Content

Chest pain, severe wet cough, fever are common signs of pneumonia. In 80% of cases the disease is community-acquired. Every year it affects 5% of the population. At risk are children under 7 years of age and the elderly. Pneumonia develops quickly and can lead to death, so it is important to start treatment at the first symptoms.

What is community-acquired pneumonia

This diagnosis is made when a person has pneumonia and the infection enters the body outside of a medical facility. This also includes situations where symptoms of the disease appeared in the first 48 hours after hospitalization or 2 weeks after discharge. In 3-4% of patients, a severe form of the pathology ends in death. Other complications:

• lung abscess - limited abscess;
• heart failure;
• infectious-toxic shock;
• purulent pleurisy;
• inflammation of the heart muscle.

Classification

ICD-10 codes for community-acquired pneumonia are J12–18. The figure depends on the cause of the disease and the pathogen. In the patient’s card, the doctor indicates the code and features of the diagnosis. According to severity, the disease is divided into 3 forms:

1. Easy. The symptoms of the disease are mild, the patient’s condition is close to normal. Treatment is carried out at home.
2. Moderate weight. In this form, community-acquired pneumonia occurs in people with chronic pathologies. The signs of the disease are pronounced, the patient is admitted to the hospital.
3. Heavy. Up to 30% of patients die due to the high risk of complications. Treatment is carried out in a hospital.

According to the general picture, community-acquired pneumonia is divided into 2 types:

• Spicy. Symptoms of the disease appear suddenly, there are signs of intoxication. The course of the acute form is severe in 10% of cases.
• Protracted. If the disease is not treated, it becomes chronic. Deep tissues are affected, the bronchi are deformed. Relapses occur frequently, and the area of ​​inflammation increases.

On the affected side, the pathology has 3 forms:

• Right-handed. It occurs more often because the bronchus here is shorter and wider. This type of community-acquired pneumonia develops in adults due to streptococci. Right-sided lesions are often lower lobe.
• Left-handed. Here inflammation occurs when the immune system is severely weakened. Pain in the side appears, and respiratory failure develops.
• Double-sided. Both lungs are affected.

Classification of pathology by area affected:

• Focal. The disease affected 1 lobe, the affected area is small.
• Segmental. Several areas are affected. Often this is a middle and lower lobe pathology.
• Upper lobe. A severe form of the disease, the symptoms are pronounced. The blood flow and nervous system suffer.
• Middle lobe. Inflammation develops in the center of the organ and therefore has mild symptoms.
• Lower lobe. Pain appears in the abdomen, and sputum is actively expelled when coughing.
• Total. Inflammation covers the lung completely. This form of pathology is the most dangerous and difficult to treat.

Reasons

According to the pathogenesis (mechanism of development) and causes of occurrence, the following types of community-acquired pneumonia are distinguished:

• Airborne. Bacteria and viruses enter the nose and mouth along with the air, where they enter when a sick person coughs or sneezes. The lungs act as a filter and destroy germs. If a failure occurs due to risk factors, bacteria and viruses remain. They settle on the alveoli (lung tissue), multiply, and cause inflammation.
• Post-traumatic. Infection enters the lower respiratory tract due to chest trauma.
• Aspiration. Microbes enter the lungs during sleep with a small amount of mucus. In a healthy person they will not remain there. If immunity is reduced, the functions of defense mechanisms are weak or there are many microbes, inflammation will begin. Less commonly, vomit is thrown into the lungs. In children, a lipoid form of the pathology occurs: liquid (milk, oil drops) enters the lower respiratory tract, which collects in lumps.
• Hematogenous. Chronic infection from the heart, teeth or digestive organs penetrates the blood.

Pathogen of pneumonia

There are always many microbes in the upper respiratory tract. Under the influence of external factors, they become pathogenic and threaten health. From the nasopharynx, pathogens enter the lungs and trigger inflammation.

In 60% of cases, this happens with pneumococcus - the bacterium Streptococcus pneumoniae.

Other main infectious agents:

• Staphylococcus– often cause community-acquired pneumonia in children. The disease is severe and treatment is difficult to choose. If the drugs are chosen incorrectly, the pathogen quickly develops resistance to them.
• Streptococci– in addition to pneumococcus, there are other, rarer types of bacteria in this group. They cause a disease with an indolent course, but a high risk of death.
• Haemophilus influenzae– accounts for 3–5% of cases of community-acquired pneumonia, often found in older people. It is infected in humid, warm climates.
• Mycoplasma– this bacterium causes pneumonia in 12% of patients, often affecting adults aged 20–30 years.
• Influenza virus– accounts for 6% of cases of pneumonia, dangerous in autumn and winter.

Atypical pathogens of community-acquired pneumonia:

• Klebsiella– dangerous for children 3–10 years old. This microbe causes prolonged mild inflammation.
• Coronavirus– in 2002–2003, it was the causative agent of the epidemic of severe atypical pneumonia.
• Herpes virus– strains of types 4 and 5. Rarely, type 3 causes chickenpox in adults with severe pneumonia. A simple herpes virus, in which blisters appear on the mucous membrane, is almost harmless. It affects the respiratory tract only in people with very weak immune systems.

Risk factors

Community-acquired pneumonia develops when immunity declines. Causes and risk factors:

• Influenza epidemic and frequent ARVI– they do not allow the body to fully recover.
• Frequent hypothermia– it causes vasospasm. Blood flows poorly, and immune cells do not have time to reach the desired area in time to protect the body from infection.
• Chronic inflammation– caries, diseases of the joints or nasopharynx. Bacteria are constantly in the body, moving from the main focus to other organs.
• HIV status– forms persistent immunodeficiency.

Less commonly, the body’s defenses weaken due to the following factors:

• hormonal imbalances;
• alcoholism;
• smoking;
• operations;
• poor oral hygiene;
• stress.

Symptoms

The incubation period of infection lasts up to 3 days. Afterwards, pneumonia develops very quickly. It starts with the following signs:

• Temperature. It rises to 39–40 degrees. Paracetamol doesn't knock it down. After 2-3 days the fever goes away, but then returns.
• Cough. First dry, after 2-3 days - wet. The attacks are frequent and severe. The type of sputum depends on the type of pneumonia. Gray, viscous mucus is often discharged, rarely with pus or streaks of blood.
• Shortness of breath and suffocation. If the disease is severe, the respiratory rate is above 30 breaths per minute.
• Pain behind the sternum. It can be left- or right-handed. It is characterized by aching pain, which intensifies with inhalation and coughing. The symptom rarely extends to the stomach area.

Other signs of community-acquired pneumonia:

• General intoxication. Headaches, weakness, nausea, rarely – vomiting.
• Pain in muscles, joints.
• Abdominal cramps, diarrhea.

Older people do not have fever or cough. Here the main signs of the disease are confusion, speech disturbances, and tachycardia. Community-acquired pneumonia in children can appear in the first weeks of life and has the following course features:

• In infants, the skin turns pale and a bluish triangle appears around the lips. The baby becomes lethargic, sleeps a lot, and is difficult to wake up. He spits up frequently and does not breastfeed well. With severe left- or right-sided damage, the child’s fingers turn blue.
• Children under 3 years old cry a lot and sleep poorly. Clear mucus is released from the nose, which turns yellow or green after 3-4 days. Shortness of breath occurs when coughing and crying. The temperature rises on the first day to 38 degrees, chills occur.
• In children over 3 years of age, the disease progresses as in adults.

Diagnostics

The doctor collects the patient’s complaints and listens to his chest. Moist rales are heard, breathing is changed.

When the area above the diseased lung is tapped, the sound becomes short and dull.

A diagnosis is made and the severity of the disease is determined using the following methods:

• Blood test– shows a high erythrocyte sedimentation rate, changes in the level of leukocytes. These are the main markers of inflammation.
• X-ray of the chest is taken straight and from the side. Pneumonia is indicated by darkening in the image. After the procedure, the affected area and the area of ​​inflammation are known. The causative agent of the disease is determined by the nature of the changes in the image. During treatment, x-rays will help evaluate the effect of therapy.
• Sputum examination– identifies the causative agent of the disease, helps prescribe the correct medications.
• Express urine test– needed to identify antigens of pneumococcus or Haemophilus influenzae. The method is expensive, so it is rarely used.
• A CT scan is performed to examine the lungs in more detail. This is important for prolonged community-acquired pneumonia, recurrent or atypical. If there are no changes in the X-ray image, but there are signs of the disease, CT will help clarify the diagnosis.

