What causes pneumonia? Causes of abscess and gangrene after pneumonia. Diagnosis and treatment of pneumonia

Pneumonia (pneumonia) is inflammation of tissue in one or both lungs caused by infection.

At the end of the breathing tubes in the lungs (alveolar ducts) there are tiny sacs filled with air (alveoli), collected in bundles. In pneumonia, these sacs become inflamed and fill with fluid.

The most common symptoms of pneumonia:

cough;
heat;
labored breathing.

Most common reason Pneumonia is a pneumococcal infection, but there are many other types of bacteria and viruses that cause pneumonia.

sick mild form pneumonia is usually treated at home. They are given antibiotics, plenty of fluids and rest. People in good health usually get better without any consequences.

People with other illnesses may have severe pneumonia and may require hospital treatment. This is because pneumonia can cause complications, which, depending on the health condition and age of the patient, can even lead to death.

According to various sources, 1-2 million people fall ill with pneumonia every year in Russia. People are more likely to get pneumonia in the fall and winter. Mortality from community-acquired pneumonia in Russia, according to various sources, ranges from 1% to 5%, but among patients requiring hospitalization and in the elderly, this figure is many times higher. You can get pneumonia at any age.

Symptoms of pneumonia

Symptoms of pneumonia can develop very quickly (over 24 to 48 hours) or relatively slowly over several days. Manifestations of the disease vary and may be similar to those of other respiratory tract infections such as acute bronchitis.

Pneumonia is characterized by a cough. It may be dry or accompanied by sputum (thick mucus) that is yellow, green, brownish, or even bloody.

Other common symptoms:

difficulty breathing - breaths are frequent and shallow, shortness of breath is possible even during rest;
severe increase in body temperature;
general poor health;
sweating and chills;
lack of appetite;
chest pain.

Less common symptoms include the following:

headache;
fatigue;
nausea;
vomit;
wheezing;
pain in joints and muscles;
loss of orientation in time and space (especially in older people).

If you notice symptoms of pneumonia, contact your doctor for a diagnosis. If you experience severe symptoms, such as rapid breathing, pain, or confusion, contact your doctor immediately.

Causes of pneumonia

The most common cause of pneumonia is an infection, usually of bacterial origin.

However, pneumonia is caused different kinds bacteria, viruses and (occasionally) fungi, depending on where the pneumonia started. For example, the microorganisms that cause pneumonia caught in a hospital are different from those that can cause it in everyday life.

Microorganisms that cause infection usually enter the lungs through inhalation. IN in rare cases pneumonia can be caused by an infection in another part of the body. Then the pneumonia pathogen enters the lungs through the blood.

The four types of pneumonia are described in detail below.

Bacterial pneumonia

The most common cause of pneumonia in adults is the bacterium Streptococcus pneumoniae. This form of pneumonia is sometimes called pneumococcal pneumonia.

Less commonly, pneumonia is caused by other types of bacteria, including:

Haemophilus influenzae;
Staphylococcus aureus;
Mycoplasma pneumoniae (outbreaks occur on average every 4-7 years, usually among children and young people).

In very rare cases, pneumonia is caused by the following bacteria:

Chlamydophila psittaci: this bacterium is the causative agent rare form pneumonia, called psittacosis or psittacosis, which is transmitted to humans from infected birds such as pigeons, canaries, long-tailed and budgies(this form of pneumonia is also called parrot disease or parrot fever);
Chlamydophila pneumoniae;
Legionella pneumophila: causes legionellosis, or Legionnaires' disease, unusual shape pneumonia.

Viral pneumonia

Viruses can also cause pneumonia, most commonly respiratory syncytial virus (RSV) and sometimes influenza A or B. Viruses most often cause pneumonia in young children.

Aspiration pneumonia

In rare cases, pneumonia can be caused by infection in the lungs.

vomiting;
foreign body, such as peanuts;
harmful substance, such as smoke or chemical.

An inhaled object or substance irritates or damages the lungs. This phenomenon is called "aspiration pneumonia."

Fungal pneumonia

Pneumonia, caused by a fungal infection of the lungs, is rare in people in good health. It most often affects people with weakened immune systems (see below). Although fungal pneumonia is rare, it is more common among people traveling to places where this type of infection is more common: parts of the United States, Mexico, South America and Africa.

Some medical names for fungal pneumonia are histoplasmosis, coccidioidomycosis, and blastomycosis.

Risk groups for developing pneumonia

People in the following groups are more at risk of getting pneumonia:

infants and young children;
aged people;
smokers;
patients with other diseases;
people with weakened immune systems.

Diseases that increase the likelihood of pneumonia:

other lung diseases such as asthma or cystic fibrosis (fibrocystic degeneration or cystic fibrosis);
heart diseases;
kidney and liver diseases;
weakened immunity.

Your immunity can be weakened by:

a recent illness such as influenza;
cancer treatments such as chemotherapy;
certain medications taken after an organ transplant (they are taken specifically to weaken the immune system, thereby reducing its rejection of the transplanted organ);

Diagnosis of pneumonia

A doctor can often diagnose pneumonia by asking you about your symptoms and examining your chest. In some cases, additional research may be required. Pneumonia can sometimes be difficult to diagnose because many of the symptoms overlap with other illnesses such as colds, bronchitis and asthma.

To make a diagnosis, your doctor may first ask:

whether you are breathing faster than usual;
Do you suffer from shortness of breath (feeling out of breath);
how long have you had a cough?
Do you expectorate mucus and what color is it?
Does chest pain intensify when you inhale or exhale?

The doctor will likely take your temperature and use a stethoscope to listen to the front and back of your chest to determine if you hear any characteristic crackling or rattling sounds. He may also listen to your chest by tapping it. If your lungs are filled with fluid, they make a sound that is different from that of normal, healthy lungs.

To confirm the diagnosis, the doctor will send you for an x-ray chest and other studies. A chest x-ray can show how badly your lungs are affected. X-rays also help doctors differentiate pneumonia from other lung infections, such as bronchitis. In addition, a sputum test and a blood test are performed. Testing sputum or blood samples helps determine whether the infection is caused by bacteria or a virus.

Screening for lung cancer

Although rare, pneumonia can be a symptom of hidden lung cancer in smokers and people over 50 years of age. If you fall into one of these groups, your doctor may order a chest x-ray. Lung cancer usually appears as a "white-grey" mass on X-ray.

