Recently, viruses and other pathogens of well-known diseases have learned to adapt to modern methods of treatment so much that it is sometimes difficult not only to cure them, but also to diagnose them. It is customary to combine such cases of manifestations of inflammation and disorders in the functioning of the lungs under the general name SARS. The insidiousness of this category of diseases lies in the fact that severe consequences can seriously harm the body, sometimes it is difficult to recover, and often complications end in death. This fact imposes a special responsibility on those who are the guardians of the patient, or those who are raising a young child. Delay in diagnosis can cause significant harm to health, and even lead to death.

Among the pathogens and infections that are the cause of this or that form of pneumonia, there are the main ones. These are the following types:

• chlamydia;
• mycoplasmas;
• legionella;
• coxiella;
• salmonella;
• klebsiella;
• viruses.

Signs of pneumonia, especially atypical pneumonia, can be blurred, which explains the percentage of incorrect diagnoses and prescribed treatment.

SARS, the symptoms of which may not be obvious, there are similarities with other diseases, often accompanied by severe complications. Without a preliminary examination, even an experienced doctor is not able to establish a correct diagnosis and prescribe an effective treatment, therefore it is so important not to self-medicate, and if at least one atypical sign of the disease appears, it is imperative to consult a therapist. Self-medication in this case is unacceptable, since only a qualified doctor is able to correctly diagnose.

Causes

For the first time this term appeared in the 30s of the last century, non-characteristic viruses and microorganisms appeared that changed the clinical picture of the disease. This made it difficult to diagnose, and allowed the disease to flow into a chronic form. In our century, in the early 2000s, an epidemic arose, SARS affected about 30 countries of the world, there were many deaths and serious consequences after illnesses.

The difficulty lies in the fact that the constant mutations of the virus do not allow us to say that it was possible to find an effective treatment for SARS.

The fact that the epidemiological and microbiological characteristics of the main pathogens differ significantly, they are all resistant to antibiotics, especially the penicillin group. They are also difficult to diagnose, there are a number of other factors. An unpleasant moment is the fact that atypical signs are observed most often in young people under 40 years old. Such pneumonia has a relatively short incubation period of a maximum of 10 days.

Mycoplasma pneumonia

Among children, the percentage of cases is 5 times higher than in cases where there are signs of SARS in adults. This is due to the fact that outbreaks of the disease occur in the team, and the spread occurs very quickly. In mild cases, SARS occurs without particularly pronounced manifestations. Body temperature does not rise above 38 degrees, there is a slight dry cough, malaise. In this case, the cough can disturb for several weeks, while the inflammation spreads to both lungs.

In severe form, fever appears, and symptoms of SARS in adults and children such as:

• allergy;
• intoxication of the body;
• lymphadenitis;
• microhematuria;
• albuminuria;
• microhematuria;
• myalgia;
• myocardial changes.

The danger lies in the fact that the sluggish course of the disease, in contrast to bacterial inflammation, which signals its presence in the body in the early days, can result in a chronic form.

Complications that are observed after this form, most often bronchiectasis, bronchitis and similar diseases associated with the bronchi.

Diagnosis of this disease is carried out by radiography, sputum culture and radioimmunoassay.

Treatment is with macrolide drugs such as azithromycin and erythromycin. Additionally, mucolytic agents are prescribed.

Chlamydial pneumonia

Microorganisms of this group affect the cells of the genitourinary system, bronchi, lungs. In percentage terms, about 10% of all cases of treatment with signs of pneumonia are caused by microorganisms of the genus Chlamydophila, that is, chlamydia. In the risk group, first of all, children, older and elderly people, a feature of chlamydia can be called the fact of a long existence in the body without visible and obvious symptoms. In manifestations, this is similar to SARS accompanied by rhinitis and pharyngitis. The following symptoms may be observed:

• dyspnea;
• dry cough;
• joint pain;
• pain in the muscle area;
• cervical lymphadenopathy.

Diagnosis is carried out in a period of 10 days, then you can observe physical changes in the body. Later, an x-ray study is connected, up to 30 days pathology and darkening can be observed. Microscopic method, ELISA, PCR are also used.

Treatment is carried out using drugs of the tetracycline group, for a period of at least two weeks. If the duration of therapy is shortened, then the disease easily passes into the chronic phase and, with a visible recovery, the disease is in “sleep mode”, waiting for the right moment to activate. Or a long period of the chronic form entails side diseases caused by this particular microorganism.

legionella pneumonia

Pneumonia is caused by the bacterium Legionella pneumophila, a form often referred to as Legionnaires' disease. A fairly common type of pneumonia that affects calving of the respiratory tract. It is noticed that most often the disease is transmitted through the ventilation system of premises, air conditioners and various air humidifiers. Middle-aged and elderly people with reduced immune defenses are most at risk. The course of the disease proceeds in such a way that the terminal bronchioles and alveoli are involved, they have pathological processes. There is also massive exudation and swelling of the tissue in those areas where there is inflammation.

