possible, when the patient complains of unmotivated weakness, fatigue, heavy sweating at night. In elderly patients, with concomitant pathology, in drug addicts, against the background of alcohol intoxication, extrapulmonary symptoms (drowsiness, confusion, anxiety, disruption of the sleep and wake cycle, loss of appetite, nausea, vomiting, signs of decompensation of chronic diseases of the internal organ -nov) often prevail over bronchopulmonary.

Lobar (croupous) pneumonia - symptoms

The information obtained during the physical examination of the patient depends on the severity of the disease, the prevalence of inflammation, age, concomitant diseases and, above all, on the morphological stage of development of lobar pneumonia.

High tide stage (1-2 days) characterized by a sharp chill, high body temperature (39-40 ° C), shortness of breath, increasing symptoms of intoxication, chest pain associated with breathing, the appearance of a dry, painful cough. On examination, the patient lies on his back or sore side, pressing his hands on the area of ​​\u200b\u200bthe chest, where the pain is most pronounced. This position somewhat reduces chest excursion and pain. The skin is hot, there is a feverish blush on the cheeks, acrocyanosis, redness of the sclera of the eyes, more on the side of the lesion. If lobar inflammation of the lung is accompanied by a viral infection, then herpetic eruptions are noted on the lips, wings of the nose and earlobes. In severe pneumonia, cyanosis of the lips, tip of the nose, and earlobes is noted, which is associated with an increase in respiratory failure and impaired hemodynamics.

There is a lagging of the diseased side of the chest in the act of breathing, although the symmetry of the chest is still preserved. On palpation, local soreness of the chest is determined, associated with inflammation of the parietal pleura, a slight increase in voice trembling and bronchophony on the side of the lesion due to compaction of the lung tissue. With percussion, there is a dullness (shortening) of percussion sound with a tympanic tinge.

During auscultation, weakened vesicular breathing and crepitus are heard in the projection of the affected lobe of the lung. In the initial stage of lobar pneumonia, the alveoli only partially retain their airiness, the inner surface of their walls and bronchioles is lined with a viscous fibrinous (inflammatory) exudate, and the walls themselves are edematous and rigid. During most of the inhalation, the alveoli and bronchioles are in a collapsed state, which explains the weakening of vesicular respiration. To straighten the sticky walls of the alveoli, a higher pressure gradient in the pleural cavity and upper respiratory tract is required than normal, and this is achieved only by the end of inspiration. During this period, the walls of the alveoli containing exudate come apart, and a specific sound arises - initial crepitus (crepitatioindux). In sound, it resembles moist, finely bubbling rales, but differs in that it occurs only at the height of a deep breath and does not change when coughing.

Hepatization stage (5-10 days - the height of the disease)characterized by the persistence of high fever, symptoms of intoxication, the appearance of a cough with the separation of "rusty" and mucopurulent sputum, an increase in signs of respiratory and sometimes cardiovascular insufficiency. On examination, for several days from the onset of the disease, the forced position of the patient on the sore side may persist, associated with the involvement of the pleura in the inflammatory process, as well as facial hyperemia and redness of the sclera on the side of the lesion. With a severe degree of pneumonia, cyanosis increases due to an increase in ventilation respiratory failure. Breathing is frequent (25-30 or more in 1 minute) and superficial. When two or more lobes of the lung are involved in the process - tachypnea, shortness of breath of the inspiratory type (difficulty inhaling), participation in the act of breathing of auxiliary muscles, swelling of the wings of the nose, etc. There is a distinct lag in the act of breathing of the diseased half of the chest. Voice trembling and bronchophony are increased on the side of the lesion. With percussion - a pronounced dullness of percussion sound over the affected area. On auscultation, weakened vesicular breathing is replaced by hard, bronchial breathing, crepitus is not heard. Within a few days, a pleural friction noise is heard over the affected area.

Resolution stage (from the 10th day) in an uncomplicated course of pneumonia, it is characterized by a decrease in body temperature, a decrease in symptoms of general intoxication, coughing, and respiratory failure. Percussion - dullness of percussion sound with a tympanic tinge, which is gradually replaced by a clear pulmonary sound. On auscultation, there is weakened vesicular breathing and at the end of inspiration, when the alveoli and bronchioles “stick apart”, final crepitus (crepitatioredux) is heard. As the exudate is removed from the alveoli and the swelling of their walls disappears, the elasticity and airiness of the lung tissue is restored, vesicular breathing is heard over the lungs, crepitus disappears.

Focal pneumonia (bronchopneumonia) - symptoms

It has a less acute and prolonged onset. It often occurs as a complication of acute respiratory viral infections, acute or exacerbation of chronic bronchitis. Within a few days, the patient notes an increase in body temperature to 37.5-38.5 ° C, runny nose, malaise, weakness, cough with mucosal or mucopurulent sputum. Against this background, it is difficult to diagnose bronchopneumonia, but the lack of effect from treatment, the increase in intoxication, the appearance of shortness of breath, tachycardia speaks in favor of focal pneumonia. Gradually, the patient's cough and the separation of mucopurulent or purulent sputum increase, weakness, headache increase, appetite decreases, body temperature rises to 38-39 ° C. On examination, there is hyperemia of the cheeks, cyanosis of the lips, the skin is moist. Sometimes pallor of the skin is noted, which is explained by severe intoxication and a reflex increase in the tone of peripheral vessels. The chest on the side of the lesion only slightly lags behind in the act of breathing. With percussion, dullness of percussion sound is noted above the lesion, but with a small focus of inflammation or its deep location, percussion of the lungs is not informative. During auscultation, a pronounced weakening of vesicular respiration is heard over the affected area, due to a violation of bronchial patency and the presence of many microatelectases in the inflammation focus. The most reliable auscultatory sign of focal pneumonia is the auscultation of sonorous moist small bubbling rales over the affected area throughout the entire breath. These wheezing are due to the presence of inflammatory exudate in the airways. When the pleura is involved in the inflammatory process, a pleural friction rub is heard.

Thus, the most significant clinical signs that make it possible to distinguish focal bronchopneumonia from lobar (croupous) pneumonia are:

• The gradual onset of the disease, which develops, as a rule, against the background of acute respiratory viral infections or exacerbation of chronic bronchitis.
• Cough with mucopurulent sputum.
• Absence of acute pleural pain in the chest.
• Absence of bronchial breathing.
• The presence of moist sonorous small bubbling rales.

Diagnosis of pneumonia

Based on the patient's complaints, anamnesis data and physical examination methods.

In a general blood test, leukocytosis is detected, blood biochemistry can determine an increase in liver enzymes, creatinine, urea, and changes in the electrolyte composition. Microscopic examination of sputum and blood serology allow to verify the causative agent of pneumonia.

Instrumental methods: x-ray examination of the lungs in two projections. Evaluate the presence of infiltration, pleural effusion, destruction cavities, the nature of the darkening: focal, confluent, segmental, lobar or total.

Differential diagnosis of pneumonia

The main nosologies that require differential diagnosis with pneumonia are the following:

• Acute respiratory viral infections (ARVI)
• Intercostal neuralgia
• Pulmonary tuberculosis
• Acute diseases of the abdominal organs
• Acute cerebrovascular accident (ACV)
• Acute myocardial infarction
• Pulmonary embolism (PE)
  

• Acute respiratory viral infections

The absence of seasonality in pneumonia (which is more typical for ARVI), the presence of a fever that exceeds that in ARVI, the results of a physical examination obtained with careful percussion and auscultation - a shortening of the percussion sound, foci of crepitus and / or moist fine bubbling rales.

• Intercostal neuralgia

The misdiagnosis of "intercostal neuralgia" is one of the most common causes of underdiagnosis of pneumonia. For the correct diagnosis of pneumonia, it is important to take into account the peculiarities of the pain syndrome: if with pneumonia, pain is usually associated with breathing and coughing, then with intercostal neuralgia, it intensifies when turning the body, moving the hands. Palpation of the chest revealed areas of skin hyperalgesia.

• Pulmonary tuberculosis

To verify the diagnosis of tuberculosis, it is necessary, first of all, to use well-known diagnostic methods, such as anamnestic data (the patient has a history of tuberculosis of any localization, information about past diseases, such as exudative pleurisy, prolonged low-grade fever of unknown origin, inexplicable malaise, profuse sweating at night, weight loss, prolonged cough with hemoptysis). Of diagnostic value are such physical data as the localization of pathological percussion sounds and auscultatory data in the upper sections of the lungs.

The leading role in the diagnosis of tuberculosis belongs to X-ray methods of research, incl. CT, MRI, microbiological research.

• Lung cancer, lung metastases

Of great importance in the diagnosis of lung cancer are anamnestic data (smoking, work with carcinogenic substances, such as heavy metals, chemical dyes, radioactive substances, etc.). In the clinical picture of lung cancer, there is a persistent cough, a change in the timbre of the voice, the appearance of blood in the sputum, weight loss, lack of appetite, weakness, chest pain. Final verification of the diagnosis is possible on the basis of sputum examination for atypical cells, pleural exudate, tomography and / or CT of the lungs, diagnostic bronchoscopy with a biopsy of the bronchial mucosa.

