The author - Chuklin Olga, general practitioner, internist. Work experience since 2003.
Pneumonia called acute infectious disease, which is characterized by the development of lung tissue inflammation, always in the process involves the alveoli
Causes
There are the following possible causes of the disease:
- bacteria;
- viruses;
- fungi.
Among the bacteria leading role belongs to streptococcus pneumonia (pneumococcus), rarely cause pneumonia, Mycoplasma, Legionella, Chlamydia, Klebsiella.
Lead to the development of pneumonia is influenza virus, including virus type A (H1N1), adenovirus, Rhinovirus.
Fungal pneumonia causes the fungus Candida.
Infection occurs by droplets (sneezing, coughing) of a human patient, or an infection in the lung tissue can come from lesions of a chronic infection (chronic sinusitis, tonsillitis, caries teeth).
Factors contributing to the development of the disease are:
- hypothermia;
- chronic lung disease (bronchitis);
- decreased immunity;
- patient age of 65 years;
- smoking;
- alcohol abuse;
- inhalation of harmful substances in the workplace;
- presence of chronic disease (cardiovascular, diabetes, kidney disease);
- finding a patient on a ventilator.
types of pneumonia
Pneumonia can be:
- primary - Pneumonia is an independent disease;
- secondary - pneumonia develops against the backdrop of concomitant disease (congestive);
- aspiration - develops when entering the bacteria in the bronchi with vomitus, foreign bodies;
- postoperative;
- posttraumatic - resulting in lung injury.
etiology
- Typical - caused by common pathogens (pneumococcus, virus);
- atypical - caused by atypical pathogens (Chlamydia, Mycoplasma, Legionella, Klebsiella).
The morphological features:
- Alopecia - affected a small area of the lung;
- lobar - affected lobe of the lung may be unilateral or bilateral.
By origin:
- community-acquired - are developing outside the hospital;
- nosocomial - developed after 2 days or more after receipt of the patient in the hospital.
Nosocomial pneumonia are more severe.
The symptoms of lung inflammation
The clinical picture of pulmonary inflammation depends largely on the type of agent, the state of health, presence of concomitant diseases, immunodeficiency.
In most cases, pneumonia is the focal form and is characterized by the following symptoms:
- acute onset;
- Body temperature rises to febrile digits (38.5 - 40 degrees);
- general weakness;
- pain in the chest with a deep breath, and coughing;
- increased sweating;
- fast fatiguability;
- dry cough at the beginning of the disease later becomes productive (wet);
- dyspnea.
For pneumonia and is characterized by local signs - auscultation heard any weakening of breath, or finely, krepitiruyuschie wheezing.
For small focal pneumonia may not be changes in auscultation.
Temperature pneumonia lasts for three to four days under the condition treated early.
Symptoms of lobar pneumonia
Lobar pneumonia characterized by pronounced intoxication syndrome, the temperature rises sharply to 39 - 40 degrees, developed tachycardia (increased heart rate).
Most often with lobar pneumonia causes severe shortness of breath, increase in breathing frequency, cough appears early.
Important! The peculiarity of the wet cough with lobar pneumonia is the presence of the "rusty sputum" (present in sputum blood streak).
asymptomatic pneumonia
It is also possible for asymptomatic pneumonia, it can be for small focal pneumonia, with a decrease in immunity.
The patient has no specific signs of the disease - cough, fever. It can only be a general weakness, fatigue.
Discover a pneumonia accidentally during fluorography examination.
Particularly viral pneumonia
For viral pneumonia characterized by the fact that the patient in the beginning there are signs of respiratory disease. And after one or two days will appear symptoms of pneumonia - cough with blood-streaked, fever, shortness of breath occurs.
Diagnostics
Diagnosis of pulmonary inflammation is based on the presence of characteristic clinical picture of the disease, the inspection data and characteristic changes during examination of the patient.
On examination can reveal:
- auscultation - respiratory depression, the presence of finely moist rales, crepitation.
- It may be the lag of the chest when breathing on the affected side;
- with the development of respiratory failure - increased frequency of respiratory movements, retraction of the intercostal spaces during inspiration, akrozianoz.
