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Pneumonia - what it is, causes, signs, symptoms in adults and treatment of pneumonia. Pneumonia Second degree pneumonia

Modern doctors are faced with various forms of pneumonia: from mild subclinical forms to severe, life-threatening manifestations. The difference in the types of inflammatory processes is explained by the variety of pathogens that cause pneumonia, as well as the individual local and general immune response of the entire body to the invasion of these pathogens.

There are several classifications of pneumonia based on the etiology, severity and duration of the disease, and x-ray morphological differences.

The division of pneumonia according to the form of infection and the conditions for the development of the disease has become widespread throughout the world. This classification principle dictates a separate approach to the treatment of each type of pneumonia.

Classification of pneumonia according to the form of infection and conditions for the development of the disease

Community-acquired pneumonia - most often occurring at home as a complication of acute respiratory viral infection. This is the most typical type of pneumonia.
Nosocomial (nosocomial, hospital) pneumonia – developing during the patient’s stay in the hospital or 2 days after discharge from it. This type of pneumonia is usually caused by strains that are resistant to common antibiotics and requires a special approach to treatment.
Aspiration pneumonia - develops when microorganisms from the oropharynx and stomach enter the respiratory tract. As a rule, this happens with vomiting in patients with gastrointestinal diseases, with alcoholism and drug addiction, in patients after anesthesia, as well as in newborns as a result of aspiration of amniotic fluid during childbirth.
Pneumonia in immunodeficiency states is the lot of cancer patients receiving treatment with immunosuppressants, patients with immunodeficiency states.

Classification of pneumonia according to clinical and morphological characteristics

1. Parenchymatous (lobar, focal, segmental)

Segmental pneumonia is characterized by inflammation of an entire segment, the airiness of which is reduced due to collapse of the alveoli (atelectasis). Such pneumonias tend to be protracted, leading to fibrosis of the lung tissue and deformation of the bronchi.

2. Interstitial pneumonia

Interstitial pneumonia is most often caused by viruses, mycoplasmas or fungi. The diagnosis of interstitial pneumonia must be approached with great responsibility. This caution is due to the fact that interstitial inflammation can be a manifestation of a wide variety of pathological processes both in the lungs and outside them.

Severity of pneumonia

Mild severity is characterized by mild signs of intoxication (increased body temperature to 38, clear consciousness, normal blood pressure), absence of shortness of breath at rest. Slight shortness of breath on exertion. X-rays reveal small foci of inflammation in the lung tissue.
Moderate severity is manifested by moderately severe intoxication (body temperature above 38, tachycardia up to 100 beats per minute, mild euphoria, sweating, slight decrease in blood pressure), shortness of breath at rest. The radiograph shows pronounced infiltration of the lung tissue.
A severe degree occurs with pronounced signs of intoxication (temperature above 39, tachycardia - more than 100 beats per minute, clouded consciousness, delirium, decreased blood pressure up to collapse). Signs of respiratory failure are sharply expressed. X-ray: extensive infiltration. Complications may develop.

Downstream There are acute, protracted and chronic pneumonia, each of which can be complicated or uncomplicated.

Pneumonia is a disease associated with the development of an inflammatory process in the lung tissue, intra-alveolar exudation under the influence of infectious and, less commonly, non-infectious agents. Depending on the type of pathogen, pneumonia can be viral, viral-bacterial, bacterial or fungal.

Typical acute pneumonia is one of the common diseases. The average statistical indicator is approximately 10-13% of patients who are in therapeutic hospitals. The incidence rate of typical pneumonia is 10 men and 8 women per 1000 people. The majority of patients (about 55%) are elderly people. Also, a large number of patients are young children (up to three years of age).

Types of pneumonia

Modern medicine is faced with various forms of pneumonia: from mild subclinical to severe and life-threatening. This variation can be explained by the variety of pathogens that can provoke pneumonia, and the individual immune response of the body to a specific infectious agent.