• Congestive heart failure

In patients with left ventricular failure, which is a complication of coronary artery disease, arterial hypertension, heart disease, cardiomyopathy, asthma attacks usually occur at night. Patients wake up with a painful hacking cough and a feeling of suffocation. At the same time, bilateral moist rales are heard, mainly over the lower parts of the lungs. A simple technique allows to differentiate the origin of wheezing: the patient is offered to lie on his side and auscultation is repeated after 2-3 minutes. If at the same time the number of wheezing decreases over the overlying sections of the lungs and, on the contrary, increases over the underlying ones, then with a greater degree of probability these wheezing are caused by congestive heart failure. In acute pulmonary pathology, ECG signs are noted: P-pulmonale (overload of the right atrium); blockade of the right leg of the bundle of Giss; high R waves in the right chest leads. Acute diseases of the abdominal organs When pneumonia is localized in the lower parts of the lungs, the pain syndrome often spreads to the upper parts of the abdomen. The severity of abdominal pain, sometimes combined with other gastrointestinal disorders (nausea, vomiting, dyspepsia), often causes erroneous diagnosis in patients with pneumonia, acute diseases of the abdominal organs (cholecystitis, perforated ulcer, acute pancreatitis, impaired intestinal motility). In such cases, the diagnosis of pneumonia is helped by the absence of tension in the abdominal muscles and symptoms of peritoneal irritation in patients.

• Acute cerebrovascular accident (ACV)

Symptoms of CNS depression - drowsiness, lethargy, confusion, up to stupor, developed with severe pneumonia, can cause erroneous diagnosis of stroke and hospitalization of patients in the neurological department. At the same time, when examining such patients, as a rule, there are no symptoms characteristic of stroke, such as paresis, paralysis, pathological reflexes, and the reaction of the pupils is not disturbed.

• Acute myocardial infarction

With left-sided localization of pneumonia, especially in patients with involvement in the inflammatory process of the pleura, a pronounced pain syndrome may develop, which can lead to an erroneous diagnosis of "Acute myocardial infarction". To differentiate pleural pain, it is important to assess its relationship with breathing: pleural pain intensifies on inspiration. To reduce pain, patients often take a forced position on their side, on the side of the lesion, which reduces the depth of breathing. In addition, the coronary genesis of pain is usually confirmed by characteristic changes in the electrocardiogram.

• Pulmonary embolism (PE)

The acute onset of the disease, observed in particular in pneumococcal pneumonia, is also characteristic of thromboembolism in the pulmonary artery system (PE): shortness of breath, dyspnea, cyanosis, pleural pain, tachycardia and arterial hypotension up to collapse. However, along with severe shortness of breath and cyanosis in PE, swelling and pulsation of the jugular veins are observed, the boundaries of the heart shift outward from the right edge of the sternum, pulsation often appears in the epigastric region, accent and bifurcation of the II tone above the pulmonary artery, gallop rhythm. Symptoms of right ventricular failure appear - the liver enlarges, its palpation becomes painful. On the ECG - signs of overload: right atrium: P - pulmonale in leads II, III, AVF; right ventricle: McGin-White sign or SI-QIII syndrome.

Complications of pneumonia

Diagnostic and therapeutic management of patients with community-acquired pneumonia is determined by the presence or absence of complications. Common complications include:

• Acute respiratory failure
• Pleurisy
• Broncho-obstructive syndrome
• Acute respiratory distress syndrome (non-cardiogenic pulmonary edema)
• Infectious-toxic shock

Acute respiratory failure (ARF)

This is one of the main manifestations of the severity of pneumonia and can develop from the first hours from the onset of the disease in 60-85% of patients with severe pneumonia, and more than half of them need mechanical ventilation. The severe course of pneumonia is accompanied by the development of a predominantly parenchymal (hypoxemic) form of respiratory failure. The clinical picture of ARF is characterized by a rapid increase in symptoms and involvement in the pathological process of vital organs - the central nervous system, heart, kidneys, gastrointestinal tract, liver and the lungs themselves. Among the first clinical signs is shortness of breath, while rapid breathing (tachypnea) is accompanied by a growing feeling of respiratory discomfort (dyspnea). As ARF increases, a pronounced tension of the respiratory muscles is noticeable, which is fraught with its fatigue and the development of hypercapnia. The increase in arterial hypoxemia is accompanied by the development of diffuse cyanosis, reflecting a rapid increase in the content of unsaturated hemoglobin in the blood. In severe cases, with SaO2 values<90%, цианоз приобретает сероватый оттенок. Кожа при этом становится холодной, часто покрывается липким потом. При тяжелой дыхательной недостаточности важно оценить динамику выраженности цианоза под влиянием оксигенотерапии - отсутствие изменений свиде-тельствует о паренхиматозном характере ОДН, в основе которой лежат выраженные вентиляционно-перфузионные расстройства. Отрица-тельная реакция на ингаляцию кислорода указывает на необходимость перевода больного, на искусственную вентиляцию легких (ИВЛ). ОДН при пневмонии на начальных стадиях сопровождается тахикардией, отра-жающей компенсаторную интенсификацию кровообращения. С раз-витием декомпенсации и дыхательного ацидоза нередко развивается брадикардия - весьма неблагоприятный признак, сопровождающийся высоким риском летального исхода. При тяжелой дыхательной недостаточности нарастает гипоксия ЦНС. Больные становятся беспокойными, возбужденными, а по мере прогрессирования ОДН развивается угнетение сознания и кома.

Treatment. It is necessary to ensure normal gas exchange in the lungs with the achievement of Sa02 above 90%, and PaO2> 70-75 mm Hg. and normalization of cardiac output and hemodynamics. To improve oxygenation, oxygen inhalation is performed, and if oxygen therapy is not effective enough, respiratory support in the ventilator mode is indicated. In order to normalize hemodynamics, infusion therapy is carried out with the addition of glucocorticoid hormones and vasopressor amines (dopamine).

Pleurisy

Pleurisy is one of the frequent complications of community-acquired pneumonia and more than 40% of pneumonias are accompanied by pleural effusion, moreover, with a massive accumulation of fluid, it acquires a leading role in the clinic of the disease. The onset of the disease is characterized by the appearance of acute intense pain in the chest associated with breathing. Shortness of breath often takes on the character of suffocation. At the first stages of fluid accumulation, paroxysmal dry ("pleural") cough may be noted. On examination - restriction of respiratory movements, the intercostal spaces are wider, the lagging of the affected half of the chest in the act of breathing. During percussion - above the effusion zone, the percussion sound is shortened, and the upper limit of dullness has a characteristic arc-shaped curve (Damuazo line), weakening of voice trembling. On auscultation - weakened vesicular breathing. With a significant amount of fluid in the lower parts of the pleural cavity, respiratory noises are not carried out, and in the upper (in the zone of lung collapse) breathing sometimes acquires a bronchial character. Percussion can reveal signs of mediastinal displacement in the opposite direction, which is confirmed by a change in the boundaries of cardiac dullness.

Treatment. For the relief of pleural pain and inflammation in pneumonia, non-steroidal anti-inflammatory drugs, in particular, lornoxicam, are indicated.

Broncho-obstructive syndrome

This syndrome is typical for patients with community-acquired pneumonia that developed against the background of chronic obstructive pulmonary disease (COPD).

The main symptoms of broncho-obstructive syndrome:

• Cough - persistent or aggravated periodically, as a rule, productive;
• Shortness of breath, the severity of which depends on the severity of inflammation of the lungs and the severity of bronchial obstruction.

On auscultation, dry whistling rales are heard over the entire surface of the lungs against the background of an extended exhalation. Wet rales, as a rule, are limited to the zone of inflammatory infiltration. The severity of bronchial obstruction is detected by assessing exhalation, which is much longer than inhalation, as well as using expiratory tests. The study of the function of external respiration, in particular, a simple technique of peak flowmetry, allows you to determine the degree of severity of obstructive ventilation disorders.

Treatment. Berodual is an effective means of eliminating broncho-obstructive syndrome in patients with pneumonia. Berodual can be used both in the form of metered aerosols and in the form of solutions through a nebulizer - at a dose of 1-2 ml (20-40 drops) in a dilution of sodium chloride 0.9% - 3 ml. Patients in whom edema of the bronchial mucosa predominates in the pathogenesis of broncho-obstructive syndrome, which is especially characteristic of COPD, a good result is achieved by combined therapy through a nebulizer: 20-25 drops of berodual in combination with corticosteroid budesonide (pulmicort) at a starting dose of 0.25 -0.5mg. In the absence or insufficient effectiveness of inhalation drugs, it is possible to use theophyllines, in particular, intravenous administration of 5-10 ml of a 2.4% solution of aminophylline slowly, as well as intravenous injections of prednisolone 60-120 mg. All noted measures to eliminate bronchial obstruction should be assessed by dynamic control of the results of peak flowmetry. Carrying out oxygen therapy has a positive effect on lung function and hemodynamics of the pulmonary circulation (high pressure in the pulmonary artery decreases), however, caution is needed in patients with COPD, because. inhalation of high concentrations of oxygen in the inhaled air is fraught with the development of hypercapnic coma and respiratory arrest. In such patients, the recommended concentration of oxygen in the inhaled air is 28-30%. The result of oxygen therapy is evaluated by pulse oximetry. It is necessary to achieve an increase in Sa 02 more than 92%.