To separate community-acquired pneumonia from tuberculosis, tumors, allergies and obstructive pulmonary disease, differential diagnosis is carried out:

• An ultrasound of the lungs will show the fluid inside the pleural cavity and its nature, tumors.
• Serodiagnosis will determine the type of microbe that caused the disease.
• A test for tuberculosis will rule out or confirm this disease.

Treatment of community-acquired pneumonia

According to the protocol, therapy begins with antibiotics. They kill germs and help avoid complications. Afterwards, agents are used that remove phlegm and remove the symptoms of the pathology. Features of treatment:

• Community-acquired pneumonia in infants and the elderly requires hospital treatment.
• If the disease is mild, therapy is carried out at home.
• The patient is prescribed bed rest, plenty of warm liquid (2.5–3 liters per day). The basis of the menu is pureed porridge with water, vegetables and fruits.
• Physiotherapy improves the patient’s general condition, relieves symptoms of pneumonia, and speeds up recovery. They are carried out in a course of 10–12 sessions.

• The patient is urgently hospitalized if he has septic shock. This is the main sign of a serious condition. Minor criteria: low blood pressure, impaired consciousness, severe respiratory failure, shortness of breath and temperature below 36 degrees. If there are 2-3 of these signs, the patient is admitted to a hospital.
• If the cause of the disease is not clear, antibiotics are used for 10 days. When the source of infection is outside the lungs, the lesion is in the lower lobe, or the course is complicated, treatment is extended to 2-3 weeks.
• In case of acute respiratory failure, the patient is given oxygen therapy– a special mask is put on the face or nose area, air with a high oxygen content is supplied.

Medication

Etiotropic (eliminating the cause) treatment of community-acquired pneumonia is carried out for 7–10 days with antibiotics of the following groups:

• Penicillins (Amoxicillin). These are the main drugs for infection. Medicines are administered through an IV. After 3-4 days they switch to tablets. In children, penicillins are used for typical flora.
• Macrolides (Azithromycin). They are used against mycoplasma and legionella. The same drugs are used for allergies to penicillin, in children under 6 months and with atypical flora. On an outpatient basis (at home), macrolides are taken orally.
• 3rd generation cephalosporins (Ceftriaxone). They are used in older people and for severe complications. The drugs are administered through a drip or injections.
• Fluoroquinolones (Levofloxacin). They are prescribed to replace other antibiotics for home treatment. The drugs are used in tablets.

The antibiotic treatment regimen is drawn up individually based on test results, age and clinical picture. If after 3 days the patient does not feel better, the medicine is changed. The following drugs help with the symptoms of community-acquired pneumonia:

• Bronchodilators– relieve spasm and shortness of breath. They are not effective for allergies. Administered through a dropper 2 times a day Eufillin. Berodual used through inhalation with a nebulizer 4 times a day.
• Analgesics (Baralgin)– relieve pain. They are used in tablets once.
• Antipyretics- bring down the temperature. Adults are prescribed tablets Ibuprofen, for children - syrups and paracetamol suppositories ( Tsefekon D). These drugs are used once at temperatures above 38.5 degrees: they interfere with the work of antibiotics.
• Expectorants (Lazolvan)– remove phlegm and speed up recovery. They are used in the form of syrups 2-3 times a day. In severe cases of the disease, they are used through a nebulizer.

Physiotherapeutic

When the body temperature becomes normal and the acute symptoms of the disease go away, the patient is prescribed the following procedures:

• Electrophoresis- it is carried out with Eufillin to relieve bronchospasm and swelling. Novocaine used to relieve severe pain. During this procedure, drugs penetrate into the blood faster and in greater volume. The course consists of 10 sessions of 10–20 minutes each day.
• UHF, or high frequency current treatment– relieves swelling, reduces sputum production and stops the proliferation of microbes. The procedure is performed in the acute period, but without fever. The course consists of 10–12 sessions of 8–15 minutes each.

Prevention

To prevent the development of community-acquired pneumonia, follow these recommendations:

• Temper your body: take a contrast shower, douse yourself with cold water.
• Take courses of medications that strengthen the immune system: Immunal, Grippferon.
• Take a walk in the fresh air and play sports.
• Introduce vegetables and fruits into your diet.
• Don't get too cold.
• Treat diseases of the teeth, ear, nose and throat in a timely manner.
• Give up cigarettes and alcohol.
• Do not go to crowded places during ARVI epidemics.

A good measure to prevent community-acquired pneumonia are pneumococcal and influenza vaccines. It is better to make them before the onset of cold weather. The procedure is needed for the following groups of people:

• Elderly, pregnant women, children under 10 years old.
• Persons who have chronic heart and lung diseases.
• Nursing home nurses and hospital staff.
• Family members at risk.

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Despite the fact that acute pneumonia belongs precisely to those diseases that are considered to be constant companions of humans and doctors or traditional healers in any era tried to find an effective method of treating it, even modern medicine has not been able to create effective methods for diagnosing and treating this dangerous disease.

Features of pneumonia today

A huge amount of research has been devoted to this disease, the purpose of which was to study the characteristics of the development of pneumonia in the era of widespread introduction of antibiotics into clinical practice, and their results prove that:

• even the use of the most modern examination techniquesdoes not allow timely diagnosis of the development of acute exudative-inflammatory processes in the alveoli and interstitial (connective) tissue of the lung - for every case of identified pneumonia, there are 3-4 cases of the disease that were not detected in a timely manner;
• in some patients, even the prescription of highly effective antibiotics does not guarantee the absence of complications dangerous to life and health, and a complete recovery;
• pneumonia that occurs in a hospital setting (in-hospital) and out-patient (community-acquired) is caused by completely different pathogens,have differences in the clinical picture and require a balanced approach to the disease in order to prescribe effective treatment.

This division is based on the dependence of the clinical picture and prognosis of the disease on the conditions for the occurrence of the pathological process in the lungs, the characteristics of infection of the lung tissue and the state of the patient’s immune system.

Outpatient and hospital-acquired pneumonia - what are the similarities and differences

It has been proven that in the vast majority of cases, community-acquired pneumonia develops in patients without severe concomitant diseases of internal organs (healthy or practically healthy before the onset of pneumonia), has a favorable course and most often occurs during epidemic outbreaks of acute respiratory viral infections and colds. More often, this disease is detected in patients who, due to the nature of their professional activities, have to constantly contact a large number of people in close groups, or work with birds or animals (some pathogens of pneumonia can cause diseases in warm-blooded fauna and humans).

Nosocomial pneumonia is considered to be all pneumonia that occurs in a patient no earlier than 48 hours from the moment of hospitalization, regardless of his profile. This variant of the disease is characterized by a severe course and rapid increase in clinical symptoms, frequent complications and a fairly high percentage of deaths (even with timely treatment, it reaches 20-25%). Most often, this variant of pneumonia occurs in people with significant changes in the immune system - in newborns directly in the maternity hospital, in elderly patients against the background of severe somatic pathology, including diabetes, diseases of the blood and circulatory system. Separately, nosocomial pneumonia is distinguished, which occurs in people against the background of severe immunodeficiencies, and aspiration, associated with the entry into the respiratory tract of infected secretions of the upper respiratory tract (nasopharynx and oropharynx) and changes in the white blood formula (determined according to clinical analysis).

In the pathogenesis (mechanism of development) of hospital pneumonia, characteristic features were discovered associated with rapid changes in the microflora of the upper respiratory tract and skin - in patients, the epithelial integuments are very quickly “populated” by microorganisms circulating in a particular department of the hospital, the number of which progressively increases against the background of a decrease in the functions of local protection systems in small caliber bronchi and alveoli.

The source of infection in this case may be department staff, solutions used for transfusions and infusions, equipment (catheters, endoscopes, probes). The most common causative agents of this variant of pneumonia are gram-negative microorganisms, Pseudomonas aeruginosa, staphylococcus, and anaerobic infection.

Clinical picture - is there a difference between community-acquired and nosocomial pneumonia?

