Pneumonia - Causes, symptoms and treatment. MF.
Jun 02, 2018
Pneumonia in children and adults
Despite the achievements of modern medicine and the emergence of new effective antibacterial drugs, pneumonia is an extremely common and life-threatening disease. According to the frequency of fatalities, pneumonia stands at the first among all infectious diseases of the place. Reduce the incidence does not work for many years. For example, in Russia, according to official statistics, at least 400,000 new cases are registered each year. At the same time, many experts consider this figure to be too low. In their opinion, in Russia annually carry pneumonia more than 1 000 000 people.
Pneumonia is an acute infectious inflammation of the lower respiratory tract with mandatory involvement of pulmonary tissue( alveoli, bronchi, bronchioles).
Currently, several types of pneumonia are isolated:
1) Community-acquired pneumonia is the most common type of disease.
2) Nosocomial or hospital pneumonia .This form refers to the disease that developed when the patient was in the hospital for more than 72 hours. At the time of admission, the patient did not have clinical manifestations of pneumonia.
3) Aspiration pneumonia - occurs as a result of ingress of food, water, foreign objects into the respiratory tract.
4) Atypical pneumonia .A type of disease caused by an atypical microflora( chlamydia, mycoplasmas, legionella, etc.).
Causes of pneumonia
Pneumonia is, above all, a bacterial disease. The main causative agents of pneumonia : pneumococcus( Streptococcus pneumoniae), staphylococcus aureus, Haemophilus influenzae and "atypical" infections( Chlamydya pneumoniae, Mycoplasma pneumoniae, Legionella pneumoniae).
More rarely, the cause of acute pneumonia can be( Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter, etc.).They are more common in patients with severe concomitant diseases, in patients with weakened immune system.
The starting factor in the development of pneumonia can be various viral infections. They cause inflammation of the upper respiratory tract and provide "comfortable conditions" for the development of bacterial pathogens.
Risk factors that increase the likelihood of developing pneumonia:
1) Diseases of the internal organs, primarily of the kidneys, heart, lungs, in the decompensation stage.
3) Oncological diseases.
4) Performing artificial ventilation.
5) Diseases of the central nervous system, including epilepsy.
6) Age is more than 60 years.
7) General anesthesia.
Symptoms of pneumonia
The main symptoms of pneumonia - fever with a fever rise to 38-39.5 C, cough more often with the passage of abundant sputum, dyspnoea with physical exertion and at rest. Sometimes patients may experience discomfort or pain in the chest.
All patients with pneumonia note general weakness, decreased efficiency, fast fatigue, sweating, sleep disturbance, decreased appetite. In elderly patients, symptoms of general intoxication may dominate.
Auscultation of the patient with pneumonia over the focus of inflammation hears rales of a different nature( more often small-bubbles).With percussion of the chest, dulling of the sound over the area of inflammation. But in some patients( about one in five) local symptoms of pneumonia may not be.
What tests should be taken if you suspect a pneumonia
If you suspect a pneumonia and the appearance of the corresponding symptoms, you will need to do a clinical blood test. A sharp increase in leukocytes, an increase in the number of stab neutrophils, and ESR - can indicate acute bacterial inflammation. In this case, an increase in the concentration of leukocytes more than 10 * 109 with a high degree of probability indicates the development of pneumonia. Reduction of leukocytes less than 3 * 109 or a rise of more than 25 * 109 are unfavorable prognostic factors indicating a severe course of the disease and a high risk of complications.
Indispensable for the accurate diagnosis of pneumonia is chest radiography. It is carried out in a straight line, and if necessary in the lateral projection and allows not only to establish the diagnosis of acute pneumonia and to identify possible complications, but also to evaluate the effectiveness of treatment.
Unfortunately, in a number of cases, radiography is not informative. In such situations, a more accurate method of research is used - computed tomography of the lungs. When does it make sense to resort to this variant of diagnosis?
1) if the patient has all the signs of acute pneumonia, but the X-ray examination does not allow to identify the focus of inflammation.
2) with relapsing pneumonia( more than 3 episodes), provided that the focus of inflammation is located in the same lobe of the lungs.
3) if the X-ray picture does not match the clinical manifestations of the disease. For example, the patient has signs of acute pneumonia, and on the roentgenogram a picture of atelectasis, etc.