Taking into account criteria such as infection conditions, pneumonia is classified into:

Community-acquired - occur at home, more often after a cold, against the background of ARVI. This type of pneumonia is more common than others.
Intrahospital (hospital, nosocomial) - arise and develop when the patient is in the hospital. In this case, the criterion for nosocomial pneumonia is the appearance of symptoms of the disease in a patient hospitalized for another reason within 48 hours or more from the moment of admission to the hospital. The development of the disease before the end of the second day from the moment of admission is regarded as community-acquired pneumonia.
Aspiration - develops from the ingress of stomach contents and saliva containing oral microflora into the lungs. As a rule, this occurs with vomiting. At risk for aspiration pneumonia are bedridden patients, patients on mechanical ventilation, and patients with chronic alcoholism.
Pneumonia in people with immunodeficiency – oncology (against the background of specific treatment), HIV, drug-related immunodeficiencies, and congenital conditions.

Based on clinical and morphological features, pneumonia is divided into parenchymal and interstitial. The first type, in turn, is divided into lobar (polysegmental), focal and segmental pneumonia.

According to the severity of clinical manifestations, three degrees of severity of pneumonia are determined:

Mild severity is characterized by mild signs of intoxication with a body temperature of up to 38 degrees, a respiratory rate (RR) of up to 25 movements, clear consciousness and normal blood pressure, and leukocytosis.
The average degree is classified as moderate intoxication with a body temperature above 38 degrees, respiratory rate - 25-30, heart rate up to 100 beats per minute, sweating, a slight decrease in blood pressure, an increase in the number of leukocytes in the CBC with a shift of the formula to the left.
A severe degree is considered to be indicators of pronounced intoxication with a body temperature above 39 degrees, a respiratory rate of more than 30, a heart rate of more than 100 beats, clouding of consciousness with delirium, a strong decrease in blood pressure, respiratory failure, severe leukocytosis, morphological changes in neutrophils (granularity), and a possible decrease in the number of leukocytes.

Currently, only two degrees of severity of the disease are most often distinguished: mild and severe. To identify a severe degree, scales for assessing the severity of the disease are used: PSI, ATS, CURB-65, etc.

The principle of these scales is to identify groups at risk of poor prognosis among patients with pneumonia. The figure below shows the ATS scale for identifying severe disease.

On the territory of the Russian Federation, taking into account the shortcomings of American and European scales, as well as taking into account Russian specifics, criteria of the Russian Respiratory Society have been developed for assessing the patient’s condition (figure below).

Pneumonia is considered severe if at least one criterion is present

It is worth mentioning separately a number of factors in which pneumonia is more severe

Pneumonia develops against the background of concomitant diseases. At the same time, the immune system is weakened, the disease occurs more often (on average compared to other categories), and recovery occurs later. This is especially true for patients with chronic diseases of the respiratory system, cardiovascular system, alcoholism and diabetes.
Pathogen type. When affected by gram-negative flora, the likelihood of death is much higher.
The greater the volume of lung tissue exposed to the inflammatory process, the more severe the patient’s condition.
Late treatment and diagnosis contributes to the development of severe disease.
Severe pneumonia often occurs in people who are homeless or living in poor conditions, who are unemployed or have low incomes.
Severe pneumonia is more common in people over 60 years of age and newborns.

