Pneumonia in adults

The reasons

Types of pneumonia

Symptoms of pneumonia

Diagnostics

Pneumonia treatment

Complications

Prevention of pneumonia

Pneumonia is an acute infectious disease, which is characterized by the development of inflammation of the lung tissue, alveoli are necessarily involved in the process.

The reasons

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There are the following possible causes of the disease:

  • bacteria;
  • viruses;
  • fungi.

Among the bacteria, Streptococcus pneumonia (pneumococcus) plays the leading role, rarely causing Mycoplasma, Legionella, Chlamydia, Klebsiella pneumonia.

Influenza virus, including type A ( H1N1 ) virus, adenovirus, rhinovirus, can lead to the development of pneumonia. 

Fungal pneumonia is caused by a fungus of the genus Candida.

Infection occurs through airborne droplets (sneezing, coughing) from a sick person, or an infection can enter the lung tissue from chronic infection foci (chronic sinusitis, tonsillitis, dental caries).  

Factors contributing to the development of the disease are:

  • hypothermia;
  • chronic lung disease ( bronchitis );
  • reduced immunity;
  • the age of the patient is over 65;
  • tobacco smoking;
  • alcohol abuse;
  • inhalation of harmful substances in the workplace;
  • the presence of chronic diseases ( cardiovascular system, diabetes, kidney disease);
  • finding the patient on the medical ventilator.

Types of pneumonia

Pneumonia can be:

  • primary – pneumonia is an independent disease;
  • secondary – pneumonia develops against the background of a concomitant disease (stagnant);
  • aspiration – develops when bacteria is introduced into the bronchi with vomit, foreign bodies;
  • postoperative;
  • posttraumatic – due to lung injury.

By etiology

  • typical – caused by typical pathogens (pneumococcus, virus);
  • atypical – caused by atypical pathogens (chlamydia, mycoplasma, legionella, Klebsiella).

By morphological features:

  • focal – affects a small area of ​​the lung;
  • croupous – the lobes of the lung are affected, it can be unilateral and bilateral.

By origin:

  • community-acquired – develop outside the hospital;
  • nosocomial – develop 2 or more days after admission of the patient to the hospital.

Nosocomial pneumonia is more severe.

Symptoms of pneumonia

The clinical picture of pneumonia depends largely on the type of pathogen, on the state of human health, the presence of concomitant diseases, and immunodeficiency.

In most cases, pneumonia has a focal form and is characterized by the following symptoms:

  • acute onset;
  • body temperature rises to febrile numbers (38.5 – 40 degrees);
  • general weakness;
  • chest pain with deep breath and cough;
  • increased sweating;
  • fast fatiguability;
  • cough at the onset of the disease is dry, later becomes productive (wet);
  • dyspnea.

Pneumonia is also characterized by local signs – with auscultation, either weakening of the breathing or finely bubbling crepitus are heard .

With small focal pneumonia, there may be no changes during auscultation of the lungs.

The temperature in pneumonia is kept for three to four days, provided that treatment is started in a timely manner.

Symptoms of lobar pneumonia

Croupous pneumonia is characterized by a pronounced intoxication syndrome, the temperature rises sharply to 39-40 degrees, tachycardia develops (heart rate increases).

Most often, with lobar pneumonia, severe shortness of breath occurs, respiratory rate increases, and a wet cough appears early.

Important! The peculiarity of wet cough with lobar pneumonia is the presence of “rusty sputum” (in the sputum there are streaks of blood).

Asymptomatic pneumonia

It is also possible asymptomatic pneumonia, it can be with small focal pneumonia, with a decrease in immunity.

The patient has no characteristic signs of the disease – cough, fever. There can only be general weakness, fatigue.

Detect such pneumonia by chance during fluorography examination.

Features of viral pneumonia

Viral pneumonia is characterized by the fact that the patient has symptoms of a respiratory disease at the beginning. And after one or two days, symptoms of pneumonia appear – cough with blood streaks, fever, shortness of breath.

Diagnostics

Diagnosis of pneumonia is based on the presence of a characteristic clinical picture of the disease, inspection data and characteristic changes during examination of the patient.

On examination, you can identify:

  • with auscultation – weakening of breathing, the presence of fine moist rales, crepitus.
  • there may be lagging of the chest when inhaling on the affected side;
  • with the development of respiratory failure – increased respiratory movements, intercostal space inhalation during inhalation, acrocyanosis.