The clinical picture is clearly expressed, the temperature rises to 40 degrees, there is a severe headache and fever. As an indispensable symptom of pneumonia, a dry cough appears first, then a severe one, with sputum and even a small amount of blood. The disease is severe, all joints and muscles hurt, there may be a disorder of the stool, malfunctions of the heart muscle, nausea and accompanying vomiting appear. Complications may be associated with diseases of the respiratory system or kidney failure.

First of all, to make a correct diagnosis, x-rays are performed, it is also recommended to perform a CT scan, MRI of the lungs. Diagnosis is quite complicated, tests do not always allow to establish a diagnosis, they resort to tracheal aspiration to take biological material.

Therapy is carried out using the latest developments with intensive use of antibiotics. Well-established in medical practice such drugs as:

• erythromycin;
• ciprofloxacin;
• rifampicin;
• doxycycline.

The treatment is long, important parts of the lung tissue are affected, in some cases pneumosclerosis occurs, healing is slow, while weakness is constantly maintained, the person is very tired and feels certain unpleasant symptoms.

SARS

To date, this is a little-studied form of pneumonia, it is acute and affects the lower respiratory tract.

The risk group is also atypical, like the disease itself. These are young people, which is rare. The virus is transmitted by airborne droplets, but the possibility of infection by the fecal-oral route is not excluded. The incubation period, as a rule, does not exceed three days, the onset of the disease is pronounced, the temperature rises, chills and sweating appear, and the head hurts. Intestinal upset and vomiting may occur.

A few days after the onset of the disease, cough and shortness of breath appear, and hypoxemia progresses. The heart rate changes, tachycardia occurs. In severe cases, cases of death from intoxication, acute cardiac and respiratory failure have been recorded. Many other associated complications may occur.

Diagnosing the disease is not easy. This is due to the lack of test systems applicable to such a disease as SARS. The situation is complicated by the fact that it is necessary to take into account the attendance of disadvantaged areas by people who may subsequently be carriers of the infection. Strict control over the movement of citizens, and monitoring their condition ensures control of the epidemiological situation.

Auscultation can reveal only a change in breathing, wheezing and other visual changes in the patient's condition. A more accurate result is determined using laboratory tests and analyzes, determine changes in the gas composition of the blood. Due to the fact that this disease is little studied, SARS is treated with great difficulty, and if misdiagnosed, it risks becoming fatal. It is important to remove intoxication in the body, diuretics are prescribed to get rid of the virus, the use of antimicrobials is mandatory, which will prevent such an unpleasant complication as association, or layering of a bacterial infection.

How the disease will proceed, and how it will be possible to localize and carry out therapy, depends on the form of the disease. For prevention, it is necessary to wear masks and refrain from visiting areas with an unfavorable epidemiological situation.

In order to create an effective agent or vaccine for the treatment and diagnosis of pneumonia, research is being conducted in all leading laboratories.

Microbes of the causative agents of pneumonia were established later than bacteria, since they have features that make research difficult. They are able to live and multiply only inside human cells, and this is similar to viruses that exist only in connection with the human body.

Signs of pneumonia are expressed in different ways, depending on the form of the disease.

Prevention

In order to exclude a particular disease, it is important to accurately diagnose. In therapy, this is the most difficult moment.

Most importantly, in order to prevent the onset of the disease, it is necessary to observe not only the regime, but also the general rules. First of all, avoid contact with those who are likely to be at risk of getting sick.

To strengthen the general condition of the body, it is necessary to observe the basic rules of hygiene and caution in contacts.

For those whose immunity is strong enough, the infection is not terrible. But at the first signs of the disease, you should consult a doctor. This will prevent complications and infection.

Strengthening the immune system, diet and exercise will help both prevent the action of the virus and minimize its consequences. Since its effect on the human body has not yet been studied, it is worth taking its manifestation seriously, and at the first sign, be sure to consult a doctor.

On Friday, a young man B., 32 years old, was admitted from the polyclinic to the therapeutic department (2006). On the hands of a digital fluorogram. Conclusion on the picture: focal pneumonia S5.

Complaints at admission: temperature rise to 38 degrees, chilling, weakness, loss of appetite, cough with mucous light sputum, runny nose and sore throat no.

Disease history: the onset of the disease is acute. Against the background of a temperature rise to 38 degrees, a productive cough with light mucous sputum, weakness, weakness, and headaches appeared. I took Fervex. The effect is insignificant in the form of a decrease in temperature for a short period. On the third day there was no improvement, he turned to the place of residence. After the digital FLG, changes were detected in the image - focal shading of S5. Sent to hospital for treatment.

He notes that a child in the family has recently been ill.

Anamnesis of life: previous diseases - SARS, appendectomy at 10 years old. I do not smoke. Allergy does not note. There are no chronic diseases.

As for pets, they recently gave me a parrot, there are no other animals.

Inspection: normosthenic addition, the skin is physiological, moist. No skin rashes were found. Peripheral l / y without changes, the mucous membrane of the oropharynx is pale pink without rashes, there is no discharge from the nasal passages. Temperature - 38.3.

Percussion of the lungs without deviations. Auscultatory: hard breathing over the entire surface of the lungs. Auscultation of the heart: clear heart sounds, heart rate 90, correct rhythm. RR 18, heart rate on the radial arteries 90, blood pressure 120/90 mm Hg. Art.

