Pneumonia is an acute inflammatory process that occurs in the tissues of the lungs. It involves all structures of the lungs, most often the alveoli, in which exudate is formed, and interstitial tissues are affected. The term “pneumonia” refers to a whole group of pulmonary diseases that differ in the nature of their course, causes of occurrence, pathogenesis, radiological, clinical and laboratory signs, and methods of treatment.
According to statistics, acute pneumonia occurs on average in 12-13 people per thousand, elderly people and young children get sick more often. It is diagnosed more often in men than in women. It is a serious illness that often leads to complications and death of the patient. The high percentage of deaths (9 people out of a hundred cases) cannot be reduced, despite the constant emergence of effective antibiotics, improvement of detection methods and therapy. Pneumonia is one of the most common causes of death, ranking fourth.
Classifications of pneumonia
Several classifications of pneumonia have been adopted for various reasons. Depending on the etiology of inflammation, the following types are distinguished:
- infectious (bacterial);
According to the mechanism of occurrence and development, the following types are distinguished:
- primary (develop independently);
- secondary (arise as a complication of another pathological process);
- pneumonia that develops as a consequence of trauma or surgery ;
- aspiration pneumonia (occurs when various foreign bodies enter the tracheobronchial tree and lungs);
- radiation pneumonia;
- inflammation that develops as a reaction to thromboembolism of small vessels that are branches of the main pulmonary artery (often occurs after a heart attack).
Depending on the epidemiology, hospital and community-acquired pneumonia are distinguished, as well as atypical and those arising from immunodeficiency states.
According to the prevalence of the pathological process of inflammation, there are:
The process may involve both lungs (bilateral pneumonia) or only one of them.
By the nature of the clinical course, the disease can be either acute (sometimes protracted) or chronic. By severity, light, severe and moderate inflammatory processes are distinguished. Also, when making a diagnosis, the presence or absence of complications, the intensity of structural and functional transformations of lung tissue are taken into account.
Symptoms of pathology may differ depending on the type of disease. In typical inflammatory processes, patients experience a sharp rise in temperature, a rapid increase in symptoms of intoxication and fever. Also characteristic is a strong cough with expectoration of large volumes of sputum (often purulent).
Atypical processes, as a rule, begin imperceptibly, the clinical picture unfolds gradually. Manifested by unproductive cough, cephalalgia, myalgia, severe weakness. At the same time, almost no changes are visible on the x-ray.
Croupous pneumonia begins acutely, the temperature rises sharply, to febrile values, there are manifestations such as general malaise, chest pain, difficulty breathing, cough (at first dry, and after 2-3 days – with sputum separation). Fever and cough in this form of the disease can last for about 10 days.
Causes of occurrence
The most common cause of pneumonia is bacterial lesions. In more than half of all cases, pneumococci become the causative agents of this disease. The following types of microorganisms can also provoke the disease:
- hemophilic sticks;
- Escherichia coli;
- legionella ;
- Afanasyev- Pfeiffer sticks ;
- Pseudomonas aeruginosa;
- fungi (usually of the genus Candida, as well as molds that cause aspergillosis);
- influenza and parainfluenza viruses;
- herpes viruses;
Infectious agents most often enter the body through the bronchi. This can occur by aspiration, inhalation of microbes upon contact with an infectious person, penetration of pathogenic microorganisms into the respiratory tract during certain medical procedures and their spread to the lower respiratory system from the nasopharynx. Less often, the spread of infection occurs with the blood flow, extremely rarely – by the lymphogenous pathway.
A person can get sick not only by contracting an infection. Sometimes the process is of non-infectious origin (trauma or injury to the chest and lungs, exposure to allergens, toxic substances or radioactive radiation).
Pulmonologists identify factors that contribute to the development of pneumonia. In young children, these include congenital heart and lung defects, hereditary autoimmune and immunodeficiency states, hypovitaminosis, pneumopathy , birth trauma, intrauterine asphyxia.
In older children, pneumonia has:
- passive smoking (there are smokers in the family);
- the presence of congenital and acquired heart and lung defects;
- frequent bronchitis;
- the presence of chronic infectious foci in the nasopharynx.
In adults, provoking factors are considered:
- smoking, alcohol and drug abuse;
- chronic pathologies of the bronchopulmonary system;
- severe diseases of the cardiovascular, endocrine systems;
- prolonged lying position (in severe conditions);
- surgical interventions on the chest and abdominal organs.
Diagnosis of the disease
If signs of pneumonia appear, you should consult a physician or pulmonologist. Diagnostics includes interrogation and examination, collection of anamnestic data, laboratory and instrumental studies. Diagnostic measures are necessary to establish the etiology of the disease, identify the features of its course, stage and degree of damage, determine the severity of the inflammatory process, detect possible complications, and also differentiate pneumonia from other pulmonary pathologies.