During acute typical lobar pneumonia there are also stages:

The flushing stage is the first stage of development of this disease. Lasts from several hours to three days. At this time, the pulmonary capillaries expand, and the blood in the lung tissue rushes in and begins to stagnate. The patient's body temperature rises sharply, a dry cough appears, shortness of breath is observed, the patient feels pain when inhaling and coughing.
The second stage is the red liver stage. Lasts from one to three days, the alveoli are filled with sweating plasma, and the lung tissue thickens. At this time, the alveoli lose their airiness, and the lungs become red. The pain gets worse, the body temperature is steadily elevated, and “rusty” sputum appears.
The third stage of gray hepatization lasts from four to eight days. During the flow in the alveoli, red blood cells disintegrate and the hemoglobin contained in them becomes hemosiderin. During this process, the color of the lung turns brown. And the leukocytes entering the alveoli also make it gray. The cough becomes productive, the patient coughs up purulent or mucous sputum. The pain dulls, shortness of breath decreases. Body temperature decreases.
The fourth stage of resolution is accompanied by the process of recovery and resorption of sputum. Its duration is from 10 to 12 days. At this time, gradual dissolution and liquefaction of sputum occurs and the airiness of the lungs is restored. The resorption process is long, but painless. Symptoms subside, sputum is coughed up easily, pain is practically absent or mild, breathing process and body temperature are normalized.

The results of radiography allow us to determine the stage of development of the disease. At the height of the disease, a darkening of varying extent and size (focal, segmental, lobar) is observed on the radiograph. At the resolution stage, the darkening decreases in size, infiltration disappears, and an increase in the pulmonary pattern may persist as residual effects for up to a month. Sometimes after recovery, areas of fibrosis and sclerosis may remain. In this regard, it is recommended to keep the last photographs in hand after the disease has resolved.

In atypical pneumonia associated with a lack of immunity, the above stages are not inherent. It is characterized by smoother symptoms and changing periods of the disease. In addition, with atypical pneumonia, only interstitial changes without clear infiltration are often observed.

Correct and timely determination by the attending physician of the degree and stages of pneumonia allows one to avoid many complications in the further course of the disease. Therefore, it is very important to identify the source of infection and begin treatment on time.

Additional studies and patient management tactics

Patients with suspected pneumonia will be prescribed:

UAC, OAM;
X-ray of the chest organs in two projections (if necessary, the number of projections increases, this is decided by the radiologist);
Biochemical blood test;
Sputum tests: general, for BK, for microflora and its resistance-sensitivity spectrum;
Computed tomography and bronchoscopy may be additionally performed for special indications. This is done, as a rule, to exclude/clarify the localization of cancerous tumors in the lungs, abscesses, encysted pleurisy, decay cavities, bronchiectasis, and so on.

Based on all the collected data, after determining the degrees and stages of development of pneumonia, the doctor can determine the optimal tactics for managing the patient and where it is best to treat him. Also, based on data reflecting the severity of the disease, make a forecast. This is all important for further patient management.

*(1) — International statistical classification of diseases and related health problems, X revision

*(2) The probability of providing medical services or prescribing drugs for medical use (medical devices) included in the standard of care, which can take values from 0 to 1, where 1 means that this activity is carried out by 100% of patients corresponding to this model , and numbers less than 1 indicate the percentage of patients with appropriate medical indications specified in the standard of medical care

*(3) - International non-proprietary or chemical name of the medicinal product, and in cases of their absence - the trade name of the medicinal product

*(4) — Average daily dose

*(5) — Average course dose

1. Medicines for medical use registered on the territory of the Russian Federation are prescribed in accordance with the instructions for use of the medicinal product for medical use and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization, as well as taking into account the method of administration and use medicinal product. When prescribing drugs for medical use to children, the dose is determined taking into account body weight and age in accordance with the instructions for use of the drug for medical use.

2. The prescription and use of drugs for medical use, medical devices and specialized medical nutrition products that are not included in the standard of medical care are allowed in the case of medical indications (individual intolerance, for health reasons) by decision of the medical commission (part 5 of article 37 of the Federal Law of November 21, 2011 N 323-FZ On the fundamentals of protecting the health of citizens in the Russian Federation (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2012, N 26, Art. 3442, 3446)).

A standard of medical care has been approved, defining the basic requirements for the diagnosis and treatment of patients with severe pneumonia with complications. The standard is recommended for use in the provision of specialized medical care.