Acute vascular insufficiency (collapse)

Patients complain of a severe headache, general weakness, dizziness, aggravated by a change in body position. In the supine position, a decrease in systolic blood pressure to a level of less than 90 mm Hg is usually determined. Art. or a decrease in the patient's usual systolic blood pressure by more than 40 mm Hg. Art., and diastolic blood pressure less than 60 mm Hg. Art. When trying to sit or stand, such patients may experience severe fainting. Vascular insufficiency in pneumonia is caused by dilatation of peripheral vessels and a decrease in BCC due to the transfer of fluid from the vascular bed to the extracellular space. Emergency care for arterial hypotension begins with giving the patient a position with the head lowered and the foot end raised. In severe pneumonia and arterial hypotension (BP<90/60 мм рт.ст.) необходимо восполнение потери жидкости: у больных с ли-хорадкой при повышении температуры тела на 1°С количество жидко-сти в организме уменьшается на 500 мл /сутки.

Treatment. Jet intravenous drip injection of 0.9% sodium chloride solution 400 ml or 5% glucose solution 400 ml. Prior to the normalization of blood pressure, antipyretic drugs should not be prescribed, as this can lead to aggravation of arterial hypotension. With persistent arterial hypotension - but only after replenishing the BCC, the use of vasopressor amines is indicated until systolic blood pressure reaches 90 - 100 mm Hg. Art.: 200 mg of dopamine diluted in 400 ml of 0.9% sodium chloride solution or 5% glucose solution and injected intravenously at a dose of 5-10 mcg / kg per minute. Drop infusion cannot be stopped abruptly, a gradual decrease in the rate of administration is necessary. To eliminate the increased permeability of the vascular endothelium, glucocorticoid hormones are used - prednisolone at an initial dose of 60-90 mg (up to 300 mg) intravenously in a stream.

Acute respiratory distress syndrome (ARDS, non-cardiogenic pulmonary edema)

ARDS most often develops within the first 1-3 days of the onset of pneumonia. In the acute exudative phase of ARDS, the patient is disturbed by excruciating shortness of breath, dry cough, discomfort in the chest, and palpitations. After some time, shortness of breath intensifies and turns into suffocation. If the exudate penetrates into the alveoli (alveolar pulmonary edema), suffocation increases, a cough appears with foamy sputum, sometimes pinkish in color. On examination, the patient is agitated, takes a forced semi-sitting position (orthopnea). Diffuse, gray cyanosis appears and rapidly increases, due to a progressive impairment of oxygenation in the lungs. The skin is moist, the body temperature is elevated. Breathing, regardless of the genesis of ARDS, is accelerated, auxiliary muscles are involved in the act of breathing, for example, retraction during inspiration of the intercostal spaces and supraclavicular fossae, swelling of the wings of the nose. With percussion - there is a slight shortening of the percussion sound in the posterior-lower chest. On auscultation, in the same place, against the background of weakened breathing, crepitus is heard symmetrically on both sides, and then a large number of moist, finely and medium bubbling rales that spread to the entire surface of the chest. In contrast to the auscultatory manifestations of pneumonia, rales in ARDS are heard diffusely in symmetrical areas of the lungs on both sides. In severe cases of alveolar pulmonary edema, noisy breathing and coarse, moist rales audible at a distance (bubbling breathing) appear. Heart sounds are muffled, heart rate is 110-120 in 1 min. Arterial pressure is reduced, the pulse is rapid, may be arrhythmic, small filling. In the terminal stage of acute respiratory distress syndrome, signs of multiple organ failure may appear due to the effect of systemic inflammation on the internal organs, and the functions of the kidneys, liver, and brain are impaired. Pulmonary edema, which develops with pneumonia, is among the non-cardiogenic pulmonary edema. At the same time, transcapillary filtration increases not due to an increase in hydrostatic pressure, but mainly due to increased vascular permeability. The accumulated fluid and protein in the interstitial tissue enter the alveoli, which leads to an increasing deterioration in the diffusion of oxygen and carbon dioxide. As a result, patients develop signs of acute respiratory distress syndrome. The main clinical manifestations of pulmonary edema in pneumonia are cough and shortness of breath. Unlike cardiogenic pulmonary edema, shortness of breath in patients with ARDS develops into a feeling of suffocation. During auscultation, moist rales are heard over the entire surface of the lungs, oxygen saturation drops sharply (Sa02< 90%), нарастает ар-териальная гипотензия. Интенсивная терапия направлена на нормализацию повышенной проницаемости альвеоло-капиллярной мембраны и улучшение газо-обмена. Для устранения высокой проницаемости стенки капилляров легких и блокирования мембраноповреждающих факторов воспале-ния (интерлейкины, фактор некроза опухоли и др.) применяют глюкокортикоидные гормоны - преднизолон внутривенно болюсно 90-120 мг (до 300 мг) или метилпреднизолон из расчета 0,5-1 мг/кг (суточная доза 10-20 мг/кг массы тела). Важным элементом патогенетической терапии ОРДС при пневмонии является адекватная оксигенотерапия, которую начинают с ингаляции 100% увлажненного кислорода через носовой катетер 6-10 л/мин. При отсутствии эффекта и нарастании гипоксемии необходимо перевести больного на искусственную вентиляцию легких. В настоящее время считается нецелесообразным увеличение до-ставки кислорода к тканям у больных с острым респираторным дистресс-синдромом с помощью инотропных аминов (дофамин). Исключение составляют случаи, где имеются признаки сердечной недостаточности, и снижение сердечного выбро-са связано не с развитием гиповолемии, а с падением сократительной способности сердечной мышцы.

Infectious-toxic shock

The number of patients with severe pneumonia, complicated by infectious-toxic shock, can reach 10%. Most often, infectious-toxic shock is caused by gram-negative flora, while mortality reaches 90%. The so-called "cold" or "pale" shock develops, which is based on the high permeability of the vascular wall, and the massive release of the liquid part of the blood into the interstitial space with a sharp decrease in BCC. The second component of "cold" shock is widespread peripheral vasospasm. Clinically, this type of shock is characterized by an extremely serious condition with impaired consciousness, pallor of the skin, a thready pulse, and a decrease in blood pressure below critical values. In one third of patients, shock is the result of exposure to the body of gram-positive flora, while mortality is 50-60%. Such patients develop the so-called "warm shock" with peripheral vasodilation, blood deposition, and decreased venous return to the heart. Clinically, this variant of shock is also manifested by arterial hypotension, however, the skin is warm, dry, and cyanotic. Thus, as a result of the impact of pneumonia pathogens on the vascular system, hypovolemic shock develops, characterized by a decrease in BCC, cardiac output, CVP (pressure in the right atrium) and filling pressure of the left ventricle. In severe cases, if the toxic effect of microorganisms continues, hypoxia of organs and tissues, aggravated by respiratory failure and hypoxemia, leads to the development of fatal microcirculation disorders, metabolic acidosis, DIC, and a sharp impairment of vascular permeability and the function of peripheral organs.

On examination - a sharp pallor of the skin and visible mucous membranes, acrocyanosis, the skin is wet and cold. When examining patients, characteristic signs of shock are revealed:

tachypnea;

Progressive hypoxemia (Sa02< 90%);

Tachycardia >120 beats per minute, thready pulse;

Reducing systolic blood pressure to 90 mm Hg. Art. and below;

A significant decrease in pulse blood pressure (up to 15-20 mm Hg);

Deafness of heart sounds;

Oliguria.

In severe cases, stupor and even coma may develop. Cold, moist, pale skin acquires an earthy-gray hue, which is an indicator of a pronounced violation of peripheral circulation. Body temperature drops below 36°C, shortness of breath increases, respiratory rate increases to 30-35 in 1 min. The pulse is threadlike, frequent, sometimes arrhythmic. Heart sounds are muffled. Systolic blood pressure is not higher than 60-50 mm Hg. Art. or not defined at all. Intensive care is a complex of urgent measures, the algorithm of which depends on the type and severity of shock. First of all, it is important to start antibiotic therapy in a timely manner, using drugs with the widest spectrum of action - ceftriaxone 1.0 g. intravenously diluted with 10 ml of 0.9% sodium chloride solution. Due to the high frequency of hypoxemic respiratory failure, patients with infectious-toxic shock usually need respiratory support - non-invasive mechanical ventilation with oxygen therapy, and with the development of tachypnea (respiratory rate above 30/min.), tracheal intubation and mechanical ventilation should be planned. In order to block the systemic inflammatory response, glucocorticoid hormones are used - prednisolone at the rate of 2-5 mg / kg of body weight intravenously by stream. Infusion therapy involves the intravenous administration of saline solutions, such as chlosol, acesol, trisol 400 ml intravenously with dopamine 200 mg under the control of blood pressure. Free radical oxidation of lipids and proteins, expressed in infectious-toxic shock, requires increased antioxidant protection. For this purpose, it is recommended to administer ascorbic acid at the rate of 0.3 ml of a 5% solution per 10 kg of body weight intravenously.

Treatment of uncomplicated pneumonia

Uncomplicated community-acquired pneumonia can be treated on an outpatient basis, under the supervision of polyclinic doctors. However, in recent years, patients with any form of pneumonia are trying to be hospitalized in a hospital.

Bed rest is necessary in the first days of the disease, diet therapy is easily digestible, with a sufficient amount of vitamins and free fluid, carbohydrate restriction. Antipyretics are prescribed with a significant increase in temperature, which violates the general condition of the patient. At body temperature up to 38 ° in patients without severe comorbidity, the appointment of antipyretics is not justified. With concomitant bronchitis - the appointment of expectorants, bronchodilators. Breathing exercises.