If the x-ray does not reveal cancer, it is recommended to take another x-ray after 6 weeks. This is done to make sure that everything is fine with your lungs.

Treatment of pneumonia (pneumonia)

Patients with mild pneumonia are usually treated successfully at home. They are given antibiotics, plenty of fluids and complete rest. More severe cases may require hospital treatment.

Treatment of pneumonia at home (outpatient)

The cough may continue for another 2-3 weeks after finishing the course of antibiotics, and the feeling of fatigue may linger even longer as your body recovers from the illness. If symptoms do not begin to subside within two days of starting treatment, tell your doctor. There may be no effect from treatment for the following reasons:

The bacteria causing the infection may be resistant to the antibiotics you were taking—your doctor may prescribe you a different antibiotic instead of or in addition to the first one.
the infection may be caused by a virus, not a bacterium - antibiotics do not work on viruses, and your body's immune system will have to fight it off on its own viral infection by producing antibodies.

To relieve the symptoms of pneumonia, you can take painkillers such as paracetamol or ibuprofen. They will help relieve pain and reduce fever. You should not take ibuprofen if you have:

allergy to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs);
asthma, kidney disease, stomach ulcers or indigestion.

It is not recommended to take cough medicines that inhibit the cough reflex (codeine, libexin, etc.). Coughing helps clear mucus from the lungs, so if you stop the cough, the infection may stay in the body longer. Beyond this, there is little evidence that cough suppressants are effective. Drinking a warm drink with honey and lemon will help relieve discomfort caused by cough. Drink plenty of fluids to stay hydrated and get plenty of rest to allow your body to recover.

If you smoke, it is now more important than ever to stop smoking as it harms your lungs.

Pneumonia is rarely transmitted from one person to another, so the patient can be surrounded by people, including family members. However, people with weakened immune systems should avoid contact with someone who has pneumonia until they begin to get better.

After your symptoms have eased, you may need some more time to full recovery. However, the cough may persist. If you are concerned, talk to your healthcare provider.

Treatment of pneumonia in hospital (inpatient)

At severe symptoms you may need to go to hospital for treatment. Treatment in the hospital will include antibiotics and IV fluids through an IV and/or oxygen through an oxygen mask to help you breathe.

In very severe cases of pneumonia, air can be supplied to the lungs through a machine artificial ventilation lungs in the intensive care unit.

Your doctor will likely ask you to come back about 6 weeks after you start taking antibiotics. In some cases, he may order repeat tests, such as a chest x-ray, if:

the symptoms did not appear less;
symptoms returned;
Do you smoke;
you are over 50 years old.

Complications of pneumonia

Complications from pneumonia are more common in older adults, young children, and people with certain chronic diseases, such as diabetes. If complications arise, you will be sent to hospital for treatment.

The most common complications of pneumonia—pleurisy, lung abscess, and blood poisoning (sepsis)—are described below.

Pleurisy- inflammation of the pleura, the thin membrane between the lungs and the chest. In more rare cases, in the space between the lungs and the walls chest cavity Fluid may accumulate. This phenomenon is called "pleural effusion". Pleural effusion occurs in up to half of people treated for pneumonia in hospital.

The fluid can put pressure on the lungs, making it difficult to breathe. Pleural effusion usually goes away on its own as the pneumonia is treated. In about one in 10 cases of hospital treatment for pneumonia, the fluid in the pleural cavity becomes infected with bacteria, causing a collection of pus called an empyema.

Usually purulent discharge removed using a needle or thin tube. In the most severe cases, surgery may be required to remove the pus and repair damage to the pleura and lungs.

Lung abscess — rare complication pneumonia, which most often occurs in people with existing other serious illnesses or in people who abuse alcohol. A lung abscess is the filling of a cavity in the lung tissue with pus. Expectoration of sputum with unpleasant smell, swelling of the fingers and toes are symptoms of a lung abscess.

Abscesses are often treated with antibiotics. Usually a course of intravenous antibiotics is prescribed, followed by antibiotics in tablet form for 4-6 weeks. Most patients feel better within 3-4 days. It is important not to stop taking a prescribed course of antibiotics, even if you feel completely healthy, to avoid re-infecting your lungs. About one in 10 people with a lung abscess require surgery to drain the pus from the abscess or remove the affected part of the lung.

Blood poisoning- another rare and severe complication pneumonia, also known as sepsis. Symptoms of sepsis:

high body temperature (fever) - 38º C or higher;
increased heart rate and breathing;
low blood pressure (hypotension), in which dizziness is felt when the body is upright;

outpatient treatment

How to avoid infecting others with pneumonia

You can stop the spread of germs from you to other people by practicing good hygiene. For example, cover your mouth and nose with a disposable tissue when coughing or sneezing. Throw away used ones immediately disposable tissues in the trash can or toilet - microorganisms can live for several hours after they leave the nasal or oral cavity. Wash your hands regularly to prevent pathogens from being passed on to others or onto objects.

To protect against pneumonia, people in high-risk groups should get vaccinated. The following vaccinations are recommended:

vaccination against pneumococcus (pneumococcal vaccine);
flu shot.

Smoking, heavy drinking, and intravenous drug use can increase your chance of getting pneumonia. Smoking damages your lungs, making them more susceptible to infection. Therefore, if you smoke, the best way to prevent pneumonia is to quit smoking.

There is evidence that excessive and prolonged drinking weakens the lungs' natural defenses against infection, making them more susceptible to pneumonia. According to one study, 45% of people hospitalized with pneumonia were alcohol abusers.

Alcohol abuse is the regular consumption of alcohol in excess of the permissible limit. Regular drinking refers to drinking alcohol every day or most days of the week. Not only does heavy drinking increase your risk of pneumonia, but it also makes it more likely that it will be more severe. According to statistics, the likelihood of death from pneumonia among alcohol abusers is 3 to 7 times higher than the average population.

Pneumonia, or pneumonia, is a sudden onset infection caused mainly by bacteria. In this case, the respiratory areas of the lung tissue are affected with the formation of foci different sizes. Clinical symptoms and inflammation of the lungs appear that were absent in the person before the illness.