Order of the Ministry of Health of the Russian Federation dated November 9, 2012 N 741n On approval of the standard of specialized medical care for severe pneumonia with complications

Registration N 26568

This order comes into force 10 days after the day of its official publication

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Pneumonia. Symptoms and treatment of pneumonia

Pneumonia is an acute infectious and inflammatory process in the lungs, in which all structural elements of the lung tissue are affected, and the alveoli of the lungs are also damaged.

The causative agent of pneumonia can be gram-positive and gram-negative microflora, as well as fungi, viruses, rickettsia, mycoplasma, as well as opportunistic microflora.

According to the severity of the course, pneumonia is divided into 3 groups:

1. Mild degree. With a mild degree of pneumonia, there is mild intoxication, there is no shortness of breath at rest, there is an increase in body temperature to 38.0 C, tachycardia up to 90 heart beats per minute.

2. Average degree. With moderate pneumonia, there are signs of moderate intoxication, complaints of weakness, increased body temperature up to 39.0 C, dry or wet cough, shortness of breath at rest up to 30 respiratory movements per minute, tachycardia up to 100 heart beats per minute.

3. Severe degree. During severe pneumonia, there is severe intoxication of the body, which is expressed in an increase in body temperature to 40.0 C, severe weakness, shortness of breath up to 40 respiratory movements per minute at rest, clouding of consciousness, tachycardia over 100 heart beats per minute.

Symptoms and signs of pneumonia

In the initial stage of pneumonia, the so-called hot flash stage, there is an acute deterioration in health in the form of chills, headache, chest pain with a deep breath or cough, increased body temperature, shortness of breath and dry cough. Towards the end of the flushing stage, a cough with rusty sputum, herpes labialis (nasalis), may appear.

In the next stage of development of pneumonia, the so-called compaction stage, purulent sputum begins to be coughed up during coughing, shortness of breath increases, persistently high body temperature, severe pain in the chest with deep inspiration and coughing appear, mental agitation and scleral icterus appear.

In the final stage of development of pneumonia - the resolution stage - there is a normalization of body temperature, improved sputum discharge, and a decrease in chest pain and shortness of breath.

A general blood test shows a significant increase in ESR. leukocytosis (from 10 to 25 thousand in 1 μl).

Treatment of pneumonia is carried out comprehensively, in several areas at once:

Etiotropic treatment of pneumonia. It is aimed at suppressing the causative agent of pneumonia. Initially, a broad-spectrum antibiotic is prescribed, and after receiving the results of culture for flora and sensitivity to antibiotics, treatment is adjusted if necessary.
Pathogenetic treatment of pneumonia. It consists in improving the evacuation of sputum from the bronchial tree by taking mucolytics (mucaltin, acetylbromhexine, licorice root syrup, etc.) and bronchodilators (aminophylline, theophedrine, teopec, atrovent, berodual, etc.), which improves breathing and reduces the preconditions for the propagation of infection in the bronchial tree.
Symptomatic therapy in the treatment of pneumonia. It consists of taking antipyretic drugs from a number of NSAIDs (paracetamol, analgin, ibuprofen, diclofenac, aspirin, etc.) and detoxifying the body.

Also, in the absence of contraindications, therapeutic breathing exercises (LDG) and physiotherapeutic treatment (PTT) are prescribed for the treatment of pneumonia.

Complications after pneumonia

If pneumonia is not treated adequately, the following complications may occur:

Exudative pleurisy
Empyema of the pleura
Destructive pneumonia
Acute respiratory distress syndrome
Acute respiratory failure
Infectious-toxic shock
Secondary bacteremia
Sepsis
Pericarditis, myocarditis, nephritis and other inflammatory diseases.

Preventive measures to prevent the occurrence of pneumonia include everything that strengthens local and general immunity:

A healthy lifestyle (quitting smoking, not drinking too much alcohol, conditioning the body, good healthy sleep, reducing stressful situations, physical activity, frequent exposure to fresh air).