Etiotropic therapy of pneumonia consists in antibiotic therapy. Amoxiclav or antibiotics from the groups of macrolides and cephalosporins are prescribed. The duration of treatment is usually 10-14 days.

Pneumonia is an acute infectious disease, which is characterized by the development of inflammation of the lung tissue, the alveoli are necessarily involved in the process.

The reasons

The following possible causes of the disease are distinguished:

• bacteria;
• viruses;
• fungi.

Among the bacteria, the leading role belongs to Streptococcus pneumoniae (pneumococcus pneumoniae), Mycoplasma, Legionella, Chlamydia, Klebsiella rarely cause pneumonia.

The influenza virus, including type A (H1N1), adenovirus, and rhinovirus, can lead to the development of pneumonia.

Fungal pneumonia is caused by a fungus of the genus Candida.

Infection occurs by airborne droplets (when sneezing, coughing) from a sick person, or infection in the lung tissue can get from foci of chronic infection (chronic sinusitis, tonsillitis, dental caries).

Factors contributing to the development of the disease are:

• hypothermia of the body;
• chronic lung diseases (bronchitis);
• decreased immunity;
• the age of the patient is over 65 years;
• smoking;
• alcohol abuse;
• inhalation of harmful substances in production;
• the presence of chronic diseases (cardiovascular system, diabetes, kidney disease);
• the patient is on a ventilator.

Types of pneumonia

Pneumonia can be:

• primary - pneumonia is an independent disease;
• secondary - pneumonia develops against the background of a concomitant disease (congestive);
• aspiration - develops when bacteria enter the bronchi with vomit, foreign bodies;
• postoperative;
• post-traumatic - as a result of a lung injury.

According to etiologists

• typical - caused by typical pathogens (pneumococcus, virus);
• atypical - caused by atypical pathogens (chlamydia, mycoplasma, legionella, klebsiella).

According to morphological features:

• focal - a small area of ​​\u200b\u200bthe lung is affected;
• croupous - the lobes of the lung are affected, it can be unilateral and bilateral.

Origin:

• community-acquired - develop outside the hospital;
• nosocomial - develop 2 or more days after the patient enters the hospital.

Nosocomial pneumonia is more severe.

Symptoms of pneumonia

The clinical picture of pneumonia largely depends on the type of pathogen, on the state of human health, the presence of concomitant diseases, immunodeficiency.

In most cases, pneumonia has a focal form and is characterized by the following symptoms:

• acute onset;
• body temperature rises to febrile numbers (38.5 - 40 degrees);
• general weakness;
• chest pain when taking a deep breath and coughing;
• increased sweating;
• fast fatiguability;
• cough at the beginning of the disease is dry, later it becomes productive (wet);
• dyspnea.

Pneumonia is also characterized by local signs - during auscultation, one can hear either a weakening of breathing, or finely bubbling, crepitant rales.

With small focal pneumonias, there may be no changes during auscultation of the lungs.

The temperature in pneumonia lasts for three to four days, subject to timely treatment.

Signs of croupous pneumonia

Croupous pneumonia is characterized by a pronounced intoxication syndrome, the temperature rises sharply to 39-40 degrees, tachycardia develops (the heart rate increases).

Most often, with croupous pneumonia, severe shortness of breath occurs, the frequency of breathing becomes more frequent, and a wet cough appears early.

Important! A feature of a wet cough with croupous pneumonia is the presence of "rusty sputum" (blood streaks are present in the sputum).

Asymptomatic pneumonia

An asymptomatic course of pneumonia is also possible, this can be with small focal pneumonia, with a decrease in immunity.

The patient has no characteristic signs of the disease - cough, fever. There may be only general weakness, increased fatigue.

Such pneumonia is discovered by chance during a fluorographic examination.

Features of viral pneumonia

Viral pneumonia is characterized by the fact that the patient at the beginning has signs of a respiratory disease. And after one or two days, symptoms of pneumonia appear - a cough with streaks of blood, the temperature rises, shortness of breath occurs.

Diagnostics

Diagnosis of pneumonia is based on the presence of a characteristic clinical picture of the disease, examination data and characteristic changes during the examination of the patient.

On examination, you can find:

• on auscultation - weakening of breathing, the presence of small bubbling moist rales, crepitus.
• there may be a backlog of the chest when inhaling on the side of the lesion;
• with the development of respiratory failure - increased respiratory movements, retraction of the intercostal spaces during inspiration, acrocyanosis.

Laboratory and instrumental examinations are carried out:

General blood analysis. It reveals leukocytosis, accelerated ESR.

General analysis of sputum. The presence of signs of inflammation (leukocytes), blood, identification of the pathogen is characteristic.

Sputum culture culture - to determine the pathogen and determine its sensitivity to antibiotics.

Blood chemistry. There is an increase in ALT, AST, C-reactive protein.

X-ray of the chest in two projections (direct and lateral). With pneumonia, focal blackouts, or lobar opacities, are visible.

If necessary, computed or magnetic resonance imaging of the lungs is performed.

To determine the degree of respiratory failure, pulse oximetry is performed (blood oxygen saturation is determined, this is a non-invasive method).

What can be confused with pneumonia

Differential diagnosis of pneumonia is carried out with:

• tumor formations - there is no temperature, or it is subfebrile, there is no acute onset, no effect of antibiotics;
• pulmonary tuberculosis - also the onset is not acute, there is no hyperthermia, a characteristic x-ray picture, the absence of a positive effect during therapy.

Treatment of pneumonia

Important! This section is written in accordance with the Federal Standard for Primary Health Care for Pneumonia

Treatment of non-severe forms of pneumonia can be carried out on an outpatient basis, severe pneumonia is subject to hospitalization.

• compliance with bed rest;
• regular ventilation of the room;
• plentiful drinking regimen (helps to remove intoxication);
• humidification of the inhaled air;
• food should be easily digestible.

The main treatment is the use of antibacterial drugs.

What antibiotics are indicated for pneumonia

Non-severe pneumonias are started with protected penicillins:

• Amoxiclav;
• Flemoklav;
• Augmentin.

If the patient has intolerance to this group or contraindications, recent use of drugs in this group, the patient is prescribed macrolides:

• Azithromycin;
• Sumamed;
• Hemomycin;
• Clarithromycin.

Macrolides are also prescribed for atypical pneumonia.

Third-line drugs are respiratory fluoroquinolones, cephalosporins.

Respiratory fluoroquinolones include:

• Levofloxacin;
• Glevo;
• Tavanic;
• Moxifloxacin.

Cephalosporins include:

• Cefotaxime;
• Ceftriaxone;
• Suprax.

With a mild course, the course of antibiotic therapy is from 7 to 10 days.

The effectiveness of antibiotic therapy is assessed after 48-72 hours from the start of therapy, if there are no signs of improvement in the condition (decrease in intoxication, body temperature, removal of shortness of breath), then the antibiotic is changed.

Severe pneumonia begins to be treated in a hospital with injectable forms of antibacterial drugs, it is also possible to prescribe two drugs from different groups at once.

In severe forms of pneumonia, the course of antibiotic therapy is at least 10 days.

In the case of atypical pneumonia, treatment is carried out from 14 to 21 days.

In addition to antibiotic therapy, antipyretic therapy is also prescribed. Antipyretics are prescribed when the temperature rises from 38.5 degrees:

• ibuprofen;
• Paracetamol;
• Ibuklin;
• Aspirin.

Mucolytics are used to thin sputum:

• Ambrohexal;
• Lazolvan;
• Ambrobene;
• Fluimucil;
• Fluditec.

Effective inhalation through a nebulizer:

• sodium chloride solution 0.9%;
• an aqueous solution of Lazolvan;
• in the presence of shortness of breath - Berodual.

Important! Cough syrups are not suitable for use in a nebulizer. Water-based inhalation solutions are suitable for this.

From physiotherapy it is possible to carry out:

• electrophoresis on the chest;
• UVI chest;
• magnetotherapy;
• vibration chest massage.

After recovery, a person is subject to dispensary observation for one year.

Complications

In the case of improperly selected or untimely treatment, pneumonia can cause serious complications.

• Development of acute respiratory failure.
• Pleurisy is an inflammation of the lining of the lungs.
• Lung abscess - the formation of a cavity filled with purulent contents.
• Pulmonary edema.
• Sepsis - the spread of infection throughout the body through the blood vessels.

Prevention of pneumonia

There is a specific prevention of pneumococcal infections - pneumococcal vaccine.

It is used in young children and patients at risk. Immunity is formed for five years, then you need to revaccinate.

• Avoid hypothermia.
• Rejection of bad habits.
• Treatment of chronic diseases.
• Leading a healthy lifestyle.
• Hardening of the body and regular physical activity.

Pneumonia ranks first among the most dangerous respiratory diseases. Inflammation of the lungs occurs in people regardless of age and can cause serious damage to the body and even death.

Pneumonia is classified according to a number of criteria:

• According to the etiological basis, the disease is:
  • viral;
  • bacterial;
  • mycoplasma;
  • fungal;
  • mixed.
• According to clinical and morphological manifestations, the disease can be:
  • croupous;
  • focal;
  • interstitial;
  • parenchymal;
  • mixed.
• According to the course of the disease, pneumonia is distinguished as:
  • acute;
  • acute protracted;
  • atypical;
  • chronic.
• According to the spread of the inflammatory process, pneumonia happens:
  • unilateral;
  • bilateral;
  • focal;
  • total;
  • equity;
  • sublobar;
  • basal;
  • drain.