There is a whole list of typical manifestations (symptoms) of pneumonia, a careful analysis of which will help make the correct diagnosis and prescribe the necessary treatment. Of course, the success of diagnosis will largely depend on the doctor’s ability to direct a comprehensive and thorough examination. But based on the conversation and examination data, the free doctor can make the correct diagnosis.

Community-acquired pneumonia is characterized by the appearance of the first symptoms of the disease against the previous symptoms of a cold and ARVI, but relative to the normal state of health of the patient before the onset of the viral infection. The disease is usually unilateral, has a relatively benign course and almost never causes complications if treatment is started in a timely manner. The first manifestations of pneumonia in patients without significant suppression of the immune system appear in an outpatient setting (at home) - in fact, it is they who force a person to seek medical help.

With nosocomial pneumonia, the first symptoms of the disease suddenly appear in the midst of complete well-being in the patient, who by this time has been in the hospital for at least 48 hours. The disease is severe, with bilateral or lobar pneumonia, high fever, shortness of breath, and frequent complications. In this case, the patient may experience pulmonary heart failure, pulmonary edema, septic and metabolic disorders, which requires the prescription of massive etiotropic (directed at the pathogen) antibacterial drugs.

Treatment of pneumonia depending on its origin

The choice of antibiotic for pneumonia is determined by several factors, and those prescribed today are extremely wide. However, most experts who have studied the effectiveness of antibiotics for pneumonia have noted that the determining factor at the initial stage of the disease should be the type of pneumonia.

For community-acquired pneumonia that occurs on an outpatient basis against the background of normal general immunity, the drugs of choice remain:

• penicillins and inhibitor-protected penicillins - benzylpenicillin, amoxicillin, amoxiclav;
• macrolides – macropen, sumamed, roxithromycin, azithromycin;
• cephalosporins of I-IV generations - cephaloridine, cefazolin, cefuroxime, cefotaxime, ceftriaxone, zinnate;
• fluoroquinolones – ciprofloxacin,ofloxacin, pefloxacin (abactal),

Moreover, most of these drugs can be prescribed both orally and by injection, which makes it possible to select the optimal treatment regimen for a particular patient.

For nosocomial pneumonia that occurs against the background of some serious concomitant disease and is caused by pathogens resistant to antimicrobial agents, the following may be prescribed:

• inhibitor-protected penicillins- amoxiclav;
• cephalosporins of the II, III and IV generations - ceftazidime, cefotaxime, cefepime, ceftriaxone;
• aminoglycosides – gentamicin, tobramycin, amikacin;
• respiratory fluoroquinolones - moxifloxacin, levofloxacin, pefloxacin;
• carbapenems - thienam,

but these drugs should be prescribed only parenterally (intravenously, intramuscularly), in age-specific dosages and taking into account compatibility.

The ideal condition for prescribing antibacterial therapy is obtaining the results of microbiological and bacteriological examination of sputum, which is not always practically feasible - the wait for the result can take 5-7 days. Therefore, in the overwhelming majority of cases, the doctor has to rely on the results of patients who were previously in the department (the composition of the microflora in the departments is constant, and the most modern and effective antiseptics cannot significantly change it). That is why, when Pseudomonas aeruginosa is detected in the department, inhibitor-protected penicillins and aminoglycosides, cephalosporins and aminoglycosides, cephalosporins and macrolides have to be prescribed for the treatment of pneumonia.

Non-steroidal anti-inflammatory drugs (indomethacin, ibuprofen, diclofenac), drugs to support the functioning of the cardiovascular system, vitamins, drugs that improve the drainage functions of the bronchi - bronchodilators and mucolytics - are becoming an obligatory component of the complex therapy of nosocomial pneumonia. If complications develop, appropriate symptomatic therapy is necessarily prescribed, which necessarily includes glucocorticoids, detoxification therapy, immuno-replacement drugs, drugs that eliminate microcirculation disorders in the body tissues, and oxygen inhalation.

To improve the condition of the lung tissue in any pneumonia, physiotherapeutic treatment is indicated, which may include inductothermy, UHF, amplipulse therapy, and to accelerate the resorption of inflammatory loci, electrophoresis and laser therapy are used.

Features of the course of pneumonia that occur in outpatient and inpatient settings necessitate the division of these diseases into two large clinical groups. Each of these forms requires a separate approach to prescribing antibacterial drugs and symptomatic therapy

Pneumonia is the presence of an inflammatory process in the lungs. And the name of the disease “community-acquired pneumonia” indicates that it occurs as a result of exposure to an etiological factor outside a hospital setting. The pulmonary parenchyma is subject to inflammation, and one lung, its lobe, or a small area may be affected. If both lungs are involved in the process, then the diagnosis will be bilateral community-acquired pneumonia.

Causes of the disease

The cause of inflammation can be many different microorganisms, fungi, viruses. Among them, the most common are: strepto-, staphylo- and pneumococci, Klebsiella, influenza and parainfluenza viruses, mycoplasmas and other pathogens. The disease can be caused by weakened immunity, severe hypothermia, prolonged and constant exposure to harmful chemicals at work. Community-acquired pneumonia can develop as a complication of inflammatory diseases of the upper respiratory tract, etc.), as well as in the presence of an allergic predisposition of the body.

The pathogenesis of the disease is as follows: the pathogen, having penetrated the lung tissue by air or hematogenous route, begins to multiply intensively. This is facilitated by bronchial secretions and fluid formed as a result of edema of the lung lobes. An important role is played by the immunological reaction to the presence of tissue damage. With a viral etiology of the disease, pneumonia can be complicated by the addition of a bacterial infection. It usually appears seven to ten days after the onset of a viral disease, against the background of a sharply weakened immune system and reduced antibacterial activity of the macrophage system of the lungs. Chronic community-acquired pneumonia in adults may result from an undertreated acute form.

Clinical manifestations of the disease

Mild forms of pneumonia can be treated at home, under the supervision of a physician. Other forms are treated in a hospital. Antibiotics are a mandatory component of therapy. They are used taking into account the sensitivity of the pathogen. At the same time, for the purpose of detoxification, antihistamines, expectorants, and multivitamins are prescribed. Physiotherapeutic treatment can be effective

Community-acquired pneumonia is one of the most common diseases and ranks 4–5 in the mortality structure of developed countries. Mortality due to pathology is 2–5%; among elderly and senile people it increases to 15–20%. The basis of effective treatment is antibacterial chemotherapy. The decisive factor in choosing a drug should be a correct judgment about the nature of the disease.

Pneumonia is a group of diseases of the lower respiratory tract caused by infection. In this case, there is a predominant damage to the alveoli and interstitial tissue of the lung.

The following, purely pragmatic differentiation of pneumonia is widespread:

• community-acquired: develops outside the hospital walls;
• nosocomial, or hospital: occurs during the treatment of other diseases in a medical institution (hospital).

This is a conditional division of pneumonia, but it is justified because their etiological agents differ. After collecting anamnesis, the doctor can make a judgment about the place of development of pneumonia, thanks to which it is possible to more reasonably approach the choice of an antibacterial agent.

Etiology of disease development

The causative agents of community-acquired pneumonia are usually bacteria: pneumococci, streptococci, Haemophilus influenzae. In recent years, the epidemiological significance of such agents as chlamydia, mycoplasma, legionella, and pneumocystis has increased. In young patients, pneumonia is more often caused by a monoinfection, and in people over 60 years old - by associations of pathogens, most of which are represented by a combination of gram-positive and gram-negative flora.

While staying in gerontological institutions or some time after discharge from the hospital, the likelihood of developing pneumonia caused by gram-negative bacilli and staphylococci increases.

Symptoms of pneumonia

The main symptoms of pneumonia are usually:

• increase in body temperature to febrile and subfebrile levels (above 37.1 °C);
• cough (usually with sputum production).

Less common are pleural pain, chills, and shortness of breath.

With lobar pneumonia, in particular with lower lobe pneumonia, signs of consolidation of lung tissue are revealed - bronchial breathing, shortening of percussion sound, increased vocal tremors. Auscultation most often reveals local fine bubbling rales or the characteristic phenomenon of crepitus. In elderly and senile patients, classic manifestations of pneumonia may be absent. Other signs of inflammation are possible: shortness of breath, hypothermia, fever, confusion (either alone or a combination of these symptoms).