Biochemical blood test does not help in diagnosing pneumonia, but it allows to identify accompanying disorders in the work of internal organs. Usually, the following indicators are determined: glucose, AST, ALT, bilirubin total, bilirubin direct, creatinine, urea, CRP.
The development of respiratory failure is a direct indication of the saturation of blood with oxygen and carbon dioxide. Pulse oximetry is more accessible. To do this, the patient is put on a finger a special sensor that estimates the oxygen saturation of blood in small capillaries.
Sputum examination is mandatory. Conduct her microscopic and bacteriological examination.
If a patient is suspected of pneumonia of an atypical infection, a blood test for antibodies( IgM and IgG) against the causative agents Chlamydya pneumoniae, Mycoplasma pneumoniae, Legionella pneumonia is performed.
If the patient has signs of tuberculosis development, it is necessary to consult a phthisiatrician with mandatory sputum examination, in-depth X-ray examination, and conducting intradermal tests.
Tumor signs of tuberculosis:
1) coughing for more than 3 weeks with or without sputum,
2) appearance of hemoptysis,
3) occurrence of chest pain,
4) prolonged temperature ranging from 37.1 to 37.90C,
5) increased sweating, especially at night,
6) progressive weight loss.
Treatment of pneumonia
Treatment of uncomplicated forms of pneumonia can deal with general practitioners: therapists, pediatricians, family doctors and general practitioners. The patient's serious condition requires hospitalization, preferably in specialized hospitals( pulmonology department).
Indications for hospitalization for pneumonia:
1) Objective examination data: impaired consciousness, respiratory rate more than 30 per minute, diastolic pressure lower than 60 mmHg, and systolic pressure less than 90 mmHg, increased frequencyheart rate more than 125 per minute.
2) Body temperature less than 35.5 ° C or more than 40.0 ° C.
3) Reduced oxygen saturation of blood is less than 92% of the norm.
4) Changes in laboratory parameters: leukocyte concentration less than 4 or more 25 per 109 per liter, a decrease in hemoglobin of less than 90 grams per liter, a rise in creatinine of more than 177 μmol per liter.
5) Changes in the radiograph: changes in more than one lobe, the presence of a cavity, effusion in the pleura.
6) Presence of foci of infection in other organs and systems( bacterial arthritis, meningitis, sepsis, etc.).
7) Decompensation of concomitant diseases of the heart, liver, kidneys, etc.
8) Impossibility of adequate home therapy according to social indications.
Drugs for the treatment of pneumonia
The basis for the treatment of pneumonia is the use of antibacterial drugs. The choice of the drug, its dosage and duration of application is determined by the doctor, depending on the age of the patient, the features of the clinical picture of pneumonia and the presence of concomitant diseases. Most often for the treatment of pneumonia, a combination of two antibacterial drugs is required.
Currently, the following pharmacological groups of antibiotics are used for the treatment of pneumonia: macrolides( eg, clarithromycin, macropen, fromilide, azithromycin, sumamed, chemomycin, vilprafen), penicillin and its derivatives( eg, amoxiclav, flemoclav, flemoxin, augmentin, ampiox, and tcephalosporins( preparations: cefazolin, suprax, rocefin, zinnate, fortum, cefixime, cephalexin, cefataxime, ceftazidime, cloforan, cefepime, ceftriaxone), respiratory fluoroquinolones( levofloxacin, sparfloxacin).The average duration of antibiotic therapy is at least 7-10 days.
In the presence of cough with sputum, expectorating and thinning medications are prescribed. Drugs of choice ATSTS, fluimitsil, lazolvan, bromheksin. A frequent mistake is the administration of drugs of this group in patients without coughing or with a dry, unproductive cough.
With the development of dyspnea, bronchodilators are prescribed. Most preferably, inhalation agents such as beryl, beotech, salbutamol are used. The best way to deliver - inhalation with a nebulizer. If it is not possible to use inhalants, prescribe euphyllin or its derivatives( teopek, theotard).
According to the indications, infusion therapy is performed. For this purpose, drippers with saline solutions( saline, disul, Ringer's solution, etc.) or glucose solution are made.
In severe pneumonia, immunomodulatory therapy is possible. For this purpose, immunoglobulins for intravenous administration, for example, octagam, pentaglobin, intraglobin, may be administered. Well-established drug polyoxidonium, which has both immuno-fortifying and pronounced detoxification effect.