Conducted laboratory and instrumental examinations:
General blood analysis. It is found leukocytosis, accelerated ESR.
The overall analysis of sputum. Characterized by signs of inflammation (white blood cells), blood, detection of the pathogen.
Bak.posev sputum - to determine the pathogen and determine its sensitivity to antibiotics.
Blood chemistry. there is an increase ALT, ASTC-reactive protein.
Rentgenogrfiya chest in two planes (AP and lateral). When visible pneumonia focal darkening or equity.
If necessary the computer or magnetic resonance tomography of the lungs.
To determine the degree of respiratory insufficiency pulse oximetry is performed (determine blood oxygen saturation, it is a noninvasive method).
With what could be mistaken for pneumonia
Differential diagnosis of pneumonia is carried out:
- tumor formations - there is no temperature, or it is low-grade, no acute onset, lack of effect of antibiotics;
- pulmonary tuberculosis - also began not sharp, no hyperthermia, a characteristic X-ray pattern, the lack of a positive effect of the therapy.
treatment of pneumonia
Important! This section is written in accordance with Federal standard primary health care with pneumonia
The treatment is not severe pneumonia can be done on an outpatient basis, is subject to severe pneumonia hospitalization.
There are general guidelines:
- compliance with bed rest;
- regular airing of the premises;
- plentiful water schedule (intoxication promotes removal);
- moisturizing of inhaled air;
- food must be easily digestible.
The main treatment is the use of antibacterial drugs.
Which antibiotics are indicated for pneumonia
Not severe pneumonia begin to treat with penicillin protected:
- amoxiclav;
- Flemoklav;
- Augmentin.
If the patient has an intolerance or contraindication this group, the recent use of drugs of this group, the patient is prescribed macrolides:
- azithromycin;
- sumamed;
- Hemomitsin;
- Clarithromycin.
Also macrolides prescribed for SARS.
Preparations of the third row are respiratory fluoroquinolones, cephalosporins.
By respiratory fluoroquinolones are:
- levofloxacin;
- Glewe;
- tavanic;
- Moxifloxacin.
Cephalosporins include:
- cefotaxime;
- ceftriaxone;
- Supraks.
In less severe course of antibacterial therapy for 7 to 10 days.
The effectiveness of antibiotic treatment is estimated at 48-72 hours after initiation of therapy, if there are no signs of improvement (reduction of toxicity, body temperature, lifting of dyspnea), then produce the shift antibiotic.
Severe pneumonia begin to heal in a hospital injectable forms of antibacterial drugs, it is also possible appointment of two drugs from different groups.
In severe forms of pneumonia, antibiotic therapy is not less than 10 days.
In the case of atypical pneumonia treatment is 14 to 21 days.
In addition to antibiotic therapy is appointed and antipyretic therapy. Antipyretics assigned when raising the temperature from 38.5 degrees:
- ibuprofen;
- Paracetamol;
- Ibuklin;
- Aspirin.
To liquefy the sputum mucolytics are used:
- ambrogeksal;
- Lasolvan;
- ambrobene;
- ACC;
- Fluimucil;
- Flyuditek.
Effective inhalation via nebulizer:
- sodium chloride 0.9%;
- Mucosolvan aqueous solution;
- in the presence of dyspnea - Berodual.
Important! Cough syrups are not suitable for use in a nebulizer. For this purpose, aqueous solutions are suitable for water-based inhalation.
Of physiotherapy possibilities:
- electrophoresis on the chest;
- UFO chest;
- magnetic therapy;
- vibrating massage chest.
After recovery, the person is subject to dispensary observation for one year.
complications
In case of wrong or delayed treatment of pneumonia can produce serious complications.
- The development of acute respiratory failure.
- Pleurisy - inflammation of the lung membrane.
- lung abscess - forming a cavity filled with purulent content.
- 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 infants and patients at risk. Formed immunity for five years, then revaccination should be performed.
There are also general recommendations:
- Avoid hypothermia.
- Rejection of bad habits.
- Treatment of chronic diseases.
- Maintain a healthy lifestyle.
- Hardening of the body and regular exercise.