It must be remembered that pneumonia is a dangerous infectious disease, the causative agent of which can be spread by airborne droplets or contact.

Right-sided pneumonia develops more often than damage to the left lung. This is due to the peculiarities of the anatomical structure of the respiratory tract.

When examining patients, danger signs should be carefully recorded: shortness of breath, hypotension, oliguria, severe bradycardia/tachycardia, confusion. The presence of septic foci can significantly affect the diagnosis and nature of therapy: pleural empyema, peritonitis, endocarditis, arthritis, brain abscess, meningitis, pericarditis.

Extrapulmonary manifestations help to understand the nature of the disease. Thus, polymorphic erythema and bullous otitis are characteristic of mycoplasmosis, erythema nodosum is often observed with tuberculosis, retinitis is characteristic of toxoplasmosis and cytomegalovirus infection, skin rash is characteristic of chickenpox and measles.

Symptoms of acute community-acquired pneumonia

Acute pneumonia is characterized by the following symptoms:

• bilateral, abscess or multilobar pneumonia;
• rapid progression of the inflammatory process: within 48 hours of observation, infiltration zones can increase by 50% or more;
• severe respiratory and vascular failure (the use of pressor amines may be required);
• acute renal failure or oliguria.

Often, against the background of a severe course of the pathology, life-threatening manifestations such as multiple organ failure, infectious-toxic shock, disseminated intravascular coagulation syndrome, and distress syndrome are diagnosed.

Diagnosis of pathology

In order to identify the causative agent, bacteriological examination of sputum is traditionally carried out. The most convincing data are those obtained from sputum cultures obtained before the start of therapy.

Conducting a bacteriological study requires a certain time; its results can be obtained after 3–4 days. The indicative method is microscopy of a sputum smear stained with a Gram stain. Its main advantages are its accessibility and short duration. Thanks to this study, it is possible to determine the choice of the optimal antibiotic.

Determining the sensitivity of the isolated microflora to an antibacterial agent is especially important in cases where the initial therapy was ineffective. It should be taken into account that the results of bacteriological examination may be distorted due to previous antibiotic therapy.

Despite the widespread use of laboratory diagnostic methods, it is often not possible to identify the causative agent of pneumonia, and in patients with mild disease this figure is especially high (up to 90%). This is partly due to the known difficulties in timely obtaining material from the site of inflammation. Extreme difficulties in the etiological diagnosis of pathology are caused by:

• absence of sputum (in 10–30% of patients in the early stages of the disease) and difficulty in obtaining it in children, especially under the age of one year;
• inability to obtain bronchial secretions by invasive methods due to the severity of the patient’s condition, insufficient qualifications of medical staff or for other reasons;
• combining bronchial contents with the microflora of the upper respiratory tract and oral cavity;
• high level of carriage of S. pneumoniae, H. influenzae and other conditional pathogens.

For the etiological deciphering of chlamydial, legionella, mycoplasma, and viral pneumonia, so-called non-cultural methods are often used. Currently, it is possible to use kits to determine antigens of pneumococcus, Legionella, and Haemophilus influenzae in urine. Unfortunately, these rapid diagnostic methods are quite expensive, and not every person can afford them.

To make a diagnosis, an x-ray examination is performed. The identified infiltrative changes can be lobar and multilobar. This is typical for the bacterial etiology of the disease (for pneumococcal, legionella pneumonia, as well as for pathologies caused by anaerobes and fungi).

With lobar pneumonia, in particular with lower lobe pneumonia, signs of consolidation of lung tissue are revealed - bronchial breathing, shortening of percussion sound, increased vocal tremors.

In the presence of diffuse bilateral infiltrates, pathogens such as influenza virus, staphylococcus, pneumococcus, and legionella are usually detected. Multifocal and focal infiltration can be homogeneous (legionella, pneumococcus) or inhomogeneous (viruses, staphylococcus, mycoplasma). The combination of interstitial and infiltrative changes is typical for diseases of a viral, Pneumocystis and mycoplasma nature.

Treatment of community-acquired pneumonia

In almost all cases, the doctor chooses a first-line antibiotic for the treatment of pneumonia empirically, based on knowledge of the allergy history, clinical and epidemiological situation, and the spectrum of action of the antibiotic.

Possible drugs for therapy:

• penicillins and aminopenicillins (Ampicillin, Amoxicillin): for pneumonia caused by pneumococci;
• macrolides (Erythromycin, Clarithromycin, Midecamycin, Roxithromycin, Spiramycin) and azalides (Azithromycin): for pneumonia caused by legionella, mycoplasma, chlamydia.

Macrolides are also an alternative treatment for streptococcal (pneumococcal) infections in cases of allergy to β-lactam drugs. Instead of macrolides, tetracyclines (Doxycycline) can be prescribed, however, it is necessary to take into account the frequent resistance of gram-positive flora to this group of drugs.

In cases where it is assumed that a mixed flora has led to the development of community-acquired pneumonia, enhanced aminopenicillins (Amoxicillin/Clavulanate, Ampicillin/Sulbactam) or third-generation cephalosporins (Cefotaxime, Ceftriaxone) are prescribed.

When treating pathologies caused by gram-negative microorganisms, aminoglycosides (Gentamicin, Amikacin) and fluoroquinolones are usually used. In severe cases, a combination of aminoglycosides and fluoroquinolones may be prescribed.

Despite the widespread use of laboratory diagnostic methods, it is often not possible to identify the causative agent of pneumonia, and in patients with mild disease this figure is especially high (up to 90%).

Particularly difficult is the treatment of pneumonia caused by Pseudomonas aeruginosa and other multidrug-resistant microorganisms. In such cases, the use of antipseudomonal cephalosporins (Ceftazidime), fourth-generation cephalosporins (Cefepime), carbapenems (Meropenem) or a combination of these antibacterial agents with aminoglycosides or fluoroquinolones is indicated.

Carbapenems, Clindamycin, Metronidazole, Cefepime are active against anaerobic flora, which often leads to aspiration pneumonia. For the pneumocystis form of the disease, it is best to use co-trimoxazole (Biseptol).

In what cases is hospitalization indicated?

In severe cases of pathology, hospitalization is indicated for all patients, especially for infants and the elderly. Antibiotic therapy should be carried out exclusively intravenously. For septic pneumonia, which is characterized by high mortality, early initiation of chemotherapy is extremely important; in this case, the use of antibacterial agents should be started within one hour of diagnosis.

To stabilize hemodynamics, infusion therapy is necessary; the administration of pressor amines and (according to vital indications) high doses of corticosteroids are indicated.

Blood pressure in case of unstable hemodynamics, infectious-toxic shock should be increased as quickly as possible. This is because multiple organ dysfunction and mortality are directly related to the duration of hypotension.

In cases of severe pneumonia, the use of antibiotics with the broadest spectrum of action, such as carbapenems or third-fourth generation cephalosporins in combination with macrolides, is completely justified. Subsequently, after the patient’s condition improves, the clinical situation or the causative agent of the pathology is clarified, the volume of antibacterial chemotherapy is reduced to the required minimum.

Possible complications

In adults and children, the most common complications of community-acquired pneumonia are:

• acute renal failure;
• respiratory failure;
• abscess formation;
• acute vascular insufficiency;

Prevention

It must be remembered that pneumonia is a dangerous infectious disease, the causative agent of which can be spread by airborne droplets or contact.

Considering that pneumococcus is the cause of up to 76% of pneumonia, vaccination is an effective protection against this common disease. For this purpose, the use of polysaccharide polyvalent vaccines containing antigens of 23 serotypes, which cause the majority (up to 90%) of diseases of pneumococcal etiology, is indicated.

Vaccination is carried out once, subsequent revaccination is necessary for patients belonging to a high-risk group - people over 65 years of age, as well as patients with reduced immunity.

Treatment for community-acquired pneumonia is usually carried out at home. In order for the body to effectively cope with the causative agent of the disease, it is necessary to strictly follow medical prescriptions.

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Often in therapeutic practice, a pathology such as community-acquired pneumonia is diagnosed, the treatment of which can be carried out at home. Most often, the disease has an infectious etiology.