The abdomen is soft on palpation. Liver, spleen are normal. Physiological departures without features.

Full diagnosis: Community-acquired focal S5 pneumonia, moderate course, DN 1.

1. Detailed clinical blood test.
2. General urine analysis.
3. Biochemical analysis of blood: AST, ALT, direct and indirect bilirubin, plasma creatinine, urea, fasting plasma glucose, total protein, lipid profile.
4. Sputum culture for microflora and sensitivity to antibiotics.
5. Sputum on the MBT.

1. General mode.
2. Diet number 15, drink plenty of water.
3. "Ceftriaxone" 1.0 intramuscularly 2 times a day every 12 hours.
4. "ACC" 2 tab. 2 times a day, diluted in water and taken after meals.
5. Multivitamins.
6. UHF No. 5 after temperature normalization.
7. Breathing exercises.

On the background of therapy throughout the weekend, the temperature was up to 38.3, the doctor on duty was not examined. No improvement is noted.

Taking into account the anamnesis, the course of the disease, and the lack of data on sputum culture, it was decided to treat pneumonia as atypical. The antibiotic was changed (“Sumamed” according to the scheme of 500 mg intravenously by drip at 400.0 saline 1 time per day).

In the dynamics, there was a significant improvement in the patient's well-being, a decrease in temperature to normal numbers. After completing the course of antibiotic therapy and X-ray control on the eleventh day, the patient was discharged.

On the radiograph, there is a clear positive trend in S5.

Six days after the man was admitted to the same department, his wife was hospitalized with focal pneumonia and similar symptoms. Antibiotic therapy was started with "Azithromycin".

1. Appearance at the clinic the next day.
2. Examination of a parrot for infectious diseases.

Multivitamins course up to 1 month.

Which are included in the group of inflammatory diseases provoked by atypical infectious pathogens, and having an uncharacteristic clinic. The term "SARS" was first used in medicine in the 30s of the last century. Physicians of that time used it to refer to pneumonia caused by non-coccal microorganisms.

ICD code 10 - A 48.1, J 15.7, J 16.0. There are several varieties of this disease, pathogens and the clinical picture of which differ from each other. The most common variant is the pathology caused by chlamydia, which is called atypical chlamydial pneumonia. At the beginning of our century, an epidemic of a similar disease was caused by a coronavirus, as a result, 10% of all cases died, and there were more than 8,000 of them.

pathogens

Chlamydia can live in the human body for many years, and at the same time not manifest itself in any way. But when favorable conditions arise, the growth of the pathogenic colony increases, which provokes the development of inflammatory processes in any organs, including the lungs. As a rule, favorable conditions for the development of chlamydia are a decrease in the body's immune defenses, which can cause a number of reasons. You can get infected both by airborne droplets and by household means.

At the initial stage of the disease in adults and children, the disease resembles a respiratory disease, which is accompanied by fever and intoxication symptoms.

A characteristic symptom is a paroxysmal cough with purulent sputum. The course of the disease is protracted, the outcome is usually favorable. At the beginning of our century, an epidemic of a similar disease was caused by a coronavirus, as a result, 10% of all cases died, and there were more than 8,000 people.

Mycoplasma- This is another microorganism that can also quite often cause the development of SARS. Pneumonia caused by mycoplasma has a milder course, and the symptoms are not so bright. But if the patient's immunity is significantly reduced, the disease proceeds brightly and can provoke quite serious conditions. The incubation period of the disease is 21 days, signs of the disease appear within a week after the infection enters the bloodstream.

Symptoms are fever, wheezing and chest pain.

Another microorganism that can cause SARS is legionella. This form of the disease is quite severe, it is more often diagnosed in older people. Infection can occur in public places because legionella is a Gram-negative anaerobe that lives in the water supply. Signs - intoxication symptoms, abdominal pain, vomiting, convulsions. If the case is very severe, severe pain in the affected lung is possible, as well as bloody sputum. If treatment is not started in a timely manner, the patient develops toxic shock and respiratory failure.

Coronovirus can also cause pneumonia, but this is considered a separate group of the disease. Infection occurs by airborne droplets, however, there is also a household type of infection. You need to know that under favorable conditions, this microorganism can remain viable for up to 6 hours. Signs - headaches, fever, digestive problems. Then shortness of breath and pressure in the chest joins.

There are a number of factors that contribute to a decrease in the body's defenses, and, therefore, create favorable conditions not only for the introduction, but also for the reproduction of all microorganisms that can cause SARS:

• prolonged stress;
• smoking and other bad habits;
• various chronic pathologies;
• renal failure in a chronic form;
• take antibiotics, etc.

Clinical picture in adults

The main signs of SARS are:

• the presence of sputum;
• smoothed manifestations on radiography;
• mild or not at all pronounced leukocytosis;
• the presence of headaches;
• very high temperature;
• muscle pain;
• severe weakness;
• intoxication symptoms;
• ineffectiveness of antibiotics and sulfonamides.

As mentioned above, pneumonia caused by different pathogens differ in manifestations and have characteristic features.

Atypical in children and adults begins with symptoms of chills, fever up to 37 ºС, runny nose and mild sore throat. After that, coughing and shortness of breath begin to appear.

