Inflammation of the lungs (pneumonia ) Symptoms
pneumonia referred to various diseases under the general title pneumonia .All infections of the respiratory system rank first among all human infectious diseases.Although pneumonia is usually caused by an infectious microorganism, it may also be due to inhalation of irritant gases or particles.Lungs have a complex system of protection: a strong branching and narrowing of the bronchial passages hinder the penetration of foreign bodies deep into the lungs;millions of tiny hairs, or cilia, in the walls of the bronchi constantly capture particles from the respiratory tract;when coughing irritating substances emitted from light at a high rate, and white blood cells known as macrophages, capture and destroy many infectious carriers.
Despite these defenses, pneumonia still occurs frequently.Inflammation may be limited to the air sacs (alveoli) of the lungs (lobar pneumonia) or developing centers of all the light, originating in the respiratory tract and spreads to the alveoli (pneumonia).Fluid accumulatio
is no doubt that there is a disease polyetiology pneumonia.And it is an etiological factor in determining the clinical course of disease and the choice of antibiotic therapy.It also largely determines the severity of pneumonia and its outcome.How to cure this disease folk remedies, see here.
major importance in causing pneumonia belongs pneumococci, streptococci and Haemophilus influenzae, the total share of which can reach 80%.Pneumonia can also cause negative staphylococci, Klebsiella, Proteus, Pseudomonas aeruginosa, Escherichia coli, but their share is relatively small.However, during influenza epidemics natural frequency of staphylococcal pneumonia increases.In debilitated patients with immune disorders are more common pneumonia caused by Klebsiella, Proteus and E. coli.Patients with chronic bronchitis importance belongs aureus, Haemophilus influenzae, and gram-negative flora and pneumococcus.Stand out as atypical pneumonia, which etiology associated with Mycoplasma, Legionella, Chlamydia.Their frequency increases markedly in recent years.
very doubtful independent etiological role of viral infections in pneumonia.However, it is undoubtedly an important factor contributing to the occurrence of pneumonia.
In modern conditions in connection with the necessity of choosing an adequate causal treatment options crucial to establish the etiology of pneumonia to determine the likelihood of the pathogen.It is also important because pneumonia of different etiology characterized by different clinical course, different, including radiological, symptomatic, have a different prognosis and require a differentiated determination of the duration of treatment.
Meanwhile, the quality and the possibility of bacteriological diagnosis of pneumonia is not always possible to solve correctly the question of the etiology of pneumonia.In this regard, the role of assessment of clinical symptoms and the epidemiological situation for establishing the indicative pneumonia etiology.
It is also important for the reason that, as a rule, the situation requires immediate treatment even before the establishment of bacteriological diagnosis, and the results of bacteriological examination can be obtained no earlier than 48 hours.
body cells can thus be lackingoxygen, and in severe cases this can result in respiratory failure.Before the advent of antibiotics pneumonia was the leading cause of death, and more recently the most common strains of bacterial pneumonia (caused by Streptococcus pneumoniae) have become resistant to penicillin.Pneumonia is particularly common in the elderly or those who are weakened by the main disease.Currently, it remains among the top 10 causes of death.
However, despite the serious health risks associated with the disease, the outlook for a full recovery is good, especially for the early detection and treatment.For the elderly and those who are at high risk, there is a vaccine that protects against 23 different strains of S. pneumoniae (which are responsible for 90 percent of cases of streptococcal pneumonia).
According to international consensus and Russian therapeutic protocol (order of Ministry of Health of the Russian Federation № 300, 1998), the classification of pneumonia brought additional features that provide their division into:
• Community-acquired pneumonia;
• nosocomial (hospital, nosocomial) pneumonia;
• pneumonia in immunocompromised patients of different origin;
• aspiration pneumonia.
In contrast to the "typical" pneumonia caused by pneumococcus, highlighted the so-called atypical pneumonia.
term "SARS" appeared in the 40s of XX century.and under him we understand the defeat easier flow than a typical lobar pneumococcal pneumonia.Initially, the originator of the "atypical pneumonia" was unknown and it was assumed that it is the so-called agent
Eaton.Later it was transcribed as a Mycoplasma pneumoniae, and then to a number of pathogens that cause pneumonia occurrence of this embodiment, are allocated as Chlamidia pneumoniae and Legionella pneumophila.
AISinopalnikov and AAZaitsev (2010) proposed to distinguish between:
a) protracted, slow or permitted;
b) progressive and
c) persistent pneumonia.