Laboratory and instrumental examinations are conducted:

General blood analysis. It reveals leukocytosis, accelerated ESR. 

General analysis of sputum. Characterized by signs of inflammation (leukocytes), blood, pathogen detection.

Bac.powered sputum – to determine the pathogen and determine its sensitivity to antibiotics.

Blood chemistry. An increase in ALT , AST , C-reactive protein is observed.  

Radiography of the chest in two projections (front and side). In pneumonia, focal dimming, or lobar, are visible.

If necessary, computed or magnetic resonance imaging of the lungs.

To determine the degree of respiratory failure, pulse oximetry is performed (determine the saturation of blood with oxygen, this is a non-invasive method).

What can be confused pneumonia

Differential diagnosis of pneumonia is carried out with:

  • tumor formations – there is no temperature, or it is subfebrile, there is no acute onset, no effect from antibiotics;
  • pulmonary tuberculosis is also not an acute onset, there is no hyperthermia, a characteristic X-ray picture, the absence of a positive effect during therapy.

Pneumonia treatment

Treatment of not severe forms of pneumonia can be carried out on an outpatient basis; severe pneumonia is subject to hospitalization.

There are general recommendations:

  • observance of bed rest;
  • regular airing of the room;
  • abundant drinking regime (contributes to the removal of intoxication);
  • humidification of inhaled air;
  • food must be easily digestible.

The main treatment is the use of antibacterial drugs.

What antibiotics are indicated for pneumonia

Non-severe pneumonia begins to be treated with protected penicillins:

  • Amoxiclav;
  • Flemoklav;
  • Augmentin.

If the patient has intolerance to this group or contraindications, the recent use of drugs in this group, the patient is prescribed macrolides :

  • Azithromycin;
  • Sumamed;
  • Hemomycin;
  • Clarithromycin.

Also macrolides are prescribed for atypical pneumonia.

Respiratory fluoroquinolones, cephalosporins are the third-line drugs .

Respiratory fluoroquinolones include:

  • Levofloxacin;
  • Glevo;
  • Tavanic;
  • Moxifloxacin.

Cephalosporins include:

  • Cefotaxime;
  • Ceftriaxone;
  • Suprax.

With a light course of antibiotic therapy from 7 to 10 days.

The effectiveness of antibiotic therapy is estimated in 48-72 hours from the start of therapy, if there are no signs of improvement (reduction of intoxication, body temperature, dyspnea), then the antibiotic is replaced.

Severe pneumonia begins to be treated in the hospital with injectable forms of antibacterial drugs, it is also possible to administer two drugs from different groups at once.

In severe forms of pneumonia, the course of antibiotic therapy is at least 10 days.

In the case of atypical pneumonia, treatment is carried out from 14 to 21 days.

In addition to antibiotic therapy, antipyretic therapy is also prescribed. Antipyretic drugs are prescribed when the temperature rises from 38.5 degrees:

  • Ibuprofen;
  • Paracetamol;
  • Ibuklin;
  • Aspirin.

To dilute sputum mucolytics are used :

  • Ambrohexal;
  • Lasolvan;
  • Ambrobene;
  • ACC;
  • Fluimucil;
  • Fluditec.

Nebulizer inhalations are effective:

  • sodium chloride solution of 0.9%;
  • aqueous solution Lasolvana;
  • in the presence of shortness of breath – Berodual

Important! Cough syrups are not suitable for use in a nebulizer. For this suitable aqueous solutions for inhalation, water-based. 

From physiotherapy it is possible to conduct:

  • chest electrophoresis; 
  • UFO chest; 
  • magnetic therapy;
  • vibration massage of the chest.

After recovery, the person is subject to follow-up for one year.

Complications

In the case of improper or delayed treatment, pneumonia can cause serious complications.

  • The development of acute respiratory failure.
  • Pleurisy is an inflammation of the lining of the lung.
  • Lung abscess – the formation of a cavity filled with purulent contents.
  • Pulmonary edema.
  • Sepsis – the spread of infection throughout the body through the blood vessels.

Prevention of pneumonia

There is a specific prevention of pneumococcal infections – pneumococcal vaccine.

It is used in young children and patients at risk. Immunity is formed for five years, then it is necessary to carry out revaccination.

There are also general recommendations:

  • Avoid hypothermia.
  • Rejection of bad habits.
  • Treatment of chronic diseases.
  • Maintain a healthy lifestyle.
  • Hardening of the body and regular exercise. 

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