IMPORTANT! Most often, mycloplasma pneumonia has a favorable outcome, however, in severe cases, the liver, kidneys, joints, and heart muscle can be affected.

Chlamydial pneumonia begins without symptoms of fever - there is only a sore throat and a runny nose. After a while, the temperature reaches critical levels, joints and muscles begin to hurt, a dry cough opens and shortness of breath appears. Complications of the disease can be bronchial asthma or chronic obstructive bronchitis.

"Legionnaires' disease" or pneumonia, which is provoked by legionella, develops very quickly. A couple of days after infection, the temperature rises to critical levels, a cough appears. A day later, shortness of breath joins, sputum with pus appears, in some cases hemoptysis. Diarrhea and vomiting are often observed.

As for SARS caused by the coronovirus, the incubation period is about a week, after which the temperature rises, headaches and muscle pain, vomiting, and diarrhea. A few days later, coughing and shortness of breath. In severe cases, there is a pronounced cyanosis, a decrease in pressure, a failure in the heart rhythm, and a distress syndrome. In this case, the patient is shown artificial ventilation of the lungs.

Diagnostic measures

Diagnosis of SARS is based on the following:

1. General examination of the patient - assessment of the condition of the skin, chest, lymph nodes, listening to the lungs for wheezing.
2. Collecting complaints - listening to disturbing symptoms.
3. History taking - mycoplasma pneumonia develops in close groups, chlamydia - most often after contact with birds, legionella - contact with the ventilation, water supply or air conditioning system, coronovirus can be assumed if the patient has recently returned from other countries where there are outbreaks of this disease.
4. Complete blood count - ESR is accelerated, an increase in the number of leukocytes, a decrease in hemoglobin and erythrocytes.
5. Chest X-ray.

Laboratory examination of sputum - directly pathogens of atypical pneumonia in sputum cannot be sown, because they are localized in the cells of the body and are not excreted with sputum. Therefore, in order to detect them, the following methods are needed:

• serological analysis;
• PCR analysis;
• sowing on specific nutrient media swabs from the nasal cavity and sputum.

Treatment of the disease

If you experience pain in the chest, cough, fever, you should contact a general practitioner (therapist). A specialist with suspicion of SARS can refer the patient to an infectious disease specialist and a pulmonologist. Atypical form of pneumonia is treated in stationary conditions. If complications develop, the help of an anesthesiologist-resuscitator and a consultation with a neurologist will be required. After the recovery from a critical situation, a physiotherapist can help in the treatment.

Antibacterial therapy is the basis for the treatment of an atypical form of the disease. is selected taking into account the sensitivity of the pathogen, which provoked the development of the disease.

As a rule, tablet forms of drugs are prescribed, in severe cases, injection or drip of the drug may be used.

The list of the main drugs that are prescribed for atypical pneumonia:

• Tetracycline;
• doxycycline;
• Erythromycin;
• Levoflosacin;
• Streptomycin;
• Clarithromycin;
• Gentamicin;
• Zanamivor;
• Ribavirin;
• Oseltamivir.

IMPORTANT! In the case of the viral form of SARS, a powerful antiviral agent is taken.

As additional methods of treatment are prescribed:

• ibuprofen or other antipyretic;
• bed rest;
• plentiful drink;
• oxygen therapy.

For the treatment of children, drugs from the macrodide group are prescribed:

• Midecamycin;
• Azithromycin;
• Siramycin;
• Roxithromycin;
• Clarithromycin.

If these funds do not have a positive effect, they are replaced by:

• doxycycline;
• Co-Trimoxazole;
• Viramycin.

IMPORTANT! The ineffectiveness of antibiotics is recognized on the third day of treatment without improvement in symptoms.

In addition to antibacterial agents, the following are prescribed:

• bronchodilators, expectorants, mucolytics;
• in the presence of respiratory failure - oxygen therapy;
• infusion and detoxification therapy;
• painkillers and antipyretics;
• vitamins and immunomodulators.

From non-drug methods use:

• massage;
• breathing exercises;
• physiotherapy.

The set of prescriptions outlined can expand or decrease depending on how extensive the pathological process is, the age of the child and the presence of complications should also be taken into account.

For successful recovery of the body after any form of pneumonia, it is recommended to maintain an optimal regimen. Food should be fortified, high-calorie, and also sparing from a mechanical and chemical point of view. A warm drink is very useful - milk with honey and soda, cranberry juice, tea with raspberries and more. If symptoms of heart failure are not observed, the recommended amount of fluid per day is 2.5-3 liters.

IMPORTANT! Monitor the proper functioning of the intestines - constipation and flatulence are highly undesirable.

The room where the patient is located should be frequently ventilated, the air should be fresh and clean. Bed rest must be observed for the entire period of a feverish state, however, motionless lying in bed is contraindicated.

It is recommended to periodically change the position of the body, sit down and cough up sputum. It is better to collect the outgoing sputum in a container with a tight-fitting lid; if hemoptysis occurs, you should immediately consult a doctor.

Exercise therapy classes are shown only after the temperature drops to normal levels or stops at subfebrile levels.