Each of these variants is characterized by pneumonia of varying duration course, the severity and nature of complications and finally, selection of adequate therapy.
• Medical history and physical examination.
• X-ray of the breast.
• Sowing blood cultures and saliva.
• In severe cases, can be performed lung biopsy tissue.
• Viral or bacterial infections - the most common causes of pneumonia.
• Other microorganisms can sometimes cause pneumonia;such as fungal and parasitic pneumonia usually affects people with AIDS.
• Although bacteria are usually inhaled, they can spread to the lungs through the bloodstream from another location in the body.
• Inhalation of chemical stimuli, such as toxic gases can lead to pneumonia.
• vomit into the lungs (which can occur when a person loses consciousness), can cause a disease known as aspiration pneumonia.
• Small or very great age, smoking, recent surgery, hospitalization and the use of chemotherapeutic agents and immunosuppressive drugs are risk factors for pneumonia.
• Other medical conditions increase the risk of pneumonia and may cause complications.These diseases include asthma, chronic bronchitis, poorly controlled diabetes, AIDS, alcoholism, Hodgkin's disease, leukemia, multiple myeloma and chronic kidney disease.
• Symptoms vary greatly depending on the type of pneumonia.The elderly and very sick people tend to have less obvious symptoms, and less heat, even though pneumonia is more dangerous for these patients.
• temperature (above 38 ° C, possibly up to 40.5 ° C) and fever.
• Cough, possibly with a bloody yellow or green phlegm.(Cough may persist for up to six - eight weeks after the infection subsides, especially if it is a viral infection.)
• Pain in the chest when breathing.
• Shortness of breath.
• Headache, sore throat, and muscle aches.
• General malaise.
• Weakness and fatigue.
• Excessive sweating.
• Loss of appetite.
• In serious cases: difficulty breathing, bluish skin color, confusion.
My impression is that the leading role in the emergence of community-acquired pneumonia are Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus, gram-negative flora, as well as mycoplasma.
Data from SMNavashin et al.(1999), have established the role of a marked decline in the development of Streptococcus pneumoniae pneumonia home to a level of 30% and slightly higher.Haemophilus influenzae is responsible, according to their data, for the development of pneumonia in 5-10% of adults, more common in smokers and in patients with chronic obstructive bronchitis.Moraxella (Branchamella) catarrhalis - gram coccobacilli - were the cause of pneumonia in 1-2% of patients, usually suffering from chronic bronchitis.Mycoplasma pneumoniae - devoid of the outer membrane, which makes it a natural resistance to the (i-lactam antibiotics - causing community-acquired pneumonia in 20-30% of persons under 35 years of age; the etiologic 'contribution' of this pathogen in the older age groups more modest (from 1 to 9%.) Chlamidia pneumoniae - microorganisms are exclusively intracellular parasites that are close in structure to the Gram-negative bacteria cause pneumonia in 2-3% of cases, as a rule, non-severe course of Escherichia coli, Klebsiella pneumoniae, belonging to the family Enterobacteriaceae pathogens are less than pneumonia.5% of patients, usually with concomitant illness -. diabetes mellitus, congestive heart failure, renal, hepatic insufficiency Staphilococcus aureus causes pneumonia less than 5% of patients with certain risk factors - the elderly, drug addicts, chronic hemodialysis., to the pathogen influenza pneumonias, listed above, also include microorganisms of the genus Legionella - gram-negative rods that are obligate pathogens.This is primarily Legionella pneumophila - infrequent pathogen pneumonia - from 2% to 10%.
However, Legionella pneumonia is the second largest (after pneumococcal) the frequency of deaths the disease.
Community-acquired pneumonia is one of the major health problems, which is associated with high morbidity and mortality, as well as significant direct and indirect costs associated with the disease.
incidence in Europe ranges from 2 to 15 cases per 1,000 population, and in Russia -up to 10-15 cases per 1,000 persons per year.
These rates are significantly higher in older patients, ranging from 25 to 44 cases per 1000 person-years in patients older than 70 years and from 68 to 114 patients who are in nursing homes and care homes.
Pneumonia caused by various pathogens, have clinical and radiological features, allowing the doctor with sufficiently high probability to determine its etiology and thus not only to formulate a nosological diagnosis but also to determine the treatment policy.