With fever over 38.0-38.50 C, antipyretic agents are prescribed.
Treatment of pneumonia with folk remedies
Treatment of pneumonia with "folk remedies" can only complement "traditional" drug treatment, but not be a substitute for it.
It is often recommended to use beekeeping products( honey, propolis, etc.).For example, eat 1-2 tablespoons of honey 2-3 times a day, along with hot drink. It is also advised to ingest large doses of garlic and / or onions.
Of the herbs most often recommend leaves of coltsfoot, hips, elderberry, linden flowers, raspberry berries.
There were tips that recommend wrapping with fresh leaves of plantain and burdock.
All these folk remedies for pneumonia can be used provided you do not have any allergies to these remedies.
Features of nutrition and lifestyle for the treatment and prevention of pneumonia
The bed regimen, in the stage of recovery - polupostelny. Categorically you can not smoke. Sufficient liquid intake is necessary. Recommended rates - not less than 2.5-3 liters per day. In a daily diet should be a sufficient number of proteins and carbohydrates and vitamins, especially A, B and C.
Most patients benefit from breathing exercises. For example, according to the technique of Strelnikova or Buteyko. Old practical guidelines on pulmonology recommended that patients puff balls in their spare time.
Before you do breathing exercises, consult your doctor if you can do it. In a number of conditions, for example, with abscess of the lungs, certain diseases of the heart, breathing exercises are contraindicated.
Pneumonia in children
Symptoms of pneumonia in a child are similar to those in adults. Particular attention is paid to the frequency of respiratory movements and the occurrence of dyspnea. Pathology threatening life is considered to be the frequency of respiratory movements more than 40 per minute in children over 1 year old. The appearance of dyspnea on the background of acute respiratory disease is an unfavorable prognostic sign.
I want to highlight the wider prevalence of "atypical" pathogens of pneumonia among children. In this regard, the use of antibiotics from the macrolide group in the treatment of acute pneumonia in children is desirable.
Given the high likelihood of complications from the respiratory and cardiovascular systems, inpatient treatment of such patients is preferable.
Pneumonia in pregnancy
Acute pneumonia in pregnant women, even leaking in mild form, poses a great danger for both women and the fetus. This is due both to the direct impact of intoxication, and to the negative effects of prescribed medications.
Even with the appearance of minimal cold symptoms, a doctor's consultation is necessary, which is associated with the high prevalence of latent forms of the disease, which at first are easy but can cause serious complications. Diagnosis on general principles. Radiography is possible and relatively safe for the fetus after 10 weeks of pregnancy.
Antibiotic therapy is performed only with a confirmed diagnosis. Treatment only in a hospital.
As a rule, pneumonia is not an occasion for abortion.
Possible complications of pneumonia and the prediction of
Pneumonia can lead to the development of a number of complications from the lungs: lung abscess, pneumothorax, pleural empyema, etc. The most serious complication is the development of respiratory failure. Its development is more likely in elderly patients, patients with concomitant chronic lung diseases( bronchiectasis, chronic obstructive pulmonary disease, chronic obstructive bronchitis, etc.) and the heart. Respiratory failure in such patients can cause death. Also, the lethal outcome can lead to the development of cardiovascular failure.
Prevention of pneumonia
Proven effective prevention of lung disease, including pneumonia, is the cessation of smoking. Often, pneumonia develops after a viral infection, so annual vaccination against influenza is also considered a preventive measure.
It is also recommended to vaccinate once every five years for the prevention of pneumonia. The most frequent infectious agent causing pneumonia is pneumococcus. The PNEVMO-23 vaccine creates immunity to this pathogen of pneumonia.
Answers to frequently asked questions on pneumonia:
Is it not dangerous to use antibiotics for pneumonia?
If they are not used, then pneumonia will progress, the focus of inflammation will increase. As a result, it can lead to respiratory failure and death.
During the year, a child( 7 years) suffered 3 pneumonia. What are the ways of preventing this disease?
You need mandatory consultation of two specialists: pulmonologist and immunologist. The first will help to identify concomitant lung diseases that can provoke such frequent pneumonia, the second will prescribe immuno-strengthening therapy.
The hardening also has a beneficial effect. It is better to start it in the summer and on a background of complete health.
When can I get vaccinations after my previous pneumonia?
Must pass at least 1.5 months after recovery.
- Forward & gt; & gt;