Massage and physiotherapy procedures are included in the complex of rehabilitation measures. The doctor should prescribe these procedures, starting from the course of the disease and the age of the patient. Acupressure and can massage is allowed. As a physiotherapy, the patient is recommended mud, paraffin or ozokerite applications, acupuncture, acupuncture, electroacupuncture and so on. Special indication: at elevated temperature, respiratory and heart failure, acupuncture is contraindicated.

Treatment of the disease is recommended until a complete cure, the elimination of not only clinical, but laboratory, as well as radiological signs of the inflammatory process. After discharge from the hospital, it is recommended to continue treatment in dispensaries and sanatoriums that specialize in the treatment of diseases of the bronchopulmonary system.

For the treatment of pneumonia, antibacterial drugs are most often used, which significantly disrupt the balance of normal microflora in the body. This phenomenon can be complicated by problems with digestion and the development of fungal infections. To normalize the balance of microflora, it is recommended to use kefir and yogurt, which contain live bacteria.

Forecasts for rational and timely started therapy, as a rule, are favorable. Recovery most often occurs within a month after the onset of the disease.

As for preventive measures, they relate to the general sanitary and hygienic principle - the fight against dust in the room, good nutrition, smoking cessation, and so on. It is very important to timely treat foci of infections that develop in the body, as well as provide adequate therapeutic treatment for ailments that affect the bronchopulmonary system.

Useful video

Learn more about pneumonia in the video below:

Conclusion and Conclusions

Pneumonia has always been considered a dangerous disease, and even now, in the age of antibiotics, the disease has not become less dangerous. In addition, the emergence of new forms of the disease requires the development of new approaches to treatment, since in most cases new forms of whitening are quite resistant to proven antibacterial drugs. Pneumonia is still an extremely serious and dangerous disease that requires timely access to a doctor and adequate treatment.

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). This division made it possible to differentiate between pneumonia with “typical” respiratory symptoms (lobar or lobar pneumonia) and atypical pneumonia variants (initially, all such atypical according to the manifestations of pneumonia were interpreted as mycoplasma). Atypical pneumonias are usually distinguished by the smoothing of "classic" symptoms (average amount of sputum discharge, lack of pulmonary consolidation, slight leukocytosis, etc.) with a predominance of secondary symptoms in the clinical picture - headache, myalgia, pain and sore throat, weakness.

Currently, for clinical practice, the symptomatic differences between atypical and typical pneumonias do not play such an important role, since the exact definition of the pathogen is crucial for the treatment of pneumonia. In addition, pneumococcal pneumonia is relatively rare these days.

Symptoms

As a rule, atypical pathogens cause atypical symptoms:

Causes

The following bacteria most often cause SARS (often intracellular):

In addition, SARS can be fungal, protozoal or viral in nature.

Known causes of viral SARS include human respiratory syncytial virus (RSV), influenza A and B viruses, parainfluenza virus, adenovirus, cytomegalovirus, severe acute respiratory syndrome virus (SARS), measles virus, etc.

Diagnostics

A number of atypical pneumonias (for example, pneumocystis pneumonia, invasive pulmonary aspergillosis) usually develop in conditions of immunodeficiency, against which radiographic manifestations may be minimal, and therefore such patients are shown to undergo computed tomography.

Epidemiology

Mycoplasma pneumonia is more common in young patients, legionellosis, on the contrary, is more often found in the elderly.

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Notes

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7. Commission on Acute Respiratory Diseases, Fort Bragg, North Carolina (April 1944). "" (PDF). American Journal of Public Health and the Nations Health 34 (4): 347–357. DOI:10.2105/AJPH.34.4.347.
8. Gouriet F, Drancourt M, Raoult D (October 2006). "". Ann. N. Y. Acad. sci. 1078 : 530–40. DOI:10.1196/annals.1374.104. PMID 17114771 .
9. Hindiyeh M, Carroll KC (June 2000). "". Semin Respir Infect 15 (2): 101–13. DOI:10.1053/srin.2000.9592. PMID 10983928 .
10. p714, Robbins and Cotran Pathologic Basis of Disease 8th edition, Kumar et al, Philadelphia 2010
11. MeSH MYCOPLASMA+PNEUMONIAE
13. Tang YW (December 2003). "". Acta Pharmacol. sin. 24 (12): 1308–13. PMID 14653964 .
14. . Retrieved December 21, 2008. .
15. Schneeberger PM, Dorigo-Zetsma JW, van der Zee A, van Bon M, van Opstal JL (2004). "Diagnosis of atypical pathogens in patients hospitalized with community-acquired respiratory infection". Scandinavian Journal of Infectious Diseases 36 (4): 269–73. DOI:10.1080/00365540410020127. PMID 15198183 .
16. National Heart, Lung, and Blood Institute, U.S.A.