Vitamin therapy in winter and spring.

Vaccination with 23-valent pneumococcal vaccine (pneumo 23 vaccine).

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Treatment of mild to moderate pneumonia:

After 3-4 days of treatment, upon achieving a clinical effect (normalization of body temperature, reduction in the severity of intoxication and other symptoms of the disease), you should switch from parenteral to oral administration of these drugs. The duration of treatment is 7-10 days.

Antibacterial therapy for hospital-acquired Pneumonia (PN) occurring in patients with concomitant risk factors. The drugs of choice are imipenem intravenously 0.5 g 3-4 times a day, or ceftazidime intravenously 1-2 g 2-3 times a day or cefepime 1-2 g 2 times a day, or meropenem intravenously 0.5 g 3-4 times a day in combination with amikain intravenously 15-20 mg/kg once a day or vancomycin intravenously 1 g 2 times a day. Alternative therapeutic agents are aztreonam intravenously or intramuscularly 0.5-2 g 2-3 times a day, or levofloxacin intravenously 0.5 g once a day, or moxifloxacin intravenously 0.4 g 1 time a day, or a combination amikacin intravenously 15-20 mg/kg once a day with piperacillin/tazobactam intravenously 4.5 g 3 times a day or ticarcillin/clavulanate intravenously 3.2 g 3 times a day (instead of amikacin you can use gentamicin intravenously 3 times a day -5 mg/kg 1 time per day).

Information from section sponsors for your reference:

moderate pneumonia

Questions and answers on: moderate pneumonia

The situation is this: after the 3rd fluorography I was told that the darkening in S6 on the RIGHT IS PRESERVED. I’ve been undergoing treatment for a long time, I fell ill on November 25 and the cough persists until December 22. The preliminary diagnosis is community-acquired right-sided lobar pneumonia of moderate severity. There has been no fever for 10 days, no complaints other than a cough (since the illness began with treatment from a therapist with a diagnosis of bronchitis, she took AMOXYCLAV. In the hospital, gentomycin, cefataxime, heparin, azithromycin, azitrox and levofloxacin. (maybe I didn’t have some additional I remember very much) The main thing is that I tried to learn about antibiotics.

I really want to understand whether in my situation it’s really necessary to do a bronchoscopy? Maybe I can still get by with tomography and ultrasound?

Moderate asthma since 2000

I'm 34 years old, my name is. weight 90 kg, fell ill on 12/20/10 (image on 12/20/10 - diagnosis of right-sided infiltrative tuberculosis of the upper lobe) - fever, cough, sweating, temperature from 38 to 39 C. I went to the therapist, treated for pneumonia with antibiotics (ceftriaxone, netromycin, summed, ciprofloxacin , amoxiclav). They took pictures on December 30, 2010 (same diagnosis). On January 12, 2011, a CT scan was performed and a diagnosis of infiltrative tuba was made. the right lung is in the decay phase. They sent me to a tuberculosis dispensary: they treated me - kanametsin, rifmapicin, isoniazid (liver - bilirubin increased sharply), transferred to the hospital and changed the treatment: taricin (changed to pizin), rifmapicin, isoniazid (inhalation), colbutan.

They took pictures on 03/01/11 of residual shadows and discharged me with a diagnosis of destructive pneumonia. They didn’t even wait for tests for culture and without taking blood tests, etc.

For a consultation with a pulmonologist on March 15, 2011, there were more images – darkening.

They said everything was fine, increase the dose of Symbicort by temp. and weakness, do not pay attention to the discomfort in the chest... do another sputum test for CD and culture.

Within a week they took it off the register and I’M OF COURSE HAPPY - but it’s easy to install and easy to remove.