Pneumonia occurs in both adults and children. It often occurs against the background of another serious pathology, for example, HIV infection. The risk of pneumonia largely depends on the level of social well-being, lifestyle, immunity status, working conditions, and contact with sick people. Every year, hundreds of thousands of new cases of this disease are diagnosed worldwide. If left untreated, severe pneumonia, especially in young children, can be fatal. What are the etiology, clinical picture and treatment of community-acquired pneumonia?

Features of community-acquired pneumonia

Currently, pneumonia is an inflammation of the tissues of the lung or both lungs, in which the alveoli and interstitial tissue of the organ are involved in the process. Pneumonia can be community-acquired or hospital-acquired. In the first case, there is an acute infectious pathology that arose outside the medical institution or less than 48 hours after the start of hospitalization. Depending on the location of the pathological process, the following types of pneumonia are distinguished: focal, segmental, lobar, total, confluent. The most common type is lobar pneumonia. In this situation we are talking about lobar pneumonia.

In adults and children, either one or both lungs may be affected. There are 3 types of inflammation: with decreased immunity, without it, and aspiration. The development of the infectious form of pulmonary pneumonia is based on the following processes: aspiration of secretions in the oropharynx, inhalation of air contaminated with microorganisms, entry of pathogenic microbes from other organs into the lungs and spread of the infectious agent through the blood.

Etiological factors

If inflammation develops outside the hospital, there may be several reasons for this. The most common causes of the disease are:

• presence of a viral infection;
• contact with sick people;
• hypothermia (general and local);
• impaired mucociliary clearance;
• the presence of foci of chronic infection (septic thrombophlebitis, endocarditis, liver abscess);
• penetrating chest wounds;
• decreased immunity (due to HIV infection);
• exposure to ionizing radiation and toxins;
• exposure to allergens;
• weakening and exhaustion of the body against the background of severe somatic pathology.

Diseases that increase the risk of pneumonia are kidney disease, heart disease, lung disease, tumors, and epilepsy. The risk group includes people over 60 years of age and children. The causative agents of community-acquired pneumonia are different. Most often they are pneumococci, mycoplasmas, chlamydia, Haemophilus influenzae, Staphylococcus aureus, Klebsiella, Legionella. Much less often, the disease is provoked by viruses and fungi.

Risk factors for the development of this pathology are chronic alcoholism, smoking, the presence of COPD, bronchitis, overcrowding of groups (in nursing homes, schools, kindergartens, boarding schools), unsanitized oral cavity, contact with artificial ventilation systems (air conditioners). Pneumonia of the aspiration type should be identified as a separate group. In this situation, they occur when foreign objects enter the bronchi. This could be food or vomit. Less commonly, the cause of inflammation is thromboembolism of small branches of the pulmonary artery.

Clinical manifestations

Symptoms of community-acquired pneumonia include:

• increased body temperature;
• productive cough;
• chest pain;
• shortness of breath during work or at rest;
• lack of appetite;
• weakness;
• malaise;
• increased sweating.

Sometimes pneumonia occurs unnoticed by the patient and is discovered by chance (during X-ray examination). All of the above symptoms are characteristic of the typical form of the disease. Community-acquired pneumonia can be atypical. In this case, the gradual development of the disease, the appearance of a dry cough, headache and muscle pain, and sore throat are noted. Pneumonia can occur in mild, moderate and severe forms. A mild degree is characterized by slight intoxication of the body (increase in temperature up to 38 ° C), normal blood pressure, and absence of shortness of breath at rest. Examination of the lungs reveals a small lesion.

With moderate severity, sweating, weakness are noted, the temperature rises to 39 ° C, the pressure is slightly reduced, and the respiratory rate is increased. High fever, confusion, cyanosis, and shortness of breath at rest are all signs of severe community-acquired pneumonia. Lobar pneumonia is diagnosed most often. It occurs acutely after an increase in body temperature and chills. It is characterized by severe shortness of breath and cough. At first it is dry, then phlegm is released. It has a rusty tint. Symptoms may persist for more than a week. The course of focal community-acquired pneumonia is more gradual.

Diagnostic measures

Diagnosis of community-acquired pneumonia includes:

• a detailed survey of the patient or his relatives about the development of the disease;
• life history;
• listening to the lungs;
• performing ultrasound;
• echocardiography;
• carrying out an x-ray examination.

X-ray is the most reliable diagnostic method. In this case, focal or diffuse darkening (less often total) and expansion of the roots of the lungs are detected. A sputum examination is also organized to clarify the causative agent. During auscultation, dullness of pulmonary sound, crepitus, and wheezing are revealed. Additional diagnostic methods include CT, MRI, bronchoscopy, biopsy, urinalysis, and detection of antibodies in the blood. A blood test can detect signs of inflammation.

Treatment of pneumonia

For community-acquired pneumonia, treatment should be comprehensive. In case of uncomplicated inflammation, treatment can be carried out at home. In severe cases, hospitalization is required. This also applies to young children.

Pneumonia is treated mainly with antibacterial drugs. The doctor selects medications based on the patient’s condition, his age and the type of pathogen. Antibiotics will only be effective for bacterial pneumonia. The drugs of choice for community-acquired pneumonia are protected penicillins (Amoxiclav, Amoxicillin, Ampicillin), cephalosporins (Cefazolin), macrolides (Rovamycin). The drugs can be taken orally or injected (intramuscularly or intravenously).

Treatment is carried out immediately. You should not wait for the results of a microbiological test. In severe cases of the disease, a combination of cephalosporins with macrolides (Macropen, Sumamed, Azithromycin) and fluoroquinolones is possible. For severe pneumonia, it is preferable to use Cefotaxime or Ceftriaxone. The duration of therapy is 1-2 weeks. If drugs are ineffective, they are replaced by others. At the end of therapy, a control x-ray examination is performed.

Other therapies

For successful recovery, the treatment regimen must include drugs that stimulate the immune system, expectorants and mucolytics, antihistamines, antipyretics, and NSAIDs. Mucolytics and expectorants thin the mucus and improve its elimination. This helps improve breathing function. Such drugs include Bromhexine, Ambroxol, Acetylcysteine. NSAIDs used include Indomethacin, Aspirin, and Ibuprofen.

In case of severe respiratory failure, the doctor may prescribe bronchodilators and oxygen therapy.

For airway obstruction, bronchoscopy is indicated. With the development of infectious-toxic shock, which is the most dangerous complication of pneumonia, infusion therapy, normalization of pressure, administration of sodium bicarbonate (for acidosis), cardiac drugs and Heparin, and antibiotics are indicated. The prognosis for life and health with adequate treatment is favorable. Pneumonia is most dangerous in early childhood (up to 1 year).

Community-acquired pneumonia: diagnosis, treatment. Prevention of community-acquired pneumonia

Community-acquired pneumonia is one of the most common infectious diseases of the respiratory tract. Most often, this disease is the cause of death from various infections. This occurs as a result of a decrease in people’s immunity and the rapid adaptation of pathogens to antibiotics.

What is community-acquired pneumonia?

This is an infectious disease of the lower respiratory tract. Community-acquired pneumonia in children and adults develops in most cases as a complication of a viral infection. The name of pneumonia characterizes the conditions under which it occurs. A person falls ill at home, without any contact with a medical facility.

Pneumonia in an adult

Adults most often suffer from pneumonia as a result of bacteria entering the body, which are the causative agents of the disease. Community-acquired pneumonia in adults does not depend on geographical areas and socio-economic relations.

What is pneumonia like?

This disease is divided into three types:

1. Mild pneumonia is the largest group. She is treated on an outpatient basis, at home.
2. The disease is of moderate severity. Such pneumonia is treated in hospital. The peculiarity of this group is that most patients have chronic diseases.
3. Severe form of pneumonia. She is being treated only in the hospital, in the intensive care unit.

Community-acquired pneumonia occurs:

• Focal. A small area of ​​the lungs is inflamed.
• Segmental. Damage to one or several parts of the organ is typical.
• Share. Some part of the organ is damaged.
• Total. The entire lung is affected.

Community-acquired pneumonia can be unilateral and bilateral, right-sided and left-sided.