Upper Respiratory Diseases (also Upper Respiratory Infections, Colds) Head Neck Diseases of the lower respiratory tract Bronchial diseases Pneumonia Interstitial lung disease Other diseases lungs Diseases of the pleura and mediastinum Purulent diseases Diseases of the pleura Diseases of the mediastinum

An excerpt characterizing SARS

Alpatych replied that the governor did not say anything decisively to him.
- Shall we go away on our business? Ferapontov said. - Give me seven rubles for a cart to Dorogobuzh. And I say: there is no cross on them! - he said.
- Selivanov, he pleased on Thursday, sold flour to the army at nine rubles per bag. So, are you going to drink tea? he added. While the horses were being laid, Alpatych and Ferapontov drank tea and talked about the price of bread, about the harvest and the favorable weather for harvesting.
“However, it began to calm down,” Ferapontov said, having drunk three cups of tea and getting up, “ours must have taken it.” They said they won't let me. So, strength ... And a mixture, they said, Matvey Ivanovich Platov drove them into the Marina River, drowned eighteen thousand, or something, in one day.
Alpatych collected his purchases, handed them over to the coachman who entered, and paid off with the owner. At the gate sounded the sound of wheels, hooves and bells of a wagon leaving.
It was already well past noon; half of the street was in shade, the other was brightly lit by the sun. Alpatych looked out the window and went to the door. Suddenly, a strange sound of distant whistling and impact was heard, and after that there was a merging rumble of cannon fire, from which the windows trembled.
Alpatych went out into the street; two people ran down the street to the bridge. Whistles, cannonballs and the bursting of grenades falling in the city were heard from different directions. But these sounds were almost inaudible and did not pay the attention of the inhabitants in comparison with the sounds of firing heard outside the city. It was a bombardment, which at the fifth hour Napoleon ordered to open the city, from one hundred and thirty guns. At first, the people did not understand the significance of this bombardment.
The sounds of falling grenades and cannonballs aroused at first only curiosity. Ferapontov's wife, who had not ceased howling under the shed before, fell silent and, with a child in her arms, went out to the gate, silently looking at the people and listening to the sounds.
The cook and the shopkeeper came out to the gate. All with cheerful curiosity tried to see the shells flying over their heads. Several people came out from around the corner, talking animatedly.
- That's power! one said. - And the roof and ceiling were so smashed to pieces.
“It blew up the earth like a pig,” said another. - That's so important, that's so cheered up! he said laughing. - Thank you, jumped back, otherwise she would have smeared you.
The people turned to these people. They paused and told how, near by, their cores had got into the house. Meanwhile, other shells, sometimes with a quick, gloomy whistle - cannonballs, then with a pleasant whistle - grenades, did not stop flying over the heads of the people; but not a single shell fell close, everything endured. Alpatych got into the wagon. The owner was at the gate.
- What did not see! he shouted at the cook, who, with her sleeves rolled up, in a red skirt, swaying with her bare elbows, went to the corner to listen to what was being said.
“What a miracle,” she said, but, hearing the voice of the owner, she returned, tugging at her tucked-up skirt.
Again, but very close this time, something whistled like a bird flying from top to bottom, a fire flashed in the middle of the street, something shot and covered the street with smoke.
"Villain, why are you doing this?" shouted the host, running up to the cook.
At the same instant, women wailed plaintively from different directions, a child began to cry in fright, and people silently crowded around the cook with pale faces. From this crowd, the groans and sentences of the cook were heard most audibly:
- Oh, oh, my darlings! My doves are white! Don't let die! My doves are white! ..
Five minutes later there was no one left on the street. The cook, with her thigh shattered by a grenade fragment, was carried into the kitchen. Alpatych, his coachman, Ferapontov's wife with children, the janitor were sitting in the basement, listening. The rumble of guns, the whistle of shells, and the pitiful groan of the cook, which prevailed over all sounds, did not stop for a moment. The hostess now rocked and persuaded the child, then in a pitiful whisper asked everyone who entered the basement where her master was, who remained on the street. The shopkeeper, who entered the basement, told her that the owner had gone with the people to the cathedral, where they were raising the miraculous Smolensk icon.
By dusk, the cannonade began to subside. Alpatych came out of the basement and stopped at the door. Before a clear evening, the sky was all covered with smoke. And through this smoke a young, high-standing sickle of the moon shone strangely. After the former terrible rumble of guns had fallen silent over the city, silence seemed to be interrupted only by the rustle of steps, groans, distant screams and the crackling of fires, as it were spread throughout the city. The groans of the cook are now quiet. From both sides, black clouds of smoke from fires rose and dispersed. On the street, not in rows, but like ants from a ruined tussock, in different uniforms and in different directions, soldiers passed and ran through. In the eyes of Alpatych, several of them ran into Ferapontov's yard. Alpatych went to the gate. Some regiment, crowding and hurrying, blocked the street, going back.
“The city is being surrendered, leave, leave,” the officer who noticed his figure said to him and immediately turned to the soldiers with a cry:
- I'll let you run around the yards! he shouted.
Alpatych returned to the hut and, calling the coachman, ordered him to leave. Following Alpatych and the coachman, all Ferapontov's household went out. Seeing the smoke and even the lights of the fires, which were now visible in the beginning twilight, the women, who had been silent until then, suddenly began to wail, looking at the fires. As if echoing them, similar cries were heard at the other ends of the street. Alpatych with a coachman, with trembling hands, straightened the tangled reins and horses' lines under a canopy.
When Alpatych was leaving the gate, he saw ten soldiers in the open shop of Ferapontov pouring sacks and knapsacks with wheat flour and sunflowers with a loud voice. At the same time, returning from the street to the shop, Ferapontov entered. Seeing the soldiers, he wanted to shout something, but suddenly stopped and, clutching his hair, burst out laughing with sobbing laughter.
- Get it all, guys! Don't get the devils! he shouted, grabbing the sacks himself and throwing them out into the street. Some soldiers, frightened, ran out, some continued to pour. Seeing Alpatych, Ferapontov turned to him.
- Decided! Russia! he shouted. - Alpatych! decided! I'll burn it myself. I made up my mind ... - Ferapontov ran into the yard.
Soldiers were constantly walking along the street, filling it all up, so that Alpatych could not pass and had to wait. The hostess Ferapontova was also sitting on the cart with the children, waiting to be able to leave.
It was already quite night. There were stars in the sky and a young moon shone from time to time, shrouded in smoke. On the descent to the Dnieper, the carts of Alpatych and the hostess, slowly moving in the ranks of soldiers and other crews, had to stop. Not far from the crossroads where the carts stopped, in an alley, a house and shops were on fire. The fire has already burned out. The flame either died away and was lost in black smoke, then it suddenly flashed brightly, strangely clearly illuminating the faces of the crowded people standing at the crossroads. In front of the fire, black figures of people flashed by, and from behind the incessant crackle of the fire, voices and screams were heard. Alpatych, who got down from the wagon, seeing that they would not let his wagon through soon, turned to the alley to look at the fire. The soldiers darted incessantly back and forth past the fire, and Alpatych saw how two soldiers and with them a man in a frieze overcoat dragged burning logs from the fire across the street to the neighboring yard; others carried armfuls of hay.