Now I am treated only with Symbicort (Symbicort 160 - the effect has become very weak) and Berotec (4-6 times a day) (before the disease, I took Symbicort 2 times and felt fine). Concerns: shortness of breath, in the evenings sometimes the temperature is 37 C, sometimes I rarely sweat, weakness, anti-asthma medications are less effective - sometimes there is discomfort (no more pain) on the right side of the lung. Sputum tests were negative. Mantoux was negative. Is it normal to have a temperature of 37.0 - 37.2 C for more than a month after discharge, and what should I do to make it normal? asthma, what other tests can I take?

www.health-ua.org

Description of the stages of development of pneumonia, four degrees of severity and criteria for their determination

Types of pneumonia

Taking into account criteria such as infection conditions, pneumonia is classified into:

Community-acquired - occur at home, more often after a cold, against the background of ARVI. This type of pneumonia is more common than others.
Intrahospital (hospital, nosocomial) - arise and develop when the patient is in the hospital. In this case, the criterion for nosocomial pneumonia is the appearance of symptoms of the disease in a patient hospitalized for another reason within 48 hours or more from the moment of admission to the hospital. The development of the disease before the end of the second day from the moment of admission is regarded as community-acquired pneumonia.
Aspiration - develops from the ingress of stomach contents and saliva containing oral microflora into the lungs. As a rule, this occurs with vomiting. At risk for aspiration pneumonia are bedridden patients, patients on mechanical ventilation, and patients with chronic alcoholism.
Pneumonia in people with immunodeficiency – oncology (against the background of specific treatment), HIV, drug-related immunodeficiencies, and congenital conditions.

Based on clinical and morphological features, pneumonia is divided into parenchymal and interstitial. The first type, in turn, is divided into lobar (polysegmental), focal and segmental pneumonia.

Severity of the disease

According to the severity of clinical manifestations, three degrees of severity of pneumonia are determined:

Mild severity is characterized by mild signs of intoxication with a body temperature of up to 38 degrees, a respiratory rate (RR) of up to 25 movements, clear consciousness and normal blood pressure, and leukocytosis.
The average degree is classified as moderate intoxication with a body temperature above 38 degrees, respiratory rate - 25-30, heart rate up to 100 beats per minute, sweating, a slight decrease in blood pressure, an increase in the number of leukocytes in the CBC with a shift of the formula to the left.
A severe degree is considered to be indicators of pronounced intoxication with a body temperature above 39 degrees, a respiratory rate of more than 30, a heart rate of more than 100 beats, clouding of consciousness with delirium, a strong decrease in blood pressure, respiratory failure, severe leukocytosis, morphological changes in neutrophils (granularity), and a possible decrease in the number of leukocytes.

The principle of these scales is to identify groups at risk of poor prognosis among patients with pneumonia. The figure below shows the ATS scale for identifying severe disease.

Pneumonia is considered severe if at least one criterion is present

It is worth mentioning separately a number of factors in which pneumonia is more severe

Pneumonia develops against the background of concomitant diseases. At the same time, the immune system is weakened, the disease occurs more often (on average compared to other categories), and recovery occurs later. This is especially true for patients with chronic diseases of the respiratory system, cardiovascular system, alcoholism and diabetes.
Pathogen type. When affected by gram-negative flora, the likelihood of death is much higher.
The greater the volume of lung tissue exposed to the inflammatory process, the more severe the patient’s condition.
Late treatment and diagnosis contributes to the development of severe disease.
Severe pneumonia often occurs in people who are homeless or living in poor conditions, who are unemployed or have low incomes.
Severe pneumonia is more common in people over 60 years of age and newborns.