Pneumonia is one of the most common diseases. The incidence increases in the cold season, but in the summer it is quite possible to get pneumonia. For example, in a small city with 100,000 population, signs of pneumonia will be registered in 300–900 people per year.

Depending on the picture of the disease, two classical forms of the disease are distinguished: focal (bronchopneumonia) and lobar. With focal damage, inflammation is localized in a small area of lung tissue, affecting the alveoli and adjacent bronchi. Lobar pneumonia is accompanied rapid spread infections for the whole lung lobe and the pleural membrane above it. This is a more serious condition.

Focal pneumonia

The International Classification of Diseases, 10th revision, proposes to classify all pneumonias depending on the pathogens that caused them. In particular, the following forms of pneumonia are distinguished:

Pneumonia in adults can be caused by a wide variety of pathogens and their combinations. However precise definition infection of the infectious agent takes some time, during which time the patient must be treated. Therefore, this classification is largely retrospective in nature, when data on the pathogen present at the onset of the disease have already been obtained.

In order to improve the treatment of pneumonia before identifying the causative agent, foreign and domestic medical documents recommend identifying the following groups of pneumonia, which have treatment features:

community-acquired pneumonia, which a person fell ill with while not within the walls of the hospital (at home);
nosocomial, or hospital-acquired, which occurs in people who are in the hospital for another reason and is caused by antibiotic-resistant hospital microflora;
pneumonia in patients with severely impaired immunity, for example, with acquired immunodeficiency syndrome or depression immune cells medications for organ transplantation or other serious conditions;
aspiration - occurs when stomach contents enter the lung tissue during vomiting, for example, during severe alcohol poisoning, as well as any other foreign liquids or bodies in the lumen of the small bronchi and alveoli.

Pneumonia: causes

The cause of pneumonia is damage to the respiratory sections (alveoli, small bronchi) by microorganisms. Depending on the type of disease, different pathogens predominate.

Community-acquired pneumonia is most often caused by pneumococcus, intracellular microorganisms (mycoplasma, legionella) and Haemophilus influenzae. During influenza epidemics, the role of this virus in the development of the disease increases.

In the nosocomial type, Staphylococcus aureus and gram-negative microorganisms (Pseudomonas aeruginosa, Escherichia coli, Klebsiella, Proteus), as well as anaerobes - microbes that live without access to oxygen, are more common. Hospital-acquired pneumonia occurs mainly in patients in nursing homes, various boarding schools, and also during prolonged artificial ventilation. The main problem in such cases is the immunity of microbes to most antibiotics.

In immunodeficiencies, the disease is most often caused by cytomegalovirus, fungi, atypical mycobacteria, Haemophilus influenzae, and pneumococcus. In acquired immunodeficiency syndrome, mycobacteria are often detected.

Aspiration pneumonia can be caused by germs that normally live in the mouth and enter the lungs during sleep. It especially often occurs when inhaling vomit or food, as well as when the cough reflex is suppressed.

Mechanism of development of pneumonia

Whether a person develops pneumonia is determined by the interaction of two factors: the penetration of microbes into the respiratory tract and the condition protective forces body.

How does the pathogen enter the body?

A significant proportion of healthy people constantly live in the upper respiratory tract with pneumococcus, Staphylococcus aureus, Haemophilus influenzae and other microbes. They can be inhaled into the lungs. Therefore, in order to get pneumonia, it is not necessary to have contact with a sick person; a short-term decrease in immunity is enough.

Small microorganisms form a mixture in the air consisting of separately floating cells, which, when inhaled, enters the alveoli. This is how the influenza virus, legionella and some other microbes penetrate.

The infection can spread through the bloodstream from other sites of infection. Most often it is Staphylococcus aureus when infective endocarditis, intravenous drug use, infection venous catheters if they are not properly cared for in the hospital.

The pathogen can enter directly into the lung tissue when the chest is injured or spread from a nearby purulent focus, for example, a subphrenic abscess.

Influence of the body's condition

Defense mechanisms that prevent germs from entering the lungs:

closing the glottis during swallowing;
reflex cough when hit by a foreign body;
mucus on the surface of the trachea and bronchi containing immunoglobulins - protective proteins;
mucociliary transport - upward movement of cilia lining inner surface bronchi, which removes all impurities from the lungs;
the presence in the alveoli of immune cells - macrophages and neutrophils, which capture and destroy foreign substances.

Pneumonia is dangerous for older people who have been in the hospital for a long time

Risk factors aspiration pneumonia:

alcoholism and drug addiction;
impaired consciousness during a stroke;
swallowing disorders due to neurological diseases;
the presence of a nasogastric or endotracheal tube during intensive care.

Risk factors for colonization of the oral cavity by pathogenic microflora:

hospitalization for any reason;
mental retardation;
general severe illness;
alcoholism;
diabetes;
atrophic gastritis;
violation of sterility during artificial ventilation;
presence of a nasogastric tube.

Immunodeficiency conditions:

decrease in gamma globulin level less than 2 g/l;
decrease in the level of circulating CD4+ lymphocytes less than 0.5x10 9 /l;
long-term use of glucocorticoids, in particular prednisolone.

Additional risk factors for pneumonia:

(colds);
smoking;
air pollution;
chest injury;
period after any operation;
severe heart failure;
old age;
debilitating diseases;
severe emotional shock.

Pneumonia: manifestations

Signs of pneumonia are determined by the extent of damage to lung tissue, the virulence (aggressiveness) of the pathogen, the severity of the disease, the age of the patient, concomitant diseases, the state of the body's defenses and other factors.

Pneumonia accompanied by cough

The most common complaints with pneumonia:

weakness;
lack of appetite;
chills;
rapid breathing);
coughing, then .

The pain can be caused by involvement of the pleura, then it is acute and intensifies with breathing and coughing. If the diaphragmatic pleura is affected, the pain may resemble a picture of an “acute abdomen.” Sometimes pain occurs due to inflammation of the intercostal nerves or muscles.

The cough at the onset of the disease is dry and debilitating. On the 3rd – 4th day it begins to separate in small quantities. Sputum may have the most different colour and character - from light to yellow-green. Sometimes it contains streaks of blood or has a rusty color, which is especially characteristic of lobar pneumonia. When purulent foci form in the lungs, the sputum acquires a putrid odor and its quantity increases.