Inflammation of the lungs in adults occurs by infection of the alveoli and bronchial epithelium.

The development of the disease occurs within 2 to 3 days, after which symptoms appear that can be used to diagnose pneumonia.

The disease often occurs against the background of a weakening of the body's defenses.

The following factors can contribute to this: hormonal changes in the body, frequent colds, malnutrition, constant intoxication.

Symptoms of pneumonia in adults are almost always similar to the manifestation of a cold or flu.

If a high body temperature persists for more than 5 days and does not decrease when taking paracetamol, then pneumonia can be suspected.

The main manifestations of pneumonia:

• increased body temperature;
• cough, at the beginning of the disease dry, as it develops - with copious sputum;
• dyspnea;
• increased fatigue, weakness;
• fear caused by lack of air;
• chest pain.

Depending on the type of pathogen, the symptoms of pneumonia appear acutely or occasionally. It is very important to determine the presence of a serious disease in time, and begin treatment. Not always a regular examination by a doctor can reveal pneumonia. To clarify the diagnosis, an additional examination in a medical institution is necessary.

It is especially difficult to determine latent or chronic forms of pneumonia. And yet an experienced doctor can diagnose it by the following signs:

• the appearance of a spotted blush on the cheeks;
• performance of sweat on the forehead with a slight load;
• constant thirst;
• the occurrence of pain in the chest when turning the body;
• pain when taking a deep breath;
• irregular, irregular breathing;
• frequent pulse.

Inflammation of the lungs in adults and children differs in risk factors. The disease develops for the following reasons:

In children and adults, the symptoms of pneumonia also have differences. In a child, they are usually the least pronounced.

• If for an adult a high body temperature is a frequent symptom, then in children pneumonia is not necessarily accompanied by fever. Sometimes children suffer this disease, as they say, "on their feet."
• With the development of pneumonia caused by streptococcal infection in children, fibrin is not formed in the cavities of the alveoli. Thanks to this, after recovery, breathing is completely restored.
• Symptoms of pneumonia in children are often similar to the symptoms that appear at the initial stage of bronchitis: dry cough, hoarseness.
• Loose stools, lack of appetite, frequent coughing, blueness around the mouth against the background of a cold or inflammatory diseases of the nasopharynx is a good reason to examine a child for pneumonia.
• Cough is the main symptom of the disease in both children and adults.

What are the symptoms of pneumonia in adults: symptoms of lobar inflammation

Pathogens - streptococcus, staphylococcus, pneumococcus, klebsiella. The inflammatory process occurs both in the whole lung lobe and in its segments. The onset of the disease is acute: fever, chills.

The development of the disease occurs in four stages.

1. Tidal stage. There is a sharp hyperemia of the lung tissue and the patency of the capillaries in the affected areas is disturbed.
2. Red hepatization stage. The number of leukocytes in the alveoli increases. The affected lung becomes more dense.
3. The stage of gray hepatization. A large amount of fibrin accumulates in the lumen of the alveoli, which impedes the process of gas exchange in the lungs.
4. Resolution stage. The infiltrate in the alveoli resolves.

Symptoms of lobar pneumonia:

• increase in body temperature up to 40 C Celsius;
• dyspnea;
• cough;
• confusion;
• weakness;
• "rusty" sputum;
• chest pain.

Symptoms of viral pneumonia in adults

It develops against the background of viral infectious diseases. Pathogens - influenza viruses, parainfluenza, measles, chicken pox, adenovirus. Symptoms are similar to those of a cold:

• high body temperature;
• severe headache;
• shortness of breath;
• pain in the chest;
• nausea, vomiting;
• pain in the muscles;
• runny nose.

There may be bloody discharge or pus in the sputum.

Symptoms of hilar pneumonia in adults

Pathogens - staphylococcus aureus, pneumococcus, Haemophilus influenzae. The peculiarity of the disease is that it is difficult to diagnose. The disease has 2 forms: tumor-like - proceeds imperceptibly and slowly; inflammatory - manifests itself quickly.

Main symptoms:

• coughing;
• sore throat;
• increased body temperature;
• an increase in leukocytes in the blood.

To diagnose this type of pneumonia, an x-ray is required.

Symptoms of chlamydial inflammation of the lungs in adults

The causative agent is chlamydia. Most often, the genitourinary system of the body of men and women is affected. Chlamydial pneumonia is atypical and occurs predominantly in children. In adults, it can develop against a background of reduced immunity. The manifestation is similar to the common cold.

Main symptoms:

• the temperature rises to 37.5 - 38 C Celsius;
• hacking sharp cough;
• severe weakness;
• hoarse voice;
• can develop into bronchitis.

Symptoms of fungal pneumonia in adults

The disease is provoked by fungal infections: candidomycosis, blastomycosis, streptotrichosis, actinomycosis, aspergillosis, histoplasmosis. The most dangerous pneumonia, as it is very difficult to diagnose. The patient may not even be aware of the presence of fungal pneumonia. Fungi damage the lung tissue, forming cavities in it.

Main symptoms:

• cough;
• fast fatiguability;
• dyspnea;
• the presence of pus in the sputum;
• muscle pain.

What are the symptoms of pneumonia in older adults?

The development of pneumonia in this category of persons may be accompanied by concomitant diseases:

• emphysema;
• pneumosclerosis;
• diseases of the cardiovascular system.

Especially dangerous is the development of pneumonia in acute vascular insufficiency. In this case, emergency care is needed, as there is a possibility of septic shock and pulmonary edema.

Inflammation of the lungs in people suffering from alcohol dependence

In people prone to excessive drinking of alcoholic beverages, inflammation of the lungs is especially difficult. This is due to severe intoxication of the body. Possible manifestation of various psychoses:

• visual and auditory hallucinations;
• disorientation in space and time;
• excessive overexcitation;
• inappropriate behaviour.

A chronic form of pneumonia occurs if the disease is treated untimely and improperly. It is accompanied by the following symptoms:

• cough with purulent discharge;
• chest deformity;
• hard breathing;
• hypovitaminosis;
• inflammation of the nasopharynx and mouth;
• changes in the composition of the blood;
• tachycardia;
• decreased immunity;
• body intoxication.

Treatment of pneumonia in adults

In most cases of pneumonia, the doctor makes a diagnosis based on the patient's clinical picture and x-ray.

In some cases, it is possible to talk about the etiology of the disease before conducting appropriate bacteriological studies.

Depending on the type of pneumonia, symptoms and treatment in adults vary.

The main component of treatment are drugs aimed at combating the causative agent of the disease. The rest of the drugs are aimed at relieving the symptoms of pneumonia.

In case of not severe inflammation of the lungs in adults, inpatient treatment is carried out. It consists of the following measures:

• taking drugs that dilate the bronchi for sputum discharge;
• taking antibiotics, antiviral drugs to combat the causative agent of pneumonia;
• undergoing a course of physiotherapy;
• performance of physiotherapy exercises;
• diet, drinking plenty of water.

In severe cases, the patient is hospitalized.

Drug treatment for pneumonia in adults includes the following drugs to kill the infection and relieve symptoms:

• To treat an infection:
  • penicillins: amoxiclav, ampicillin, oxacillin, carbenicillin;
  • aminoglycosides: gentamicin, kanamycin;
  • lincosamides: clindamycin, lincomycin;
  • macrolides: sumamed, clarithromycin;
  • carbapenems: thienam, meronem.
• Symptomatic remedies:
  • corticosteroids - to relieve inflammation;
  • mucolytics - for expectoration of sputum;
  • antipyretics - to reduce the temperature;
  • bronchodilators (list of drugs) - to treat cough and relieve breathing;
  • antihistamines - to relieve allergies;
  • drugs that relieve intoxication;
  • vitamins - to strengthen the body and increase immunity.
• Concomitant treatment of pneumonia in adults includes the following procedures:
  • inhalation;
  • electrophoresis;
  • paraffin therapy;
  • pneumomassage.

Doctor Komarovsky, well-known in Russia, believes that along with antibiotics and cough pills, physiotherapy for the treatment of pneumonia is no less important. During the period of exacerbation, the patient needs to take medication and adhere to bed rest. And after the state of health improves, the result of the treatment must be fixed with various auxiliary procedures.

Folk remedies are widely used to treat pneumonia. Healing plants, fruits and roots are recommended for making drinks, inhalations, compresses. Many recipes of traditional medicine can be found on the forums in the topics of discussion of the treatment of pneumonia.

Emergency care for pneumonia in adults includes the following activities:

• oxygen therapy - with severe respiratory failure;
• injections with non-narcotic analgesics - with severe pleural pain;
• antishock therapy - with toxic shock;
• psychotropic drugs - in violation of the psyche in persons suffering from alcohol dependence;
• detoxification therapy - with severe intoxication.

Inappropriate treatment of pneumonia can cause the following complications:

• destruction of lung tissue;
• pleurisy;
• obstruction of the bronchial tree;
• acute heart failure;
• spread of infection through the bloodstream (sepsis);
• meningitis;
• pulmonary edema;
• septic shock.

Prevention of pneumonia in adults:

• strengthening immunity;
• hardening of the body;
• timely treatment of colds;
• timely treatment of caries;
• to give up smoking;
• frequent wet cleaning and ventilation of the room;
• avoidance of hypothermia.

What causes pneumonia?