Characteristics of stages and their clinical symptoms

During acute typical lobar pneumonia there are also stages:

The flushing stage is the first stage of development of this disease. Lasts from several hours to three days. At this time, the pulmonary capillaries expand, and the blood in the lung tissue rushes in and begins to stagnate. The patient's body temperature rises sharply, a dry cough appears, shortness of breath is observed, the patient feels pain when inhaling and coughing.
The second stage is the red liver stage. Lasts from one to three days, the alveoli are filled with sweating plasma, and the lung tissue thickens. At this time, the alveoli lose their airiness, and the lungs become red. The pain gets worse, the body temperature is steadily elevated, and “rusty” sputum appears.
The third stage of gray hepatization lasts from four to eight days. During the flow in the alveoli, red blood cells disintegrate and the hemoglobin contained in them becomes hemosiderin. During this process, the color of the lung turns brown. And the leukocytes entering the alveoli also make it gray. The cough becomes productive, the patient coughs up purulent or mucous sputum. The pain dulls, shortness of breath decreases. Body temperature decreases.
The fourth stage of resolution is accompanied by the process of recovery and resorption of sputum. Its duration is from 10 to 12 days. At this time, gradual dissolution and liquefaction of sputum occurs and the airiness of the lungs is restored. The resorption process is long, but painless. Symptoms subside, sputum is coughed up easily, pain is practically absent or mild, breathing process and body temperature are normalized.

For a quick recovery, it is important that the mucus is expectorated and removed from the body, as pulmonologist E.V. Tolbuzina tells how to do this.

Additional studies and patient management tactics

Patients with suspected pneumonia will be prescribed:

UAC, OAM;
X-ray of the chest organs in two projections (if necessary, the number of projections increases, this is decided by the radiologist);
Biochemical blood test;
Sputum tests: general, for BK, for microflora and its resistance-sensitivity spectrum;
Computed tomography and bronchoscopy may be additionally performed for special indications. This is done, as a rule, to exclude/clarify the localization of cancerous tumors in the lungs, abscesses, encysted pleurisy, decay cavities, bronchiectasis, and so on.

Community-acquired pneumonia

Community-acquired pneumonia is a disease of infectious origin of the lower respiratory tract (it is also commonly called community-acquired lower lobe pneumonia), in which there is an accumulation of inflammatory fluid in the alveoli. Community-acquired pneumonia received its name in connection with the conditions of its occurrence, since it begins before a person seeks medical help in a medical institution or no later than 48 hours after hospitalization. Most often, people get sick due to a general weakening of the body’s reactive forces, and the difficulties of treatment and spread directly depend on the high adaptability of the causative dangerous microorganisms to antibiotic therapy.

Community-acquired pneumonia - what is it?

Community-acquired pneumonia can safely be called one of the world's most common respiratory diseases; the worldwide incidence is 15 people per 1000 population per year. It is difficult to record the exact level, since there is a low rate of seeking medical help. The disease affects everyone, regardless of gender and age, geographic zone, socio-economic nuances and climatic conditions. A greater predisposition exists in the older age category of people over 67 years of age and preschoolers; 25 - 45 people per 1000 get sick every year. So in nursing homes, due to age and a narrow circle of friends, low mobility, 70 - 115 people per thousand get sick.

Community-acquired pneumonia in children is mainly due to the anatomical structure of the respiratory tract and weak, unformed immunity. Babies have narrow trachea and bronchi, the respiratory muscles are underdeveloped, so there is sputum retention - a favorable factor for pathogenic microbes. The tendency to blood stagnation is also important, since children and the elderly, unlike the middle age category, spend more time in a supine position.

There is a classification of community-acquired pneumonia, depending on the influencing factors:

— The severity of community-acquired pneumonia is distinguished according to the size of the focus, the presence of aggravating symptoms, and physical data:

Mild degree - the most extensive group, is treated at home, under the dynamic supervision of a doctor, there is no urgent need for hospitalization (mortality rate 1-5%).

The degree of moderate severity is its peculiarity, the presence of chronic diseases in patients of this group, which is treated in the therapeutic department, since this measure is aimed at a speedy recovery and the inadmissibility of chronicity (mortality 12%).

Severe cases are carried out only in stationary settings - ICU or ICU in case of particularly dangerous manifestations of the disease (mortality rate 40%).