The patient's skin is pale and bluish. A herpetic rash may appear on the lips. In older people and severe course illness, possible disturbance of consciousness, delusional disorders. Severe shortness of breath, flaring of the wings of the nose, the participation of auxiliary respiratory muscles are signs. In this case, the patient needs urgent help.

With lobar pneumonia, a severe fever appears that lasts for several days, and then the body temperature drops sharply. Focal pneumonia is accompanied by an unstable increase in temperature, its decrease occurs gradually.

Course of the disease

In order to more correctly prescribe, doctors distinguish between the typical and atypical course of pneumonia.

Typical pneumonia is usually caused by pneumococcus, but sometimes Haemophilus influenzae and microflora from the oral cavity play a role in its occurrence. The onset of the disease is sudden, accompanied by a rapid increase in body temperature and cough with yellow-green sputum. It happens sometimes sharp pain in the chest. During a physical examination of the patient, the doctor identifies typical signs compaction and inflammation of the lung tissue: dull percussion sound, bronchial breathing, wheezing.

Atypical pneumonia develops more slowly and is accompanied by a dry cough and extrapulmonary manifestations. The patient may experience pain in muscles and joints, sore throat, headache, nausea, vomiting, loose stool. Sputum is produced in small quantities. Fever may be absent, especially in elderly and debilitated patients. In some cases, mental disorders are associated.

The classic pathogens of atypical pneumonia are mycoplasma, legionella, and klebsiella. Also, signs of pneumonia can be caused by pneumocystis (especially in acquired immunodeficiency syndrome), chlamydia, influenza virus during an epidemic, nocardia, and Staphylococcus aureus. All these types have some peculiarities clinical picture, which allow the doctor to suspect a particular pathogen. However, in general, we can say that with atypical pneumonia, the manifestations of compaction of the lung tissue are much less pronounced than with typical pneumonia. Quite often the skin, nervous system, kidneys and liver are affected, and the herpes simplex virus is activated.

Nosocomial pneumonia is often accompanied by fever and purulent sputum. However, these signs may be absent, especially against the background of other lung diseases and concomitant diseases for which the patient is in the hospital. This is the additional insidiousness of nosocomial pneumonia.

Aspiration pneumonia in most cases leads to the development of putrefactive decay of lung tissue, accompanied by cough, chills, fever, night sweats fatigue, weight loss, long-term. Such symptoms persist for several weeks and resemble pulmonary tuberculosis.

Complications

Severe consequences of the disease:

myocarditis (inflammation of the heart muscle);
meningitis (inflammation of the meninges);
glomerulonephritis (kidney damage);
infectious-toxic shock;
respiratory failure;
acute psychosis and others.

Fragment of a popular TV show dedicated to pneumonia (video)

Pneumonia in most cases refers to infectious diseases and is caused by various pathogens (pneumococci, staphylococci, streptococci, mycoplasma, legionella, chlamydia, anaerobic microorganisms, klebsiella, E. coli, viruses, etc.). The characteristic symptoms of the disease make it possible to successfully diagnose and treat this disease. Although in recent decades, thanks to the success of antibacterial therapy, mortality from pneumonia has decreased significantly.

The high prevalence of the disease, the severity of development and severity of symptoms in the initial period of the disease, the possibility serious complications make pneumonia a frequent reason for seeking emergency care. There are lobar (lobar) and focal (bronchopneumonia) inflammations. Every person who values owl health should know how to determine pneumonia.

Symptoms and signs of different forms of pneumonia

Symptoms of lobar pneumonia

The clinical picture of lobar pneumonia is characterized by an acute onset with sharp increase temperatures up to 39-40 °C, combined with chills and sweating.

At the same time, the symptoms of pneumonia are accompanied by headache, significant weakness, and lethargy.

With severe hyperthermia and intoxication, cerebral symptoms may be observed - severe headache, vomiting, stupor of the patient or confusion, and even meningeal symptoms.

Very early, pain occurs in the chest on the side of inflammation. Often with pneumonia, the pleural reaction is so severe that chest pain is the main complaint and requires treatment. emergency care.

Distinctive feature pleural pain in pneumonia - its connection with breathing and coughing: a sharp increase in inhalation and coughing. In the first days, a cough may appear with the release of sputum rusty from the admixture of red blood cells, and sometimes mild hemoptysis.

During examination, one often notices the forced position of the patient: more often he lies on the side of inflammation. The face is usually hyperemic, sometimes a feverish blush is more pronounced on the cheek, corresponding to the side of the lesion. A characteristic symptom pneumonia is shortness of breath up to 30-40 breaths per minute, combined with cyanosis of the lips, swelling of the wings of the nose. Often in early period disease, blistering rashes appear on the lips (herpes labialis). Examination of the chest usually reveals a delay in breathing on the affected side. Due to severe pleural pain, the patient seems to spare the side of inflammation. Over the zone of inflammation, percussion of the lungs reveals shortening percussion sound, breathing acquires a bronchial hue, fine-bubbly moist crepitating rales appear early. Characterized by tachycardia up to 100 beats per minute and a slight decrease in blood pressure. A pronounced pleural reaction is sometimes combined with reflex pain in the corresponding half of the abdomen, pain on palpation in its upper parts. Ictericity skin and mucous membranes may appear due to the destruction of red blood cells in the affected lobe of the lung and, possibly, the formation of focal necrosis in the liver.

How to determine focal pneumonia?

With focal pneumonia, which often occurs in patients with chronic inflammation of the upper respiratory tract and bronchi or with heart failure and other serious diseases, the symptoms are usually less pronounced: fever up to 38-38.5 ° C, dry cough or with mucous discharge purulent sputum, pain may appear when coughing and deep breathing, symptoms of inflammation of the lung tissue are objectively revealed, expressed to varying degrees depending on the extent and location (deep or superficial) of the inflammation, most often a focus of crepitant wheezing is detected.

How to identify symptoms of pneumonia in older people?

The prognosis is especially unfavorable when acute vascular insufficiency is combined with increasing cardiac weakness, leading to pulmonary edema. In the origin of pulmonary edema during pneumonia, in addition to heart failure, toxic damage to the pulmonary capillaries with increased vascular permeability is important.

The threat of developing pulmonary edema is indicated by the appearance of dry and especially moist rales over a healthy lung against the background of increased shortness of breath and deterioration of the patient’s condition.