Answers:

Muhin Vladimir

Inflammation of the lungs: causes and symptoms

DarK GoddesS

From drafts, air conditioning, viruses, staphylococcus aureus, flu, previous bronchial diseases...

doctorparacels

From bacteria or viruses

Katya Khromova

Under certain conditions, such as weakened immunity, high activity of the pathogen, violations of the qualitative composition of the inhaled air, etc., the infectious process is not localized only in the upper respiratory tract (nasopharynx, larynx, trachea), but spreads down. Sometimes the process ends with inflammation of the bronchial mucosa - bronchitis, but quite often this is not the case. Inflammation occurs directly in the lung tissue - pneumonia.
In other words, typical pneumonia, or pneumonia, in which small air bubbles, alveoli, and tissues around them are affected, occurs due to the penetration of pathogens - bacteria, viruses, fungi.

Is lung inflammation non-temperature or not? What are the first symptoms of pneumonia?

Answers:

Hedgehog

happens. . I had bilateral pneumonia without fever. . lay in the hospital for 2 months .... shortness of breath. sweating, pallor, nostrils swell during nasal breathing, dry cough, wheezing in the lungs, poor appetite ... sides may hurt

ANDREY SHABANOV

there is no temperature 100% will be, it’s still hard to breathe, pain in the upper back and chest, if you smoke, then when you try to drag on, cough to the point of nausea

BERRY

Maybe without a temperature.. The usual picture is a debilitating cough with purulent or white sputum, a high temperature of up to 40.. To confirm the diagnosis, a picture is needed !!!

Alexander Pirogov

rare, but pneumonia without fever happens. Another thing is that pneumonia is usually a serious condition, or of moderate severity, in which you don’t really jump if you are not 18 years old. well, the diagnosis of "pneumonia" is made only objectively, on the basis of pictures of all sorts of devices that you do not understand. if you didn’t take pictures with devices (a), then your diagnosis is only yours, treat yourself (a)

If there is a suspicion of pneumonia without fever, what are the symptoms

Lung tissue infection is dangerous. More often than not, it has clear signs. Inflammation of the lungs without fever, the symptoms of which are quite hidden, veiled. High body temperature and cough are one of the main symptoms of this disease. It is according to him that the doctor and the patient himself determines the importance, the inevitability of diagnostic measures and the prompt administration of strong drugs.

In rare cases, pneumonia occurs without a temperature at all, or it rises slightly and does not bother a person. It is believed that there are several reasons for this. From uncontrolled and prolonged use of antibiotics to a weak immune system.

What you need to know so that the progression of the disease does not end badly

Signs of pneumonia, when it occurs without an increase in body temperature, are rather weak, which makes it difficult to make a correct diagnosis. The most common variation of this turn of affairs is if inflammation occurs only in one of the segments of the lung tissue. Doctors have described this type of disease as latent. It is dangerous because for a long time the patient does not suspect why the insidious disease develops in his body, and may die under circumstances incomprehensible to anyone. The symptoms of occult pneumonia are as follows:

1. Malaise and general weakness.
2. Slight, short-term rise in temperature.
3. The appearance of a blush on the cheeks with a general pallor of the face.
4. Shortness of breath, which was not noticed before.
5. Whistling implicit in breathing.
6. Inability to fully take a deep breath.
7. Soreness in the region of the lungs when turning the torso.
8. Increased sweating.
9. It is difficult for a person to spend a long time on their feet.
10. Thirsty.

Even if you notice a couple of the symptoms listed above, you should immediately consult a doctor to protect yourself. It is better to prevent the disease than to regret the lost time later.

Doctors say that if you have had the flu, a common cold, bronchitis and they were accompanied by a cough that you could not eliminate for a long time, do a fluorography to make sure there are no complications in the lungs. It is known that with pneumonia in any of its forms there is a cough.

Inflammation of the lungs, which is not accompanied by fever, also occurs in children. In babies, this condition is especially dangerous, since the child is often unable to tell about the existing obvious symptoms, what to say about a latent disease. Signs of pneumonia in a child are the same as in adults, which are accompanied by:

• constant drowsiness;
• liquid stool;
• regurgitation;
• decreased appetite;
• sweating;
• blue discoloration of the areas around the eyes and nose;
• giving up games.

Parents should be attentive to any condition of their child. It is important to immediately show the pediatrician to a baby or an older baby.

Often pneumonia is accompanied by severe headache, fainting. To understand whether these symptoms are manifestations of a lung disease, you can do this: stand by the mirror, exposing your torso. Hold your breath for a few seconds, and then exhale sharply. If the plaque on the mirror is uneven, one side is more foggy than the other, it is likely that you are sick with a latent type of inflammation.

Causes leading to a latent variety of the disease

Doctors who have been working with this problem for many years note: people who have had a latent form of pneumonia before it appears for a long time:

1. They took antibiotics.
2. They drank cough medicine.
3. They suffered from reduced immunity.

Antibiotics that a person took, being treated for some unknown reason, suppressed the vivid symptoms that characterize changes in the lungs. So, the disease proceeded hidden under the influence of strong drugs. There are types of antibiotics specifically designed to treat pneumonia, some groups do not suppress it. If it so happened that a person took these particular drugs, the disease can kill him.

Antitussive medicines eliminate the symptom - cough, but not its cause. If it smoothly flows into the inflammatory process in the lungs, it cannot be stopped with a simple syrup, but only slightly muffled. Hence the hidden manifestations of the disease. When immunity is weakened at the same time, the human body is not able to direct all its defenses to the fight. He cannot even clearly state the presence of a dangerous disease.

Scientists have identified the causative agents of this disease for a long time. Among them:

• mycoplasmas;
• chlamydia;
• bacteria such as streptococcus, Haemophilus influenzae, pneumococcus;
• viruses (flu, herpes).

Scientists have proven that if you treat any of the conditions with antibiotics, this creates the ground in organs and systems for the development of infections and viruses. If you do not know this or do not attach importance, dangerous phenomena cannot be avoided.

The main places where the infection can be deployed, which subsequently leads to inflammation - tonsils, molars, lymph nodes. You can just get very cold and forget, and after a while notice alarming symptoms. In this case, only a slight malaise may be present, but there will be no cough and fever. So, the disease will develop gradually, and in the last stages, inflammation begins, shortness of breath and wheezing appear. In this case, the infection will fill the lungs so much that it will become quite difficult to help the patient.

Diagnosing a hidden threat is easy. An X-ray examination is required. It is carried out so that the result is a picture in 2 projections. Limited darkening in one of them, speaks of inflammation. If there are no blackouts, or they are poorly distinguishable, a control picture is taken. To confirm the presence of infection in the lungs, they take blood for analysis. A greatly increased level of leukocytes and ESR indicates the disease. Perhaps the doctor will send for a sputum test. But such a procedure is carried out less frequently, if the results of other analyzes are in doubt.

Urgent and long-term hospitalization will help to avoid death

In the hospital, they are treated with droppers with prescribed drugs (antibiotic) to combat pneumonia, which support the body. It is recommended to constantly ventilate the ward, but so as not to catch a cold again. It is important to drink a large amount of water such as: fruit drink, compote, tea, herbal decoction and honey. They give medicine for coughs.

Change the nature of food. It should be the most balanced and fortified. It is important to avoid everything fatty and spicy. Less salt. You need to eat more fruits and vegetables. If you really want fried, it is better to replace it with vegetables stewed in a pan. Heavy food should also not be eaten. A full stomach will put pressure on the diaphragm, and that, in turn, on the lungs.

With a favorable outcome, the patient is periodically allowed to go home, and when they are discharged from the hospital, additional treatment is prescribed at home. Physiotherapy exercises, active lifestyle are shown. Breathing exercises will also help, which consists in deep and slow breaths and forced exhalations. You need to exercise up to 4 times a day.

Pneumonia can be cured if all doctors' instructions are followed. But even in this case, the recovery process will be long - up to one and a half months. And after - rehabilitation is necessary.

It is important to carry out prevention. It consists in the mandatory hardening of the body, taking vitamin complexes. Do breathing exercises. It is very good to apply in order to prevent inflammation, inflating balloons. Get a massage. It is also useful for children. In order to restore and prevent pneumonia, the doctor will pay attention to the chest area. The technique consists in applying pats, along with other manipulations.

Avoid hypothermia, dress for the weather. Do not forget to take a warm hat with you when going to work in the morning. It may turn out that in the cold season the air temperature will go down during the day, the wind will rise, and one cannot do without a hat.

Folk remedies for restoring the body after a disease

They prefer infusions and decoctions of herbs: chamomile, levsia and eleutheracoccus. Echinacea is an excellent immunity booster and acts as an antibacterial agent. Mix it with mint in equal proportions and brew in half a liter of boiling water. Infuse for an hour and take as a drink a couple of times a day.

Honey and birch buds. Thick honey needs half a liter, and raw birch - 100 g. Brew and strain the kidneys. After cooling, mix with the beekeeping product. Take the remedy at night with a spoonful of water. Do before going to bed and honey compresses. If you carry out the procedure for a child, dilute the honey with water a little.

Propolis in the form of oil, honey, aloe juice, birch buds. In equal quantities, mix everything except honey and heat in a water bath for 20 minutes. Add honey to the cooled remedy. It should be consumed three times a day, washed down with milk.

Pour 100 ml of cahors and a little honey into the crushed agave leaves. Insist for a week and take 4 times a day, 5 g of the remedy. Rosehip tea, decoction of coltsfoot is useful.