Symptoms

• Body temperature rises.
• Chills and weakness appear.
• Performance and appetite decrease.
• Sweating appears, especially at night.
• Head, joints and muscles hurt.
• Consciousness becomes confused and orientation is disturbed if the disease is severe.
• Pain in the chest area.
• Herpes may appear.

• Abdominal pain, diarrhea and vomiting.
• Shortness of breath that occurs during physical activity. When a person is at rest, this does not happen.

Reasons

Community-acquired pneumonia develops when microbes enter a weakened human body and cause inflammation. The causes of the disease are as follows:

• Hypothermia of the body.
• Viral infections.
• Concomitant diseases: diabetes, heart, lungs and others.
• Weakened immunity.
• Excessive consumption of alcoholic beverages.
• Prolonged stay on bed rest.
• Postponed surgeries.
• Old age.

Pathogens

• Pneumococci (most often the cause of the disease).
• Staphylococci.
• Atypical pathogens: mycoplasmas and chlamydia.
• Klebsiella.
• Viruses.
• Pneumocystis.
• Escherichia coli.
• Haemophilus influenzae.

Diagnostics

During the examination, it is very important to identify and evaluate the clinical symptoms of the disease, such as fever, chest pain, cough with sputum. Therefore, if a person has community-acquired pneumonia, a medical history must be created for each patient. In it, the doctor writes down all the patient’s complaints and prescriptions. To confirm the diagnosis, a radiological examination is performed: chest x-ray. Clinical manifestations of community-acquired pneumonia are:

• Cough with the release of mucopurulent sputum, which contains streaks of blood.
• Chest pain when breathing and coughing.
• Fever and shortness of breath.
• Trembling voice.
• Wheezing.

Sometimes the symptoms differ from those typical for a given disease, which makes it difficult to make a correct diagnosis and determine a treatment method.

Radiation examination

The patient is prescribed an x-ray if he has community-acquired pneumonia. Diagnosis using the radiation method involves examining the organs of the chest cavity in the anterior part. The picture is taken in frontal and lateral projection. The patient undergoes an X-ray examination as soon as he sees a doctor, and then half a month after treatment with antibacterial agents has begun. But this procedure can be performed earlier if complications arise during treatment or the clinical picture of the disease changes significantly.

The main sign of community-acquired pneumonia during an X-ray examination is compaction of the lung tissue; darkening is detected in the image. If there are no signs of compaction, then there is no pneumonia.

Lower lobe right-sided pneumonia

Many patients go to the hospital when they are bothered by symptoms such as shortness of breath, cough accompanied by mucous sputum, fever up to 39 degrees, pain with a tingling sensation on the right side under the rib. After listening to the patient’s complaints, the doctor examines him, listens and probes where necessary. If there is a suspicion that the patient has community-acquired right-sided pneumonia, which, as a rule, is much more common (which is why we pay special attention to it), he is prescribed a full examination:

• Laboratory tests: general, clinical and biochemical blood tests, urine and sputum tests.
• Instrumental studies, which include chest x-ray, fibrobronchoscopy and electrocardiogram. The shape of the darkening on the x-ray image allows you to clarify the diagnosis, and fiberoscopy helps to identify the involvement of the bronchi and trachea in the process of inflammation.

If the results of all tests confirm that the patient has right-sided community-acquired pneumonia, the medical history is supplemented. Before starting therapy, the results of studies for all indicators are recorded in the patient’s chart. This is necessary in order to make adjustments as necessary during treatment.

Laboratory and instrumental studies may show inflammation of the lower right lobe of the lung. This is a different story of the disease. Community-acquired lower lobe pneumonia - this will be the diagnosis. When it is accurately established, the doctor prescribes treatment individual for each patient.

How to treat community-acquired pneumonia?

Patients with this diagnosis can be treated both in a hospital and at home. If a patient has community-acquired pneumonia, a medical history is required, regardless of the place of treatment. Patients undergoing outpatient treatment are divided into two groups. The first category includes people under 60 years of age who do not have concomitant diseases. The second category includes people over 60 or people with concomitant diseases (of any age). When a person has community-acquired pneumonia, treatment is carried out with antibacterial drugs.

For patients of the first group the following are prescribed:

• "Amoxicillin" dosage of 0.5-1 g or "Amoxicillin/clavulanate" - 0.625 g at a time. Taken 3 times a day.
• An alternative to these drugs may be: Clarithromycin or Roxithromycin in dosages of 0.5 g and 0.15 g, respectively. Take twice a day. Azithromycin may be prescribed, which is taken once a day in an amount of 0.5 g.
• If there is a suspicion that the disease is caused by an atypical pathogen, the doctor may prescribe Levofloxacin or Moxifloxacin 0.5 g and 0.4 g, respectively. Both drugs are taken once a day.

If patients of the second group have community-acquired pneumonia, treatment is carried out using the following drugs:

• Amoxicillin/clavulanate is prescribed three times a day, 0.625 g or twice a day, 1 g; Cefuroxime should be taken in the amount of 0.5 g at a time, twice a day.
• Alternative drugs may be prescribed: Levofloxacin or Moxifloxacin, 0.5 g and 0.4 g, respectively, once a day orally. Ceftriaxone is prescribed 1-2 g intramuscularly, also once a day.

Treatment of the disease in children

Community-acquired pneumonia in children with an uncomplicated form of the disease, depending on age, is treated with the following drugs:

• Children under 6 months are prescribed: “Josamycin” twice a day for a week at the rate of 20 mg per kilogram of body weight. Maybe Azithromycin - the daily dose should not exceed 5 mg per kilogram of body weight, the duration of treatment is 5 days.
• Children under 5 years of age are prescribed Amoxicillin 25 mg/kg orally twice a day, treatment duration is 5 days. They may prescribe Amoxicillin/clavulanate at a dose of 40-50 mg per kilogram of body weight or Cefuroxin Axetil at a dosage of 20-40 mg/kg, respectively. Both drugs are taken twice a day, the duration of treatment is 5 days.
• Children over 5 years of age are prescribed Amoxicillin at a dosage of 25 mg/kg in the morning and evening. If there is a suspicion of atypical pneumonia, prescribe Josamycin orally, increasing the dosage to 40 mg/kg per day for a week or Azithromycin according to the scheme: 1 day - 10 mg/kg, then 5 mg/kg for 5 days. If there is no positive result in treatment, you can replace Amoxicillin at the rate of 50 mg/kg once a day.

Preventive measures to prevent the disease

Prevention of community-acquired pneumonia is carried out using pneumococcal and influenza vaccines. If necessary, they are administered simultaneously, only in different hands. A 23-valent unconjugate vaccine is used for this purpose. It is introduced:

• People who are over 50 years old.
• Persons living in nursing homes.
• Adults and children with chronic diseases of the lungs, heart and blood vessels or who are under constant medical supervision.
• Children and adolescents (from six months to adulthood) who have been taking aspirin for a long time.
• Pregnant women in the 2nd and 3rd trimesters.
• Doctors, nurses and other staff of hospitals and outpatient clinics.
• Employees of patient care departments.
• Family members of those people who are at risk.
• Medical workers caring for patients at home.

Prevention of community-acquired pneumonia is:

• A healthy lifestyle that includes physical exercise, regular long walks in the fresh air, and active recreation.
• A balanced healthy diet with a standardized content of proteins, vitamins and microelements.
• Annual vaccination of children and adults against influenza, which is done before the onset of the cold season. Very often the flu is a complication. A person falls ill with pneumonia, which has a complicated course.
• Life without hypothermia and drafts.
• Daily cleaning and ventilation of the premises.
• Frequent hand washing and rinsing of nasal passages.
• Limiting contact with ARVI patients.
• During the period of massive spread of infection, take honey and garlic. They are excellent immunostimulating agents.
• If you or your child get sick with the flu, do not self-medicate, but call a doctor.

Today, community-acquired pneumonia remains a widespread and potentially life-threatening disease.

The disease is common not only among adults, but also among children. There are from 3 to 15 cases of pneumonia per 1000 healthy individuals. This range of figures is due to the different prevalence of the disease in the regions of the Russian Federation. 90% of deaths after 64 years are due to community-acquired pneumonia.

If a patient is diagnosed with pneumonia, in 50% of cases doctors will decide to hospitalize him, because the risk of complications and deaths from this disease is too great.