Development of pneumonia in individuals old age with concomitant diseases of cardio-vascular system, emphysema, pneumosclerosis often requires emergency care, but recognizing pneumonia in early dates The illness in these patients is often complicated due to the absence of an acute onset, a mild pleural reaction with chest pain when breathing, and a slight increase in temperature.

The thought of pneumonia in the elderly and weakened patients should arise in cases where, without visible reasons The patient’s activity decreases significantly, weakness increases, he stops moving, lies down all the time, becomes indifferent, often drowsy, and refuses to eat.

A careful examination sometimes reveals a one-sided flush of the cheek, a dry tongue, and always significant shortness of breath and tachycardia.

Auscultation of the lungs usually reveals a focus of sonorous moist rales.

Manifestations of pneumonia in people with alcohol dependence

Very dangerous acute form pneumonia in patients suffering from chronic alcoholism and alcohol abuse in general. Usually their pneumonia is severe, with severe intoxication and is often complicated by the development of alcoholic psychosis - “delirium tremens”. Psychosis is accompanied by visual and auditory hallucinations, mental and motor agitation, abnormal behavior, disorientation in time and space. Often patients try to escape and even throw themselves out of the window and do not allow themselves to be examined or given injections. Meanwhile, very often pneumonia in patients in a state of “delirium tremens” is complicated by the development of severe shock.

Signs and symptoms of complications of pneumonia

Signs of pneumonia, life-threatening both in the case of lobar and focal forms, can be caused by the development of complications - septic shock, pulmonary edema, psychosis. Typically, shock and pulmonary edema are observed when pneumonia develops in elderly, weakened patients with severe concomitant cardiac pathology and often circulatory failure. A harbinger of shock due to pneumonia should be considered the appearance of persistent tachycardia, especially over 120 beats per minute with low pulse filling. The development of shock is accompanied by a significant deterioration in the condition, the appearance of severe weakness, and sometimes a decrease in temperature. The skin becomes gray shade, facial features become sharper, cyanosis increases, shortness of breath increases significantly, the pulse becomes frequent and small, blood pressure drops below 90/60 mm Hg. Art., urination stops.

How to identify pulmonary complications of pneumonia?

Pulmonary complications of pneumonia (exudative pleurisy, abscess formation, and especially breakthrough of the abscess into the pleural cavity with the development of pyopneumothorax) also require emergency care for the patient. Exudative pleurisy is manifested by a lag in the lower part of the chest on the affected side when breathing, severe dullness and weakening of breathing on the affected side. You should think about abscess formation when intoxication increases, profuse night sweats appear, and the temperature becomes hectic in nature with daily variations of up to 2 °C or more.

Breakthrough of an abscess into the bronchus during pneumonia and discharge of a large amount of purulent foul-smelling sputum make the diagnosis of lung abscess obvious. Sharp deterioration conditions, increased pain in the side when breathing, a significant, rapid increase in shortness of breath, tachycardia, a drop in blood pressure may indicate a breakthrough of the abscess into the pleural cavity and the complication of pneumonia by the development of pyopneumothorax. The condition of patients with pyopneumothorax is always severe. Usually, due to pain, they are forced to take a semi-sitting position. Breathing, coughing and movement sharply increase the pain. Shortness of breath is characteristic (over 40 per 1 min). Breathing over the sore side is weakened. Percussion reveals a boxy sound above the upper and dullness above lower sections lung Pulse is frequent and small. BP is low. Such a menacing picture of pleural shock requires emergency assistance.

Diagnostic symptoms and signs of pneumonia

Usually, pneumonia is successfully recognized on the basis of the characteristic clinical picture of the disease - a combination of pulmonary and extrapulmonary manifestations and an x-ray picture. Symptoms of pneumonia that allow diagnosis at the prehospital stage:

Pulmonary symptoms - shortness of breath, cough, sputum production (mucous, mucopurulent, etc.), pain when breathing, local clinical signs (dullness of percussion sound, bronchial breathing, crepitating rales, pleural friction noise).

Extrapulmonary symptoms of pneumonia - fever, chills and sweating, myalgia, headache, cyanosis, tachycardia, herpes labialis, skin rash, damage to the mucous membranes (conjunctivitis), confusion, diarrhea, jaundice, toxic changes in peripheral blood.

Some features of the pneumonia clinic make it possible to carry out an etiological diagnosis of pneumonia before obtaining the results of a microbiological study. The most common causative agents of “domestic” pneumonia in people under 60 years of age without severe concomitant pathology are pneumococci; in the appropriate epidemiological situation, mycoplasmas and viruses (Table 7). Elderly patients with severe somatic diseases and chronic alcoholism are especially susceptible to pneumonia caused by gram-negative microorganisms (Klebsiella, Escherichia coli, Proteus, Enterobacter), with frequent development destruction of lung tissue and the formation of lung abscesses.

Diagnostic signs of pneumonia in old age

In elderly patients suffering from severe somatic diseases or severe immunodeficiency, pneumonia can occur atypically. Such patients often have no fever, extrapulmonary symptoms predominate (disorders of the central nervous system, etc.), physical signs of pulmonary inflammation are mild or absent, and identification of the causative agent of pneumonia is difficult.

The most important method, confirming the diagnosis of pneumonia and clarifying the localization of the source of inflammation, is X-ray examination chest organs. X-ray signs pneumonia appears later than clinical pneumonia, which, along with the characteristics of the pathogen and the localization of the process, causes cases of “X-ray negative” pneumonia.

Differential symptoms of pneumonia

The spread of pain to the upper abdomen, their combination with pain on palpation, especially in the right upper quadrant of the abdomen, and increased pain when tapping on the right costal arch often complicate the diagnosis of pneumonia. All these symptoms of pneumonia are caused by involvement in inflammatory process pleura and irritation of the endings of the right phrenic and lower intercostal nerves embedded in it, which are also involved in the innervation of the upper parts of the anterior abdominal wall and abdominal organs. This explains the frequent appearance of various symptoms from the abdomen (abdominal) in acute diseases of the chest organs.