Garlic treatment. For starters, you can rub it on a crust of bread. Later, eat with bread. A day - a clove of garlic.

Do inhalations with garlic.

Grind it and put it in a piece of cloth, tie a cloth with a rope, dip it in boiling water. Breathe in pairs. Repeat the procedure up to 3 times a day, but later you can reduce the intensity of application.

Inflammation of the lungs is an acute form of development in them of infectious agents such as viruses, bacteria and microscopic fungi. The disease can be the result of foreign agents entering the lung tissue, for example, as a result of aspiration or other serious diseases (lung cancer).

People with weak immunity, pensioners and small children are more susceptible to the disease. When the first symptoms appear - high fever and cough, you should immediately consult a doctor.

This article is devoted to the question of what causes pneumonia, where this disease comes from, what varieties of it are known, and what the development of complications means.

Pneumonia is the inflammation of an entire or separate area of ​​the lung tissue caused by microscopic pathogenic pathogens, as well as foreign agents that have entered the lung. Viruses and bacteria in most cases are spread by the respiratory route, rarely enter the body through the blood. Various objects can penetrate both orally and are thrown into the lungs from the stomach during vomiting or belching.

Normally, pathogenic bacteria are constantly present in the human body, but protective mechanisms prevent them from multiplying to a scale capable of causing disease. When the immune system is weakened for various reasons (hypothermia, other infections, etc.), the harmful microflora begins to rapidly increase its population, which leads to the appearance of an inflammatory process.

When considering what causes pneumonia, in most cases it all starts with colds of the upper respiratory tract such as bronchitis and tracheitis. The infection descends into the lower parts of the respiratory system, while the symptoms are masked.

In addition, pneumonia can develop due to other diseases, as a complication during their treatment or after surgery. For example, often pneumonia in a bedridden patient develops with heart failure due to physical inactivity and poor blood circulation.

In this case, pathogenic microflora is localized in blood stasis, and leukocytes cannot reach the focus of inflammation in a timely manner.

Causes of pneumonia

From the above, it is easy to conclude that pneumonia is a polyetiological disease, i.e., its causes can be many factors, some of which are named in Table 1.

Table 1. The most common causative agents of pneumonia:

The following are the main factors that increase the risk of developing diseases of both the lower and upper respiratory tract:

• bad habits;
• chest pathology due to abnormal development or injury;
• diseases of the heart and other organs;
• chronic depression and stress;
• violations of the protective system, including immunodeficiency syndrome;
• stay of the patient for a long time in a supine position or with artificial ventilation of the lungs;
• pathology of the upper sphincter of the stomach or swallowing;
• age features (children under 3 years old or people over 60).

It is important to know that after the pathogen is in the lung tissue, a pathological process begins, to the place of which the protective cells of the body rush. Exudate accumulates in the focal zone. At the same time, there are microorganisms that can lead to the breakdown of lung tissue due to the toxic toxins that they secrete.

Symptoms of pneumonia

How clearly or characteristically the signs of the onset of pneumonia will appear depends on a combination of various reasons, for example, the strain of the pathogen, age, individual characteristics of human health. Pneumonia can be occult, acute, with classic symptoms, or vice versa.

The course of the disease is most complicated in the elderly, minors and patients with a weakened immune system.

Symptoms in adults

Hypothermia is what causes pneumonia in adults in most of the registered diagnoses, as evidenced by medical statistics. In this case, the symptoms indicated in Table 2 occur, the order of their manifestation is preserved.

Table 2. Typical symptoms of pneumonia in adults:

But not in all cases, the manifestation of symptoms and the complexity of the disease is distinct, which largely depends on the type of pathogen. For example, the well-known H1N1 virus, more familiar to the layman, the name "swine flu" was the cause of the development of an acute severe form of atypical bilateral pneumonia with large lesions of the lung tissue and significant respiratory failure. It was he who caused the deadly epidemic in Asian countries at the beginning of the 21st century.

Very often, the symptoms at first resemble a catarrhal viral infection, and characteristic wheezing is not yet heard in the lungs. Many begin to be treated on their own, which aggravates the condition, not taking into account the fact that even a therapist, during examination, cannot always determine the development of pneumonia.

Self-treatment is based on taking antipyretics and antitussive drugs. At first, an imaginary feeling of the beginning of recovery is created, but then the cough worsens, although hyperthermia can drop to subfebrile levels. Therefore, the most important prevention of pneumonia is in consultation with a narrow specialist, timely seeking help and avoiding self-medication.

Symptoms in children

The criterion from which pneumonia develops in children depends primarily on their age. According to statistics collected and published by the World Health Association, children in the first three years of life get sick several times more often than at a more mature age. For infants, cases of aspiration pneumonia are not uncommon, when, during regurgitation or as a result of pathologies of intrauterine development, the contents of the stomach appear in the respiratory system.

Symptoms in children are directly dependent on age, medical history, and localization of the focus of inflammation.

Children older than three years old have the same signs of the development of the disease as adults, but for infants under one year old, the symptoms will be somewhat different:

1. The child becomes lethargic, constantly wants to sleep, does not eat well;
2. General malaise;
3. During wakefulness, the baby is too irritable, often crying for no reason;
4. Severe fever or subfebrile temperature;
5. The frequency of respiratory movements is increased;
6. If pneumonia is unilateral, then in this case there are signs of incomplete functioning of the diseased lung. When breathing, the lagging of the chest on the affected side is noticeable;
7. The appearance of cyanosis (cyanosis) around the nose and on the phalanges of the fingers.

Older children develop weakness, fever, lack of appetite, unwillingness to play, difficulty breathing and other symptoms.

Classification of pneumonia

Lung diseases are currently well studied, therefore, based on the genesis of the pathology and a number of additional factors, the diagnosis has a certain differentiation. This classification helps to determine more accurate treatment and achieve a positive therapeutic effect faster.

Classification according to the condition of occurrence

Depending on the conditions under which the patient fell ill, community-acquired and hospital-acquired (nosocomial) pneumonia are distinguished. In the first case, the patient falls ill outside the hospital. Secondly, while in a hospital, when a person was delivered with a different diagnosis, but for two days he developed pneumonia. A significant difference is that in a hospital environment, pathogens that are quite resistant to antibiotics develop.

The aspiration form of the disease is especially distinguished when foreign particles enter the lung tissue. These can be small objects inhaled through the nose or mouth, food or stomach contents (for example, with vomiting or pathologies in which food is evacuated back).

Such masses contain harmful microorganisms that can cause serious inflammatory processes that destroy lung tissue, purulent sputum is formed, which is difficult to pass.

Classification according to the volume of lung damage

In this case, the types of the disease differ in the amount of affected tissue and the spread of inflammation in the lungs.

Focal pneumonia

With this type of inflammation, the focus has a clear localization, which can be detected using a phonoscope or x-ray. As a rule, there is a complication of diseases of the upper respiratory tract as a result of a cold or a viral infection. There comes, as it were, the second wave of the disease already at a higher temperature, a productive cough with copious sputum in which there are purulent particles.

Note. With focal pneumonia, the inflammation zones are more localized in the lower parts of the lung, usually on the right side.

Unilateral pneumonia

The name fully reflects the features of the disease, when the pathology affects one lung, affecting its entire tissue or individual sections. The nature of the course of the disease and its symptoms will depend on this; if small foci of inflammation of the lungs occur, inflammation of the lungs can be asymptomatic or resemble a cold in appearance.

Bilateral pneumonia

This part of the diagnosis is made in the case when there are lesions of varying degrees in both the right and left lungs, regardless of the size of the focus, that is, it can be a segment of the lung tissue or the whole. Thus, the main diagnostic criterion is bilateral localization without taking into account the degree of organ damage.

Croupous pneumonia

Croupous pneumonia has vivid symptoms, while a significant part of the lung (at least its share) becomes inflamed, the pleura also becomes ill, so the person immediately begins to complain of pain in the chest. The onset of the inflammatory process is accompanied by a sharp jump in temperature to 39 degrees and above.

A wet cough usually occurs on the first day, sputum has a yellowish or orange color. Often there are signs of pulmonary insufficiency, it becomes difficult for a person to breathe, he develops shortness of breath.

In most cases, the cause of the development of the disease are pneumococci. Therefore, the instruction of treatment suggests the prescription of antibiotics from the penicillin family, since they are effective against pneumonia caused by pneumococcal bacteria.

Lobar inflammation of the lungs

From the name it may seem that this is a kind of one-sided form, but this is not so and therefore they should be distinguished. Pulmonologists divide the lungs into several zones called lobes.

There are two such shares on the left, and three on the right side. With inflammation of one lobe, they speak of lobar pneumonia, if two lobes are sick, it is bidoleic, while specifying whether it is a unilateral or bilateral form.

If the foci occupy both lobes on the left, then total pneumonia is diagnosed, in the case of a pathology of two lobes of the right lung, subtotal pneumonia. Thus, all types of pathologies are characterized by the degree of distribution of foci. The more parts of the lung tissue are involved, the more intense the symptoms of the disease will appear.

Causes of pathology

In order to successfully treat the disease, you need to clearly know what causes pneumonia, choose adequate therapy and prescribe appropriate medications. The reasons for development can be varied, so we will dwell on them in more detail.

Pneumonia of viral etiology

Usually, viral pneumonia develops as a complication of influenza or other respiratory infections, and may be of primary etiology. Today, it is not always possible for physicians to reliably trace the true cause of the disease due to the lack of perfect diagnostic methods, so it is often difficult to understand which strain is responsible for the development of inflammation.