Atypical pneumonia is a group of infectious and inflammatory lung diseases that are caused by atypical pathogens and have an uncharacteristic clinical picture.

The term "SARS" was introduced into medical practice in the late 30s of the XX century. It was used to name interstitial pneumonias caused by non-coccal bacteria.

In 2002-2003, an epidemic of SARS caused by the coronavirus broke out. During the outbreak, 8437 people became infected with the disease, 813 of them died, that is, the mortality rate was 10%. Cases have been reported in more than 30 countries around the world, but most of them were in China, Hong Kong and Vietnam. This type of SARS pulmonologists called "severe acute respiratory syndrome" (SARS), or "acute respiratory disease syndrome" (SARS).

Each form of SARS has its own characteristics depending on the pathogen.

Causes and risk factors

The causative agents of SARS can be numerous infectious agents:

• chlamydia;
• mycoplasma;
• Epstein-Barr virus;
• influenza viruses A and B;
• respiratory parainfluenza viruses;
• respiratory syncytial virus;
• coronavirus;
• hantavirus;
• coxiella;
• legionella;
• causative agents of tularemia, leptospirosis.

These pathogens have different microbiological characteristics, and the infectious processes they cause also differ in epidemiology and pathomorphological picture. However, all of these microorganisms are highly resistant to beta-lactam antibiotics (penicillins, cephalosporins, carbapenems and monobactams).

Infection with atypical pneumonia occurs by airborne droplets through close contact with a sick person. Young people are more often affected.

Prevention of SARS is a healthy lifestyle that allows you to maintain the body's defenses in an active state.

Forms of the disease

Depending on the type of pathogen, the following forms of atypical pneumonia are distinguished:

• syndrome of acute respiratory disease;
• chlamydial pneumonia;
• mycoplasma pneumonia;
• legionnaires' disease;
• Q fever.

Stages of the disease

For SARS, as, indeed, for most infectious diseases, a certain staging of the course is characteristic:

1. incubation period. It starts from the moment of infection and continues until the first signs of the disease appear. On average, it lasts 7-10 days.
2. Prodromal period, or period of precursors. Lasts 1-3 days. There are non-specific symptoms of the disease, characteristic of most respiratory viral infections (headache and muscle pain, sore throat, slight malaise, dry cough).
3. Height period. There are characteristic signs of an infectious-inflammatory process in the lungs.
4. convalescence period. The activity of the inflammatory process in the lungs subsides, the condition gradually returns to normal.

Symptoms

The main symptoms of SARS in the stage of peak:

• increase in body temperature up to 40-41°C;
• intense headache;
• severe general weakness;
• cough;
• dyspnea;
• profuse night sweats;
• pain in the chest area.

These are common symptoms that are characteristic of almost all SARS. But since they are caused by different microbial agents, each form of the disease has its own characteristics.

atypical chlamydial pneumonia

The onset of chlamydial pneumonia resembles a banal respiratory viral infection with rhinitis and pharyngitis. However, after 2-3 days, the condition of patients deteriorates rapidly. There are complaints of muscle pain, aching bones and joints, dry cough, shortness of breath, fever up to 38-39 °C. Often there is an increase in the cervical lymph nodes. Chlamydial pneumonia is characterized by a long course and severe allergization of the body.

atypical mycoplasma pneumonia

Mycoplasmal pneumonia is characterized by a sluggish course with an erased clinical picture. The first symptoms of the disease, as in the case of chlamydial pneumonia, are similar to the signs of SARS (pain and sore throat, dry cough, weakness). On the 2-3rd day of the disease, the body temperature rises to 37-38 ° C.