Severity of abdominal pain combined with other gastrointestinal disorders, often causes misdiagnosis acute diseases abdominal organs in patients with lobar pneumonia, as well as pleurisy, pericarditis, myocardial infarction. Often these patients are referred to surgical departments with a diagnosis acute cholecystitis, appendicitis, perforated ulcer stomach; There are cases where they were subjected to surgical intervention. In such cases, the diagnosis of pneumonia is helped by the absence in most patients of abdominal muscle tension and symptoms of peritoneal irritation, although this sign is not absolute.

Treatment of incipient pneumonia

Emergency care for pneumonia

The scope of emergency care for pneumonia depends, naturally, on the prevailing symptoms. In the presence of severe respiratory failure, oxygen therapy is indicated, in case of persistent debilitating cough - antitussive drugs, in case of pleural pain - non-narcotic analgesics, in case of severe intoxication - detoxification therapy, in case of infectious-toxic shock - antishock therapy.

The development of mental disorders in alcoholics with pneumonia requires the use of psychotropic drugs: Seduxen (10 mg intravenously or intramuscularly, the drug is contraindicated in chronic obstructive pulmonary diseases), Haloperidol (1-2 ml of 0.5% solution), Aminazine (2 ml of 2.5% solution) solution). The hypotensive effect of Aminazine should be taken into account, therefore its use in arterial hypotension is contraindicated. In addition, the use of psychotropic drugs is contraindicated in patients with acute alcohol intoxication.

Hospitalization for pneumonia

Establishing a diagnosis of pneumonia entails the need to hospitalize the patient in the therapeutic department of the hospital, because only in a hospital setting can it be completed clinical examination and carry out fairly intensive therapy. Treatment of pneumonia at home is justified only in cases of its mild, uncomplicated course, in the absence of any doubt about the diagnosis.

For pneumonia complicated by cardiac and vascular insufficiency, the development of an abscess or pyopneumothorax, requires immediate hospitalization of the patient. Patients with abnormal behavior, mental and motor agitation should be under the constant supervision of medical personnel.

Inpatient treatment for pneumonia

In a hospital setting, before establishing the sensitivity of the pathogen to antibiotics, an empirical antibacterial therapy. In severe cases of pneumonia with pronounced physical signs of pulmonary inflammation, pneumonia is regarded as pneumococcal and penicillin is used intramuscularly or intravenously from 6 to 30 million units per day. In patients with chronic nonspecific lung diseases, Ampicillin is preferable daily dose 4-8 g. In patients with chronic alcoholism and severe somatic diseases, as well as in elderly patients, therapy begins with 2nd generation cephalosporins or with a combination of Ampicillin with betalactamase inhibitors. For bilobar (bilobar) pneumonia, severe cases with severe symptoms of intoxication and an unknown pathogen, a combination of antibiotics is used (semi-synthetic Penicillins or Cephalosporins with Aminoglycoside - Gentamicin or Netromycin), Fluoroquinolones, Carbapenems are used.

Along with pneumonia, inflammatory processes are observed, the characteristic feature of which is focal infectious destruction of all elements of the lung tissue - either limited (single or multiple abscesses) or without clear boundaries (pulmonary gangrene).

Many types of pneumonia, as well as abscess and gangrene of the lungs, develop as a result of microaspiration of microflora from the oropharynx - aspiration pneumonia. The term was introduced to refer to a disease associated with aspiration into the lungs of not only the contents of the oropharynx, but also the contents of the stomach by patients who are unconscious at the time of vomiting. Primary reaction lungs for aspiration is not of an infectious nature, but is an inflammatory process in the bronchi in response to an irritant effect of hydrochloric acid gastric juice. This reaction creates favorable conditions for the subsequent development of infection, aspirated along with the contents of the oropharynx and stomach. Mucus from the oropharynx and gastric juice contain only a large number of microflora, which is normally represented wide range anaerobic and aerobic bacteria. Anaerobes, the number of which significantly exceeds the number of aerobes (10:1 ratio), interact with each other as a mixed infection that can induce not only inflammation of the lung parenchyma, but also necrosis of the lung tissue with subsequent abscess formation.

Complications after treatment for pneumonia

Causes of destruction of lung tissue after inflammation

Typically, the causative agents of infectious destruction of lung tissue are necrotizing infections:

pyogenic bacteria (Staphylococcus aureus, Klebsiella, group A streptococci, bacteroides, fusobacteria, anaerobic streptococci, etc.);

mycobacteria (tuberculosis, etc.);

fungi (aspergillus, Histoplasma, Coccidioides);

Causes of abscess and gangrene after pneumonia

Abscess and gangrene of the lung are characterized by such signs of pneumonia as necrosis of the lung tissue that occurs in the central part of the inflammatory infiltrate, almost identical to the infiltrate observed in pneumonia, infarction pneumonia or aspiration pneumonia. Dead tissue undergoes purulent melting with subsequent formation purulent cavities.

Several factors contribute to the development of necrosis:

violation of bronchial obstruction (narrowing of the lumen of small bronchi due to swelling of the mucous membrane);

thrombosis small vessels with subsequent disruption of microcirculation;

necrotizing mixed anaerobic and aerobic infection.

Necrotic lung tissue favors the rapid development of pathogenic microflora, the progression of a purulent or putrefactive process, and the melting of lung tissue with the formation of purulent cavities.

Abscess and gangrene have a common origin and the same type of initial phase of disease development, identical to that after pneumonia. Some authors do not agree with this and tend to consider abscess and gangrene as qualitatively different pathological processes.

by Notes of the Wild Mistress

The respiratory system in general and the lungs in particular are very vulnerable to infectious diseases. With all the variety of methods of infection airborne transmission occurs most often. However, this is not surprising, since the upper respiratory tract is the vanguard in the fight against many viruses and bacteria.

Under certain conditions, such as weakened immunity, high activity of the pathogen, disturbances in the quality of the inhaled air, etc., infectious process is not localized only in the upper respiratory tract (nasopharynx, larynx, trachea), but spreads downwards. Sometimes the process ends with inflammation of the bronchial mucosa - bronchitis, but quite often the matter is not limited to this. Inflammation of the lung tissue itself occurs - pneumonia.

In other words, typical pneumonia, or pneumonia, which affects small air bubbles, alveoli, and the tissues around them, occurs due to the penetration of pathogens - bacteria, viruses, fungi.