Treatment in this case involves taking antiviral drugs, depending on the symptoms. It is not excluded the use of antibiotic therapy if there is reason to believe that a secondary infection has developed or there are certain prerequisites for this.

bacterial pneumonia

Bacteria are the most common cause of pneumonia. These microbes are the cause of the most common types of lung pathologies.

Important. For successful treatment, it is necessary to identify the strain of the pathogen and prescribe the appropriate antibiotic. As a rule, this is enough for successful treatment, but in some cases a special approach and a change in the drug are required, since bacteria can show resistance to one or another type of drug.

Features of staphylococcal pneumonia

Usually, with a weakened immune system, staphylococci develop against the background of acute respiratory infections. This is what causes pneumonia in adults, but it is more typical for children, especially if they are not accustomed to the rules of hygiene.

The danger is that these strains can cause the formation of necrosis of the lung tissue with the possibility of abscesses. There is evidence that with this development of events in adult patients, the probability of death is estimated at 30%.

The disease is characterized by the following symptoms:

• a sharp and strong increase in temperature to 39-40 degrees;
• signs of intoxication;
• profuse sputum formation, often with a reddish tint of purulent character;
• weakness and headache;
• lack of appetite.

In rare cases, the disease can cause confusion and the occurrence of symptoms similar to meningeal.

streptococcal pneumonia

Streptococcus is an undesirable microbe for humans that has a strong negative effect on many internal organs and is dangerous for the heart. As a rule, inflammation of the lungs of a streptococcal nature is less common and can be caused by an epidemic of respiratory diseases. There is a complication in the form of diseases of the pleura and necrotic changes in lung tissue, while a large amount of purulent sputum will form.

The note. If a patient whose tonsils have not been removed often has a sore throat, it is necessary to take an analysis of the microflora of the nasopharynx. There is a high probability of detecting a streptococcal infection, the source of which will be infected tonsils. In this case, a tonsillectomy is recommended, mainly because the proteins of streptococcus are identical in structure to the proteins of the heart valves, so the immune system, fighting the microbe, gradually destroys the myocardium.

Mycoplasma pneumonia

The causative agent is a bacterium of the same name. When it enters the lung tissue, it begins to actively multiply there. This is the reason why children get pneumonia more often than adults, which is typical for isolated groups, for example, in schools or kindergartens.

The initial stages are outwardly similar to a cold, so a clear differentiation is difficult from unexpressed symptoms:

• runny nose;
• subfebrile or febrile temperature;
• sore throat;
• loss of strength and other signs of a respiratory infection.

After a few days, these symptoms are accompanied by heavy breathing and shortness of breath, which indicates pulmonary insufficiency characteristic of pneumonia. Microplasma infections are treated successfully, but longer than ordinary pneumococcal pneumonia.

Chlamydial pneumonia

This pathogen is the cause of the development of a vaginal infection (chlamydia) in women and should not normally be in the lung tissue. Often the route of infection occurs during childbirth if, in the presence of infection, prenatal sanitation of the vagina was not carried out.

The disease is more common in infants and young children. Accurate diagnosis is difficult because the symptoms are similar to the common cold. It all starts with soreness of the nasopharynx or throat, the appearance of rhinitis and dry cough.

After a while, symptoms that are already more characteristic of pneumonia appear: high fever, shortness of breath. Treatment of this type of pneumonia should be prescribed based on the age and individual characteristics of the course of the disease in each case.

Mycoplasmas and chlamydia are the causes of the so-called atypical pneumonia, in which pathologies are characteristic not only of the alveoli, but also of interstitial tissues. The disease is treated for a long period and often becomes chronic.

Fungal infections

The development of pneumonia can be caused not only by viruses and bacteria, but also by microscopic fungi. With this form, a detailed diagnosis is required, since the symptomatic picture will be blurred and often different from ailments of a bacterial nature.

If the fungal pathogenesis is confirmed, then the treatment will take a rather long time period, since the appointment of antimycotic drugs is required.

legionella pneumonia

This type of inflammation is caused by contamination with bacteria and small particles of inhaled air masses after air conditioning systems in which regular cleaning of filters is not carried out. As a result of the accumulation of harmful agents in the lung tissue, the disease begins to develop.

The first signs are weakness, lack of appetite, headache, and maybe even indigestion. A little later, a sore throat, dry cough and chest pain appear.

Prevention in this case is the timely replacement or cleaning of filters in air conditioners and split systems, this should be done about once a year, depending on the frequency of operation of the devices. The price of the procedure is not so high as to pose a threat to health.

Note. Legionella pneumonia is a form characteristic of adults and is extremely rare in children.

Diagnosis of pneumonia

The doctor establishes the diagnosis on the basis of a physical, instrumental examination and laboratory tests. Initially, advising clinical symptoms indicate the likelihood of this complex disease. Auscultation audible wet rales in the area of ​​inflammation, crepitus, heavy bronchial breathing and other signs.

Attention. If pneumonia is suspected, a chest x-ray is required. At the end of the study, a second picture is taken to control a positive result.

To clarify the pathogen, a microbiological examination of sputum is carried out. Since cases of pulmonary tuberculosis have recently become more frequent, this study will help identify its causative agent - Koch's bacillus, if any. Also, for the diagnosis of pneumonia, the tests indicated in Table 3 are used.

Table 3. Laboratory tests for the diagnosis of pneumonia:

Also, the patient will be required to pass non-specific tests, which are mandatory for respiratory infectious diseases:

• general analysis of blood and urine;
• measurement of blood pressure;
• electrocardiogram.

The doctor, based on the diagnosis, determines the type and severity of the disease, the likelihood of concomitant complications and prescribes the appropriate treatment. It is especially important to exclude oncological pathologies, appendicitis, lupus erythematosus, tuberculosis, pancreatitis and liver abscess.

With inflammation of the lungs, complications can develop:

• diseases of the pleura;
• acute respiratory failure;
• lung abscess;
• pathology of cardiac activity;
• respiratory distress syndrome;
• infectious-toxic shock;
• COPD;
• meningitis;
• glomerulonephritis;
• DIC syndrome.

Treatment and prevention

Inflammation of the lungs is a rather serious disease that, before antibiotics were invented, was fatal in 80% of cases, while at the moment these figures have dropped to 5-35%.

In most cases, in the absence of significant complications, treatment lasts an average of 10-14 days. In mild cases, hospitalization in a hospital is not required. It all depends on the diagnosis, the characteristics of the course and the age of the patient. In any case, the decision on the method of therapy is made by the pulmonologist.

Important. If pneumonia is detected or suspected of it, further treatment should be carried out by a pulmonologist, it is better to refuse the services of a therapist in this situation.

Features of the diet suggest high-calorie nutrition, preferably with a minimum content of hard-to-digest foods. It is recommended during this period to eat more plant foods, vegetables, fruits with a high content of vitamins and minerals.

Be sure to drink as much fluid as possible, which is important for the formation and thinning of sputum, its evacuation, along with taking antibiotics, contribute to the speedy cleansing of the lungs from pathogenic microflora. To improve the functioning of the gastrointestinal tract, the addition of fermented milk products with bifidus and lactobacilli to the diet is shown.

The main place in the treatment of pneumonia belongs to antibacterial drugs, and recently preference has been given to the combined use of several at once. The type of medication, dosage and regimen must be determined by a pulmonologist, based on the diagnosis, the conditions of the course of the disease, the age and individual characteristics of the patient.

In addition, the doctor prescribes additional drugs for the respiratory tract, the main ones are listed in Table 4.

Table 4. Non-antibacterial drugs prescribed for pneumonia:

Advice. If there is no sputum or it coughs up badly, it is recommended to brew baking soda ash and breathe over its steam. This causes the secretion of mucus. The method is very effective if it is required to analyze it, and the selections are scarce.

Prevention of acute pneumonia is to maintain a healthy lifestyle, proper nutrition, exercise and strengthening the body's immune system. It is important to exclude infectious and catarrhal ailments, to prevent the presence of factors that provoke the occurrence of pneumonia.

Have a good preventive effect:

• hardening;
• swimming;
• breathing exercises;
• acupressure.

In elderly people who, due to weakness, practically do not get out of bed, for the prevention of hypostatic pneumonia, it is shown to do a special massage with gentle tapping movements from the bottom up. Such manipulations should be performed along the entire back, while the person lies on his stomach with his arms along the body.

Since full-fledged breathing exercises are not available to such patients, it can be performed by inflating a children's toy or balloon several times, which will make the lungs tense a little. More information can be found in the video in this article.

Conclusion

All types of pneumonia are classified as severe pathologies of the respiratory system, in which the likelihood of complications is high. This disease generally negatively affects the general condition of the body.

The main reason for the development of pneumonia is the weakening of the immune system, when, under various circumstances, pathogenic microflora (viruses, bacteria, fungi) begins to actively multiply in the lung tissue. Less often, the cause of the disease is the ingress of foreign particles into the lungs, other diseases, such as cancer, or the constant influence of irritating agents sprayed into the air (dirty air conditioner filters, toxic dust at work, etc.).

Symptoms in most cases are weakness, cough, fever and shortness of breath. The main treatment consists in prescribing antibiotics, as well as drugs that stimulate the secretion and thinning of sputum during a productive cough. Prevention - strengthening the protective properties of the body.