Occasionally, mycoplasmal pneumonia is severe, with a pronounced intoxication syndrome, high fever, and an increase in cervical lymph nodes.

The term "SARS" was introduced into medical practice in the late 30s of the XX century. It was used to name interstitial pneumonias caused by non-coccal bacteria.

A distinctive feature of the mycoplasmal form of atypical pneumonia is an unproductive, paroxysmal cough that persists for a long time in patients.

Legionnaires' disease

Its causative agent is a Gram-negative aerobic bacterium that lives in air conditioning and water supply systems.

Legionella pneumonia affects mainly the elderly and is characterized by a severe course, with pronounced symptoms of intoxication, and a strong unproductive cough. The infectious-inflammatory process covers not only lung tissue, but also bronchioles.

acute respiratory syndrome

The most severe form of atypical pneumonia, accompanied by high mortality. It begins with symptoms of influenza infection (headache, fever, weakness, fatigue). A few days later they are joined by tachycardia, dry cough, shortness of breath.

Further development of the clinical picture is determined by the immune status of the patient's body. With a good immune response, the patient recovers. If the immune system is weakened, the condition deteriorates catastrophically, respiratory distress syndrome develops. Against the background of increasing acute respiratory failure, a fatal outcome is possible.

Severe Acute Respiratory Syndrome (SARS) or Acute Respiratory Syndrome (SARS) is also a type of SARS.

Features of the course of the disease in children

Atypical pneumonia in children often occurs with a poorly expressed temperature reaction. However, despite the normal or subfebrile temperature, the general condition deteriorates rapidly and severely. Appear:

• drowsiness;
• lethargy and apathy;
• decreased or complete lack of appetite;
• dyspnea;
• increased sweating;
• vomit;
• diarrhea.

Mycoplasma pneumonia in children is often accompanied by an increase in the spleen and liver, the appearance of a polymorphic rash on the skin.

Children with SARS try to lie on their side on the side of the affected lung because this position reduces chest pain. Often they have violations of the depth and frequency of respiratory movements, there are periodic short-term apnea (breathing stops).

In newborns, atypical pneumonia is quickly complicated by the development of emphysema. In this age group, the disease is extremely difficult and difficult to treat.

Diagnostics

Atypical pneumonia can be suspected on the basis of the clinical picture of the disease and the patient's examination data. To confirm the diagnosis, an X-ray of the lungs is performed in two projections, which allows to determine the presence of an inflammatory focus. To identify the causative agent of the disease, bacteriological, immunological and microbiological studies are carried out.

It is quite difficult to diagnose SARS of viral origin. This is due to the fact that currently there are no test systems for widespread use in clinical practice.

Treatment

Treatment of atypical pneumonia includes etiotropic and symptomatic directions. Etiotropic therapy is aimed at the destruction of the causative agent of the disease. For this purpose, antibiotics are prescribed, taking into account the sensitivity of pathogenic microflora to them, with a course of at least 10-14 days. Moreover, antibiotic therapy is also justified for viral atypical pneumonia - in order to prevent (or treat) a secondary bacterial infection. However, the etiotropic treatment in this case will be the use of antiviral drugs.

Symptomatic therapy is aimed at eliminating the symptoms of the disease, for which antipyretic and anti-inflammatory drugs, expectorants, mucolytics, etc. are used.

With a significant deterioration in the general condition, an increase in respiratory failure, the patient is transferred to the intensive care unit, where they are connected to a ventilator.

With a good immune response, the patient recovers. If the immune system is weakened, the course of SARS deteriorates catastrophically, respiratory distress syndrome develops. Against the background of increasing acute respiratory failure, a fatal outcome is possible.

Possible complications and consequences

Complications of atypical pneumonia can be divided into two large groups: pulmonary and extrapulmonary. Pulmonary complications include:

• lung abscess;
• pleurisy;
• pleural empyema;
• gangrene of the lung;
• acute respiratory failure.

Extrapulmonary complications:

• myocarditis;
• infectious-toxic shock;
• encephalitis;
• meningitis;
• acute psychosis;
• Iron-deficiency anemia.

Forecast

The prognosis is favorable with a strong immune status of the patient and timely treatment.

In newborns, atypical pneumonia is quickly complicated by the development of emphysema. In this age group, the disease is extremely difficult and difficult to treat.

The outcome of SARS can be:

• complete recovery;
• fatal outcome;
• the transition of the disease to a chronic form with the formation of pneumosclerosis.

Prevention

Prevention of SARS is a healthy lifestyle that allows you to maintain the body's defenses in an active state. It is also recommended to observe the following rules:

• during the peak of seasonal viral diseases, refrain from visiting places with large crowds of people;
• when in contact with a sick person, wear a protective mask, wash hands regularly and treat them with antiseptic liquids;
• the room in which the patient is located, often ventilate, regularly carry out wet cleaning in it with the obligatory use of disinfectants. Care items, dishes should be disinfected by boiling in a solution of baking soda for 15-20 minutes.

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