In addition to breathing, the lungs perform very important functions, regulating body temperature, the exchange of fluids and salts in the body, protecting it from foreign substances from the inhaled air. Some proteins and fats that affect blood clotting are created and broken down in the lungs. And when many toxins are released into the blood, the lungs trap harmful particles, dissolve them or expel them with a cough. In a word, functionally it is a real filter for air and blood.

But the pulmonary filter does not always withstand the load created by severe illness, complex trauma and general weakening of the immune system. And then almost any microorganism or their combination, especially during seasonal exacerbations, can cause inflammation. That's why pneumonia rarely occurs primary disease- almost always it is a complication and, as a rule, develops after hypothermia.

Almost any microorganism can cause pneumonia. Which one specifically depends on a number of factors: on the age of the patient, on the place where pneumonia occurs - at home or in the hospital, if in a hospital, then in which department - in surgery there are some microbes, in therapy others. The state of health of the body in general and the state of immunity in particular play a huge role.

Acute pneumonia primarily affects weakened, premature children of the first year of life, patients with rickets and anemia, and among adults, smokers, alcohol abusers, and the elderly. Patients are especially susceptible to pneumonia diabetes mellitus, cardiovascular disease, and those whose immune systems are suppressed by drugs used to treat cancer, or long time bedridden.

Any doctor knows that if treatment is started on the first day, a patient with pneumonia will be on his feet in two to three weeks. When the disease is at its height, and even with a complication in the form of, say, pleurisy, it will inevitably follow intensive care unit or intensive therapy, treatment will take one and a half to two months.

The tricky thing about pneumonia is that characteristic changes breathing sounds are not heard at first. However, the experience of clinical and microbiological parallels helps here. For example, it is known that staphylococcal pneumonia most often occurs during an influenza epidemic. And the person himself should be on guard - if a cough with sputum, which is not typical for influenza and ARVI, appears, you must immediately call a doctor, do a chest x-ray, clinical analysis blood and sputum analysis, which is collected in the morning by rinsing the mouth with water. Sputum examination, in fact, helps to identify the specific causative agent of the disease. This is the only way to install accurate diagnosis inflammation of the lungs.

Usually, sputum is constantly secreted by the mucous membrane of the bronchi. It contains substances that maintain the elasticity of lung tissue and antimicrobial particles, such as immunoglobulin. The formation of sputum is associated with blood circulation in the lungs, which changes with increased loss of fluid from the body. Accordingly, with sweating, overheating, diarrhea, vomiting, high fever, and lack of drinking, the beneficial properties of sputum are weakened. It is removed by coughing and expectoration,

In patients with pneumococcal pneumonia, the sputum is mucous, colorless and viscous. Sometimes, due to the admixture of blood, it acquires a brownish-rusty color. After an attack of wet (that is, with sputum) cough, the patient, as a rule, usually experiences relief. This is facilitated by expectorants and sputum thinners. Intense sputum production can also be achieved with non-medicinal means, in the form of hot drinks. But you cannot use drugs that suppress sputum production, otherwise clearing the airways will be difficult, and the infection will continue to develop.

A few words should be said about the factors contributing to the spread of infection.

First of all, these include heat and stuffiness. The drier the air, the more dust particles or chemical pollutants it contains, the more difficult it is for mucus to envelop harmful substances. Therefore, one of the most important recommendations for patients with pneumonia is clean, cool air, as well as frequent ventilation of the room. This makes breathing easier and promotes mucus removal. The optimal room temperature should be about 18°C. In this case, it is necessary to dress the patient warmly, and put a wet sheet on the radiator to humidify the atmosphere.

Other negative factor - dust of city apartments, which greatly increases the likelihood of sputum drying out. Upholstered furniture and carpets are not for the room in which the patient is located. Wet cleaning is required 1-2 times a day, but it is better without disinfectants, because a strong chemical smell can cause damage to the respiratory tract in a person weakened by the disease.

High body temperature also dries out mucus. However, by carefully knocking it down, you thereby suppress the body’s production of interferon, a special protein that neutralizes viruses. There is only one way out - drink plenty of fluids (2-3 liters per day). Vegetable and fruit juices containing vitamin C, lingonberry and cranberry fruit drinks, decoctions of rose hips, currants, and rowan are especially useful in this situation.

Pneumonia(another name is) is an infectious disease in which damage occurs alveoli – bubbles with thin walls that saturate the blood with oxygen. Pneumonia is considered to be one of the most common diseases, because the human lungs and respiratory system are highly vulnerable to infectious diseases.

Types of pneumonia are determined by the area affected. So, focal pneumonia takes only a small part of the lung, segmental pneumonia affects one or more segments of the lung, lobar pneumonia spreads to a lobe of the lung, with confluent pneumonia, small foci merge into larger ones, total pneumonia affects the lung as a whole.

At acute pneumonia an inflammatory process occurs in the lung tissue, which, as a rule, is of a bacterial nature. The success of disease therapy, which is mandatory should be carried out in a hospital, directly depends on how timely the patient sought help. With lobar inflammation, the disease develops suddenly: a person’s body temperature rises sharply, reaching 39-40°C, he feels chest pain, severe chills, a dry cough, which after a certain time turns into a cough with sputum.

Pneumonia in children and adults can also occur with some symptoms erased. So, the patient may assume the presence, but weakness, moderate body temperature, and cough persist for a very long time.

In addition, a distinction is made between unilateral pneumonia (in which one lung is affected) and bilateral (both lungs are affected). Primary pneumonia occurs as an independent disease, and secondary inflammation occurs as an ailment that develops against the background of another disease.

Causes of pneumonia

The most common cause of pneumonia is Pneumococcus or hemophilus influenzae . In addition, it can act as a causative agent of pneumonia mycoplasma , legionella , chlamydia etc. Today there are vaccines that prevent the disease or significantly alleviate its symptoms

There are few bacteria in the lungs of a healthy person. , which get into them, are destroyed by a full-fledged immune system. But if protective functions the body does not work due to certain reasons, a person develops pneumonia. In view of the above, pneumonia most often occurs in patients with weak immunity , in the elderly and children.

The pathogens enter the human lungs through the respiratory tract. For example, mucus from the mouth, which contains bacteria or viruses, can enter the lungs. After all, a number of pathogens that cause pneumonia exist in the nasopharynx of healthy people. Also the occurrence of this disease provokes inhalation of air that contains pathogens. The route of transmission of pneumonia caused by Haemophilus influenzae is airborne.