Pneumonia is suspected if the patient quickly develops febrile symptoms, he is tormented by a cough, and there are growing signs of intoxication of the body.
With auscultation and percussion, pneumonia can be recognized by wheezing of various nature, squeaks, and increased passage of sound through the bronchi.
After a clinical examination and examination of the patient’s complaints, the following types of studies are prescribed for the diagnosis:
- sputum microscopy with staining;
- bacteriological culture of sputum;
- general clinical blood test;
- blood biochemistry;
- study of the gas composition of blood;
- X-rays of light.
The most informative are the results of radiography. In this study, with pneumonia of various forms, various localization and sizes of darkening, located in the form of foci or diffuse, are determined. When interstitial tissue is involved in the pathological process, the images clearly show an enhanced pattern of the lungs due to infiltration around the bronchi and blood vessels.
If the diagnosis is difficult for any reason, the doctor may prescribe additional studies:
- Chest CT;
- diagnostic bronchoscopy with biopsy sampling for subsequent laboratory studies;
- tests to detect antibodies to antigens of various pathogens;
- diagnostic thoracotomy with collection of lung tissue for analysis;
- examination of lung tissue obtained by biopsy;
- general urine analysis.
Diagnosed pneumonia is treated in a hospital setting, in the department of therapy or pulmonology. During the period of fever and signs of intoxication, the patient is shown complete rest, stay in a horizontal position, a diet rich in nutrients and vitamins, and abundant fluid intake (warm water, tea, fruit drinks). If the patient has signs of acute respiratory failure, oxygen therapy is prescribed. After eliminating the symptoms of fever and intoxication, the patient must undergo physiotherapy (electrophoresis, UHF) and exercise therapy.
Pneumonia is treated with antibiotics, the choice of a specific drug or their combination is due to the causative agent of the disease identified during the diagnosis process and its resistance to various antibiotics. The regimen and the duration of the course are also selected individually. Since the results of bacteriological inoculation have to wait for a long time, and treatment should be started immediately, the most common broad-spectrum antibiotics are prescribed at the first stage.
You can fight the causative agents of community-acquired pneumonia with the help of drugs of the groups of penicillins, macrolides, cephalosporins. For the treatment of hospital-acquired pneumonia, cephalosporins, fluoroquinolones , aminoglycosides, penicillins, carbapenems are used . Antibiotics are prescribed exclusively by the attending physician, administered by injections or by oral route. Until the pathogen and its antibiotic sensitivity have been established, a complex of several antibacterial drugs can be used. The course of antibiotic therapy is usually 7 to 14 days.
In addition to antibiotics, agents are prescribed that expand the lumen of the bronchi, mucolytic and expectorant drugs, antipyretic drugs, immunostimulants. Therapy is carried out to eliminate the symptoms of intoxication.
Predictions for pneumonia depend on the form of pathology, the presence of concomitant diseases and the general health of the patient, the ability of the pathogen to become infected, and the state of the immune system. Prospects also depend on early detection and adequate treatment. An unfavorable outcome is likely with a complicated course of pneumonia, a suppressed state of the patient’s immunity, and a high resistance of the pathogen to the antibiotics used. The prognosis is most unfavorable if pneumonia of bacterial etiology is diagnosed in a one-year-old or earlier child.
It is possible to cure the disease only with timely detection and adequate therapy.
In order to prevent pneumonia, you must follow these recommendations:
- take measures to strengthen immunity, carry out hardening procedures;
- avoid hypothermia;
- timely identify and treat infectious diseases of the respiratory system;
- regularly sanitize foci of chronic infections in the nasopharynx;
- avoid inhaling highly dusty air;
- to refuse from bad habits.
For preventive purposes, it is also recommended to vaccinate against pneumococcal infections and Haemophilus influenzae. Patients suffering from serious illnesses and in a weakened state, in order to prevent inflammatory processes in the lungs, must perform breathing exercises, exercise exercise therapy, and conduct massage courses.
The most common consequence of pneumonia is scarring of inflammatory areas of the lungs.
Pneumonia can occur with the following possible complications:
- pulmonary edema;
- the formation of suppuration in the affected tissues;
- necrotic processes, the development of gangrene;
- empyema of the pleura;
- involvement in the inflammatory process of pleural tissues;
- respiratory or heart failure;
- inflammatory processes of cardiac tissues (myocarditis, endocarditis, pericarditis);
Various forms of pneumonia are deadly, according to WHO statistics, this disease kills more than 265 thousand people every year. In addition, the disease gives serious complications to important internal organs. Measures should be taken to prevent pneumonia, be vaccinated and, if possible, exclude the effect of provoking factors.