Etiology of community-acquired pneumonia, as well as the spread of the pathogen mechanisms are very diverse.Often they are associated with the microflora, usually colonizing the upper respiratory tract.
main mechanism is microaspiration bacteria that make up the normal flora of the oropharynx.In this matter massive doses of microorganisms or their increased virulence against the backdrop of damaging the protective mechanisms of the tracheobronchial tree.Of particular importance in this respect can play a viral respiratory infection, which is associated with a violation of mucociliary function and decreased phagocytic activity of alveolar macrophages.
Less frequent pneumonia occurs when the path - the inhalation of microbial aerosol, which can occur when infected obligate pathogens (eg, Legionella spp, etc...).
Another less important is the way hematogenous dissemination of microorganisms from extrapulmonary site of infection that is usually observed in sepsis.
Finally, and perhaps direct the spread of infection from the source associated with the pathology of the liver, mediastinum, or as a result of penetrating wounds of the chest.Pathogenesis of pneumonia largely determines its etiological structure.
extremely difficult etiological diagnosis of community-acquired pneumonia, factors such as the absence of sputum, inability to obtain bronchial secretions invasive methods due to the serious condition of the patient, or insufficient training of medical personnel, contamination of bronchial content microflora oropharynx, high carriage of a number of pathogens (from 5 to 60%in different age groups), the use of antibiotics in the prehospital phase.
diagnostic value of free cough up sputum microscopy or culture studies due to the above reasons is quite limited.Sputum is satisfactory in quality, if Gram smear microscopy revealed an increase of more than 25 100 and less than 10 neutrophils epithelial cells.The value of the culture of sputum is, in particular, to identify drug-resistant strains of the probable causative agent of pneumonia.
patients with community-acquired pneumonia, treatment which is performed on an outpatient basis, shows the bacteriological examination of sputum, which should take place before the beginning of antibiotic therapy.Serology may be necessary in cases of suspected legionellosis or mycoplasma pneumonia.
However more recently it is useful for retrospective diagnosis of Legionella pneumonia during its outbreak.
Historically the start of clinical trials lobar pneumonia was laid Corvisart and his disciple Laennec.They introduced into clinical practice of auscultation, a Laennec invented the stethoscope and described the physical phenomena such as crackling, dry and crackles, and bronhofoniya egofoniya.The term "lobar pneumonia" was introduced SPBotkin to refer particularly severe course of the disease, as evidenced by the appearance of symptoms of croup.The term "lobar pneumonia" is used only in Russian literature.It is now recognized that the typical lobar pneumonia is pneumococcal always.However, the term "lobar pneumonia" is still used in clinical practice, although it is not always the lobar, and can be, in particular, segmental and sometimes - mnogodolevoy.One can not emphasize that up to 60% are also focal pneumonia pneumococcal.
Described 75 species of pneumococcus, of which no more than two or three can be agents of the so-called lobar pneumonia.
infection enters the body by the airborne route.Quickly, almost a one-time loss of lung lobe and the sudden onset of the disease gave reason to believe that the basis of its appearance is the presence of hyperergic reaction.Contributing factors are chilling, fatigue, dystrophy, severe cardiovascular diseases, etc.In these circumstances, the infection very quickly EXTEND, affecting the whole share, and sometimes all easy.
post-mortem picture of a typical pneumococcal pneumonia (lobar) have evolved over a succession of four stages of development.
Stage tide or flushing. At this stage of the capillaries dilated and filled with blood in the alveoli begins to accumulate serous fluid, a small amount of red blood cells, white blood cells and desquamated alveolar epithelium.Due to the increase in the number of red blood cells by diapedesis and deposition of fibrin, this stage in the 2-3-day illness and goes to the next.
Stage red hepatization. alveolar cavities filled at this stage with significant fibrin admixture of erythrocytes, leukocytes and a small amount of alveolar epithelial cells.Affected share increased in volume, dense, airless.Its color on the cut red-brown.On the pleura enveloping the affected fraction are fibrinous overlay;they are also visible within the lymph vessels and crevices.In the future, the red blood cells subjected to hemolysis and decay.This stage lasts for 2-3 days, and then proceeds to the next.
Stage gray hepatization. Affected share remains tight.Color it in the context of a grayish-yellowish.The alveoli contained fibrin with a dash of white blood cells.Erythrocytes absent.At the end of the stage of gray hepatization crisis comes in the development of the disease and the next stage begins.
Stage permission. Expiring proteolytic enzymes cause dilution of fibrin, white blood cells and alveolar epithelium undergo lipid transformation and decay.Dilutes exudates released by the bronchi and absorbed by the lymphatic system.