So, what is community-acquired pneumonia?

Community-acquired pneumonia is an acute infectious process in the lungs that occurred outside a medical institution or within 48 hours of hospitalization, or developed in people who were not in long-term medical observation units for 14 days or more. The disease is accompanied by symptoms of lower respiratory tract infection (fever, cough, shortness of breath, sputum production, chest pain. Radiologically, it is characterized by “fresh” foci of changes in the lungs, subject to the exclusion of other possible diagnoses.

Symptoms

Diagnosing pneumonia is difficult because there is no specific symptom or combination of symptoms unique to this disease. Community-acquired pneumonia is diagnosed based on a combination of nonspecific symptoms and an objective examination.

Symptoms of community-acquired pneumonia:

• fever;
• cough with or without sputum;
• difficulty breathing;
• chest pain;
• headache;
• general weakness, malaise;
• hemoptysis;
• heavy sweating at night.

Less common:

• pain in muscles and joints;
• nausea, vomiting;
• diarrhea;
• loss of consciousness.

In older people, symptoms from the bronchopulmonary system are not expressed; general symptoms come first: drowsiness, sleep disturbance, confusion, exacerbation of chronic diseases.

In young children with pneumonia, the following signs are present:

• increase in temperature;
• cyanosis;
• dyspnea;
• general signs of intoxication (lethargy, tearfulness, sleep disturbance, appetite, breast refusal);
• cough (may or may not be present).

In older children, symptoms are similar to those in adults: malaise, weakness, fever, chills, cough, chest pain, abdominal pain, increased respiratory rate. If a child over 6 months of age does not have a fever, community-acquired pneumonia can be ruled out according to the latest clinical guidelines.

The absence of fever in children under 6 months in the presence of pneumonia is possible if the causative agent is C. trachomatis.

Treatment in adults and children

The main treatment method is antibacterial therapy. At the first stages of outpatient and inpatient treatment, it is carried out empirically, that is, the doctor prescribes the drug based only on his assumptions regarding the causative agent of the disease. This takes into account the patient’s age, concomitant pathology, severity of the disease, and the patient’s self-use of antibiotics.

Mild community-acquired pneumonia is treated with tablets.

When treating mild pneumonia with a typical course on an outpatient basis in people under 60 years of age without concomitant diseases, therapy can be started with amoxicillin and macrolides (azithromycin, clarithromycin). If there is a history of an allergy to penicillin or an atypical course of pneumonia is observed, or the effect of penicillins is not observed, then preference should be given to macrolide antibiotics.

For patients over 60 years of age with concomitant diseases, treatment begins with protected penicillins (amoxicillin/clavulanate, amoxicillin/sulbactam). As an alternative, antibiotics from the group of respiratory fluoroquinolones (levofloxatsuin, moxifloxacin, gemifloxacin) are used.

Severe community-acquired pneumonia requires the prescription of several antibiotics at once. Moreover, at least 1 of them must be administered parenterally. Treatment begins with 3rd generation cephalosporins in combination with macrolides. Amoxicillin/clavulanate is sometimes prescribed. As an alternative, respiratory fluoroquinolones are used in combination with 3rd generation cephalosporins.

Every patient with pneumonia must undergo a bacteriological examination of sputum. Based on its results, an antibiotic is selected that is sensitive specifically to the detected pathogen.

If pneumonia caused by Legionella is suspected, parenteral rifampicin must be added.

If pneumonia is caused by Pseudomonas aeruginosa, then combinations of cefipime, or ceftazidime, or carbopenems with ciprofloxacin or aminoglycosides are used.

For pneumonia caused by Mycoplasma pneumoniae, it is best to prescribe macrolides, or respiratory fluoroquinolones or doxycycline.

For Chlamydia pneumoniae, the disease is also treated with fluoroquinolones, macrolides and doxycycline.

The principles of antibacterial therapy in children differ between groups of antibiotics. Many drugs are contraindicated for them.

The selection of an antibiotic is also carried out presumably until the microorganism that caused the disease is determined.

For mild and moderate pneumonia in children from 3 months to 5 years, protected penicillins (amoxicillin/clavulanate, amoxicillin/sulbactam, ampicillin/sulbactam) are prescribed orally. In case of severe cases in the same age category - they are the same, but parenterally for 2-3 days, followed by switching to tablet forms. Antibiotics with the prefix “Solutab” are more effective.

If hemophilus influenzae infection is suspected, amoxicillin/clavulanate with a high amoxicillin content is selected (14:1 from 3 months to 12 years and 16:1 from 12 years).

In children over 5 years of age, if there is no effect from amoxiclav therapy, macrolides (josamycin, midecamycin, spiramycin) can be added to the treatment.

The use of fluoroquinolones in children is contraindicated up to 18 years of age. The possibility of their use should be approved only by a council of doctors in a life-threatening situation.

What other antibiotics can be used in children under 3 months? If pneumonia is caused by enterobacteria, then aminoglycosides are added to protected penicillins. In addition to amoxicillin, ampicillin and benzylpenicillin can be used parenterally in children of this age. In severe cases where resistant bacteria are present, carbapenems, doxycycline, cefotaxime or ceftriaxone can be used.

Rules of antibacterial therapy

• the sooner antibacterial treatment is started, the better the patient’s prognosis;
• the duration of antibiotic use in both adults and children should not be less than 5 days;
• for mild pneumonia and long-term normalization of temperature, treatment can be stopped early for 3-4 days;
• the average duration of antibiotic treatment is 7-10 days;
• if pneumonia is caused by chlamydia or mycoplasma, treatment is extended to 14 days;
• intramuscular administration of antibiotics is impractical, because their availability is less than with intravenous administration;
• assessment of the effectiveness of treatment can be carried out only after 48-72 hours;
• effectiveness criteria: reduction in temperature, reduction in intoxication;
• The x-ray picture is not a criterion by which the duration of treatment is determined.

Among the pediatric population, community-acquired pneumonia may be caused not by bacteria, but by a virus. In such cases, the use of antibiotics will not give any result, but will only worsen the prognosis. If pneumonia develops 1-2 days after the initial manifestations of a viral disease (especially influenza), then treatment can be started with antiviral drugs: oseltamivir, zanamivir, umifenovir, inosine pranobex, rimantadine.

In severe cases, in addition to fighting the pathogen, infusion therapy is carried out to eliminate intoxication, high fever, oxygen therapy, vitamin therapy, and treatment with mucolytics.

The most common mucolytic among adults and children is ambroxol. It not only thins sputum and facilitates its removal, but also promotes better penetration of antibiotics into the lung tissue. It is best used through a nebulizer. Bromhexine can also be used for children from birth. From 2 years of age ACC is allowed, from 1 year of age - Fluimucil. Carbocisteine ​​is allowed for children from 1 month.

Forecast

The prognosis for community-acquired pneumonia is generally good. But severe pneumonia can be fatal in 30-50% of cases. The prognosis worsens if:

• a person over 70 years old;
• the patient is on artificial ventilation;
• there is sepsis;
• bilateral pneumonia;
• there is an arrhythmia with increased or decreased heart rate;
• causative agent - Pseudomonas aeruginosa;
• initial treatment with antibiotics is ineffective.

If you develop a high temperature during or after a cold, you should definitely consult a doctor and have an x-ray of your lungs taken.

Community-acquired pneumonia treatment and symptoms

This disease is one of the leading causes of death in the world. Community-acquired pneumonia is an acute infection of the lung parenchyma caused by viruses, fungi, and bacteria outside the hospital walls. The hospital-acquired form of pneumonia, on the contrary, develops in patients weakened by treatment or chronic disease during hospital therapy.

Symptoms of the development of community-acquired pneumonia

It is often in the spring that many of us catch a variety of infections: something between a cold, flu and bronchitis. As a result, serious inflammation of the lungs often occurs, resulting in a disease such as pneumonia. The fight against pneumonia occurs quickly with a correct and timely diagnosis of the disease and an effective course of therapeutic treatment. Typical symptoms of the disease in adults include:

1. increase in body temperature, which lasts for three days;

2. malaise;

3. weakness;

4. severe headache;

6. nausea, vomiting;

7. cough with pus or blood;

8. difficulty breathing;

9. shortness of breath;

10. cardiovascular failure.