The development of pneumonia in young children is provoked by the following factors: injuries received during childbirth, intrauterine And asphyxia , congenital heart defects And lung , cystic fibrosis , hereditary nature, hypovitaminosis .

In children in school age pneumonia can develop due to the presence chronic foci of infection in the nasopharynx , bronchitis with relapses , cystic fibrosisA , immunodeficiency , acquired heart defectsA .

In adults, pneumonia can be caused by Chronical bronchitis and lung diseases, heavy smoking, , immunodeficiency , transferred surgical interventions in the chest and abdominal cavity, And addiction .

Signs of pneumonia

In most cases, pneumonia in children, as well as in adults, occurs as a consequence of another disease. A number of symptoms that appear in a patient allow one to suspect pneumonia. You should pay special attention to some signs of pneumonia. So, with pneumonia the most pronounced symptom illness becomes a cough. The situation should be alarming if the patient improves after feeling unwell during a cold, or duration colds more than seven days.

There are other signs of pneumonia: coughing when trying to breathe deeply, the presence of severe pallor of the skin, which accompanies usual symptoms ARVI, the presence of shortness of breath at a relatively low body temperature. When pneumonia develops, the patient’s body temperature does not decrease after taking antipyretics ( , ).

It should be noted that if you have the above signs of pneumonia, you should immediately seek help from a specialist.

Symptoms of pneumonia

As the disease develops, a person exhibits certain symptoms of pneumonia. Thus, the body temperature rises sharply - it can rise to 39-40 degrees, there is a cough, during which purulent sputum is released. The following symptoms of pneumonia also occur: chest pain , strong , constant weakness . At night, the patient may experience very strong sweating. If you do not start treating the disease on time, then pneumonia will progress very quickly, and its result may even be death. There are types of this disease in which the symptoms of pneumonia are less pronounced. In this case, the patient may have a feeling of weakness.

Diagnosis of pneumonia

Today, doctors are able to accurately diagnose pneumonia using different methods examinations. After the patient contacts the specialist, first of all, conducts a detailed survey and listens to the patient. In some doubtful cases, a clinical blood test is performed, as well as an X-ray examination. As additional research in some cases it is carried out CT scan chest, bronchoscopy followed by , urine analysis and other examinations prescribed by the attending physician.

The results of these studies make it possible to diagnose pneumonia with high accuracy.

Treatment of pneumonia

When treating pneumonia, an important success factor is the selection, as well as the dosage and methods of introducing the drug into the patient’s body. So, antibiotics are administered either by route or taken in the form of tablets or syrups. Medicines are selected depending on the type of pathogen causing pneumonia.

Also in the process of treating pneumonia, a number of medicines, which have bronchodilator properties,. After some improvement in the condition, when the patient’s body temperature normalizes, treatment of pneumonia includes physiotherapy and massotherapy. If these methods are used, improvement occurs much faster. After recovery, in some cases the patient is prescribed a repeat x-ray to ensure the success of the treatment.

After completing the main course of treatment for pneumonia, the patient is prescribed an additional vitamin complex for a month. Indeed, during the course of pneumonia, a large number of beneficial microorganisms that produce B vitamins .

Every day, people who have had pneumonia are recommended to take special classes breathing exercises . These are exercises that help increase the mobility of the chest, as well as stretching adhesions that could have formed as a result of the disease. Breathing exercises are especially recommended for elderly patients. Also, after an illness, people should spend more time in the fresh air.

With the correct approach to treatment, recovery occurs 3-4 weeks after the onset of the disease.

The doctors

Medicines

Prevention of pneumonia

Methods for preventing pneumonia coincide with the prevention of bronchitis and acute respiratory infections. Children need to be gradually and regularly hardened, starting from a very early age. It is also important to strengthen the immune system, as well as prevent factors that provoke a state of immunodeficiency.

A risk factor for acute pneumonia is a tendency to microthrombosis, which occurs with constant bed rest and taking a number of medications ( infekundin , bisecurin , ). To prevent acute pneumonia in this case, it is recommended to carry out physical therapy, breathing exercises, massage. Special attention should be considered for the prevention of pneumonia in older patients due to a decrease in T and B immunity.

Diet, nutrition for pneumonia

In parallel with the course drug treatment Patients with pneumonia are advised to follow certain principles in nutrition, which allows them to achieve more effective results treatment. Thus, during the period of acute pneumonia, the patient is advised to observe , the energy value of which does not exceed 1600-1800 kcal. To reduce the inflammatory process, you should limit your salt intake (6 g of salt per day is enough for the patient), and also increase the amount of foods high in vitamins C and P in your diet. Especially valuable products black currants, gooseberries, rose hips, greens, citrus fruits, lemons, raspberries, etc. are considered. Equally important is compliance drinking regime– You need to drink at least two liters of fluid per day. To ensure that the body contains the required amount of calcium, it is worth consuming more dairy products, and at the same time eliminating foods containing oxalic acid from the diet.

You should eat in small portions, six times a day. Especially healthy dishes and products during the treatment of pneumonia are vegetables, fruits, berries, cranberry juice, tea with lemon, dairy dishes, eggs, cereals and mucous decoctions of cereals, low-fat broths from meat and fish. You should not eat baked goods, fatty, salty and smoked foods, fats, chocolate, and spices.

During the recovery process, the patient's diet must be made more calorie-rich with additional proteins, and foods that improve the secretion of the stomach and pancreas should also be consumed.

Complications of pneumonia

As complications of pneumonia, patients may experience a number of severe conditions: And lightweightO , pleural empyema , pleurisy , manifestations of acute respiratory failure , pericarditis , sepsis , pulmonary edema . If the treatment regimen was chosen incorrectly, or the patient has severe immunodeficiency, pneumonia can be fatal.

List of sources

Respiratory diseases / ed. N.R. Paleeva. M.: Medicine, 2000.
Manerov F.K. Diagnosis and therapy of acute pneumonia: abstract. dis. ... doc. honey. Sci. - 1992.
Fedorov A.M. Gentle methods of diagnosis and treatment of acute pneumonia: abstract. dis. ... doc. honey. Sci. - M., 1992.
Zilber Z. K. Emergency pulmonology. - M.: GEOTAR-Media, 2009.