The most minor symptoms of pneumonia oblige every patient to consult a doctor.

Diagnosis of community-acquired pneumonia

Diagnostic symptoms of the disease are:

1. feverish state,

2. dry cough,

3. fine bubbling rales,

4. leukocytosis,

5. as well as identified infiltration.

X-ray diagnostics has low sensitivity and specificity. It is known that infiltrative changes in the first days of the disease are poorly defined; they are characterized by low intensity in older people. There is a high percentage of contradictions in the interpretation of images by radiologists. The diagnosis is established only against the background of the clinical picture and examination results.

Epidemiological studies show that 25% of cases associated with respiratory tract disease are due to infectious diseases. Community-acquired pneumonia accounts for 15 cases per thousand and has a certain cyclical nature. The mortality rate is 5%, and in old age up to 20%.

Features of the treatment of community-acquired pneumonia

For mild illness, it is preferable to stay at home, preferably in bed. Carry out antibacterial treatment for 7-10 days, take fortified liquids (lingonberry, cranberry, lemon). For moderate and severe pneumonia, immediate hospitalization with the use of vascular drugs, inhalation with humidified oxygen, and the use of artificial ventilation. Empirical therapy is prescribed no later than 8 hours after the patient’s admission to the department.

The duration of treatment depends on the patient's condition. For uncomplicated pneumonia in adults, antibiotics are prescribed only to relieve the temperature; for complicated disease, treatment depends on the severity of the disease and the presence of complications.

Treatment involves influencing the pathogen, eliminating intoxication, expectorants, bronchodilators, vitamins, exercise therapy, and physiotherapy. With the development of heart failure, cardiac glycosides are prescribed, and with vascular insufficiency, analeptics are prescribed.

The goal of physiotherapy for pneumonia in adults is to reduce inflammation and restore impaired perfusion-ventilation relationships in the lungs. The objectives of physiotherapy are:

1. accelerating the resorption of the inflammatory infiltrate (anti-inflammatory and reparative-regenerative methods),

2. reducing bronchial obstruction (bronchodilator methods),

3. reducing the manifestations of hyper- and discrimination (mucolytic methods of treating community-acquired pneumonia),

4. activation of alveolar-capillary transport (methods of enhancing alveolar-capillary transport),

5. increasing the level of nonspecific resistance of the body (immunostimulating methods).

Treatment of community-acquired pneumonia in a hospital

A laboratory test of blood, sputum, and x-ray examination will help determine the location of the patient during treatment (hospital or home). Basically, pneumonia is treated within the walls of a hospital and under the strict supervision of the attending physician. Antibiotics of different groups are used (Penicillin, macrolides, antifungals, tetracyclines). Pneumonia without complications can be treated at home only after an accurate diagnosis by a doctor.

Common pneumonia in adults can be treated with tablets and cough syrups, while complex pneumonia can be treated with a course of antibiotics. Along with antibiotics, expectorants are prescribed. During the period of recovery and decrease in temperature, exercise therapy, massage, and breathing exercises can be prescribed, which consolidate the results of treatment of pneumonia in an adult. Traditional medicine (decoctions, herbal teas) also help well. We should not forget about humid air in the ward or room, constant ventilation, drinking plenty of fluids, bed rest and vitamins (vegetables, fruits). After discharge from the hospital, rest in sanatoriums is recommended.

For hospital treatment, a number of reasons must be taken into account:

1. age of the patient (over 60 years);

2. in the presence of concomitant diseases;

3. ineffectiveness of antibacterial therapy;

4. the desire of the patient.

For hospitalization of a patient, the following factors are taken into account:

• blood pressure,
• heart rate,
• disturbances of consciousness,
• body temperature,
• as well as inadequate care for the patient at home.

With the advent of antibacterial drugs with a wide spectrum of action, a high concentration of lung tissue is achieved when taking drugs orally, and allows treatment of community-acquired pneumonia on an outpatient basis.

Causes of community-acquired pneumonia

There are five main routes of penetration of pathogens of community-acquired pneumonia into the bronchial tree and alveolar parts of the lungs:

1. aerosol (infected air);

2. aspiration (oropharyngeal secretion);

3. hematogenous (spread of microorganisms from an extrapulmonary source of infection along the vascular bed, occurs in sepsis, septic endocarditis, and some infectious diseases);

4. lymphogenous (spread of microorganisms from the extrapulmonary source of infection through the lymphatic system);

5. direct spread of community-acquired pneumonia infection from adjacent affected tissues (lung abscess, tumor, chest wound).

Normally, protective mechanisms (cough reflex, mucociliary clearance, antibacterial activity of alveolar macrophages and secretory immunoglobulins) ensure the elimination of infected secretions from the lower respiratory tract. When the general and local resistance of the body is weakened after the penetration of bacteria into the lower respiratory tract, their adhesion to the surface of epithelial cells, penetration into the cytoplasm and reproduction occur. Fibronectin, sialic acids, etc. serve as adhesion factors for bacterial agents.

Damage to epithelial and endothelial cells, activation of alveolar macrophages, migration of polymorphonuclear leukocytes and monocytes to the site of inflammation as a result of community-acquired pneumonia lead to the formation of a complementary cascade, which in turn enhances the migration of polymorphonuclear leukocytes and erythrocytes to the site of inflammation, promotes extravasation of immunoglobulins, albumin and other serum factors. This is accompanied by increased production of pro-inflammatory cytokines, enzymes, procoagulants, increased exudation of the liquid part of the plasma into the alveoli and ends with the formation of a focus of inflammation.

Pneumonia or pneumonia is a very complex and dangerous infectious disease. It's hard to believe, but even today, when medicine seems to be able to cure anything, people continue to die from this disease. Community-acquired pneumonia is one of the types of disease that requires urgent and intensive treatment.

Causes and symptoms of community-acquired pneumonia

Everyone knows that the main cause of pneumonia (regardless of the form of the disease) is harmful viruses and bacteria. These microorganisms are distinguished by their vitality and ability to adapt to different living conditions. Viruses can easily live even in the human body, but do not manifest themselves in any way. They pose a danger only when the immune system, for one reason or another, can no longer prevent their growth and reproduction.

Community-acquired pneumonia is one of the types of pneumonia that a patient catches outside the walls of a medical institution. That is, the main difference between the disease is in the environment where the infection that causes it began to develop. In addition to community-acquired pneumonia, there are other forms of pneumonia:

1. Nosocominal pneumonia is diagnosed if the patient’s symptoms of pneumonia appear only after hospitalization (after two or more days).
2. Aspiration pneumonia is a disease that occurs as a result of foreign substances (chemicals, food particles, etc.) entering the lungs.
3. Another type of disease, very similar to community-acquired left- or right-sided pneumonia, is pneumonia in patients with defects in the immune system.

The main symptoms of different forms of pneumonia are practically the same and look like this:

• cough that is difficult to treat;
• fever;
• painful sensations in the chest;
• increased fatigue;
• sweating;
• pallor;
• wheezing in the lungs.

Treatment of community-acquired pneumonia

X-ray examination is the most reliable way to diagnose pneumonia. The image clearly shows darkened areas of the lungs affected by infection.

The principle of treatment of community-acquired pneumonia, be it polysegmental bilateral or right-sided lower lobe form, is to destroy the infection that caused the disease. As practice has shown, potent drugs - antibiotics - cope best with this task. You also need to be prepared for the fact that hospitalization is required during treatment.

The drug course for each patient is selected individually. Unfortunately, it is very difficult to reliably determine the virus that caused pneumonia the first time. Therefore, it can be quite difficult to prescribe the appropriate antibiotic the first time.

The list of the most effective drugs for the treatment of pneumonia is quite large and includes the following medications:

Antibiotics for the treatment of unilateral or bilateral community-acquired pneumonia are most often prescribed in the form of injections for intramuscular or intravenous (in particularly difficult cases) administration. Although some patients prefer drugs in tablets. In any case, the standard course of treatment should not exceed two weeks, but ending it prematurely is strictly prohibited.

If two to three days after starting antibiotics, the patient’s condition does not improve and the main symptoms of pneumonia do not disappear, it is necessary to select an alternative antibiotic.