- They are also divided into several types depending on the mechanism of development: primary, secondary, aspiration, post-traumatic, thromboembolic.

— Depending on the accompanying factors, community-acquired pneumonia can occur with complications or in an uncomplicated form.

— The causative agent of community-acquired pneumonia differentiates the disease into the following types: bacterial, chlamydial, mycoplasma, viral fungal, mixed.

- Depending on the degree of capture, the pathological process can be: focal - a small area is inflamed; segmental - damage to one or more parts of the lung; shared - coverage of any share; total - infection covers one or both lungs entirely (community-acquired right-sided pneumonia, left-sided or bilateral form).

Community-acquired pneumonia has a code according to ICD 10, that is, according to the international classification of doctors, in the range J12 - J18.9. This girth can be explained by concomitant pathology, what is the causative agent of community-acquired pneumonia and the mechanism of its entry into the body.

Causes of community-acquired pneumonia

All pathogens are conditionally divided into two groups:

— Typical: streptococci, staphylococci, pneumocystis, Klebsiella, Haemophilus influenzae, various respiratory tropic viruses. But the main and leading causative agent of community-acquired pneumonia is pneumococcus (Streptococcus pneumoniae), it is the root cause of 2/3 of all cases, in second place is the Afanasyev-Pfeiffer influenza bacillus.

— Atypical: legionella, chlamydia, mycoplasma, E. coli.

Community-acquired pneumonia in children has its own etiopathogenetic group: mycoplasmas, staphylococci, adenoviruses.

Community-acquired pneumonia of combined microbial origin has been scientifically proven to be the most severe and dangerous.

Penetration of the above-described pathological agents into lung tissue occurs through several routes:

- During aspiration into the lungs. In normal condition, the cavity of the oropharynx is inhabited by microorganisms that are opportunistic for humans and absolutely harmless (for example, pneumococcus). But during sleep, a collection of bacteria can spontaneously enter the lungs along with the contents of the oral cavity. In healthy individuals, musculoskeletal protective mechanisms are triggered: cough reflex, sneezing, the structure of the branching of the bronchi, the oscillatory movement of the cilia of the ciliated epithelium, immune-specific cells tend to the site of penetration, the functional ability of the epiglottis, all this ensures the elimination of microbes from the lower respiratory tract. But, in the presence of weakened defense and cleansing mechanisms, when too much pathogenic bacteria enters, which the body is simply not able to completely eliminate and eliminate, the latter cause inflammatory reactions. Severe vomiting, alternatively, can lead to ingestion of vomit into the respiratory tract.

— Transmission by airborne droplets. Contact with a patient and inhalation of air containing etiopathogenic microorganisms (this mechanism occurs much less frequently), inhalation of an aerosol contaminated with microorganisms.

— Intraorganismal spread through the bloodstream from obvious foci of infection. For example, with endocarditis of the tricuspid valve, through open injuries of the chest - infection of the wound surface during pneumothorax, as well as with the disintegration of a liver abscess and the dissemination of bacteria into the body through the hepatic vessels.

Of no small importance is the development of community-acquired pneumonia with the participation of predisposing and provoking risk factors; they are the same in terms of age. Include:

— Bad habits: smoking, alcohol abuse, drug addiction.

- Therapy with beta-lactam antibiotic medications within the last 3 months from the moment of the present illness or there was a recent hospitalization with antibacterial treatment.

— The presence of chronic processes in the pulmonary system: obstructive pulmonary disease; bronchiectasis; asthmatic manifestations.

— Severe epidemiological situation: influenza epidemic, seasonality of cold seasons, if the patient has recently had the flu or other viral diseases, that is, the presence of weakened protective forces of the respiratory system.

— Harmful working conditions (cooling microclimate, outdoors all day).

- Presence of immunodeficiency conditions - AIDS or HIV infection.

— Staying in prisons, nursing homes, shelters. In such places, the restriction of movement and the creation of favorable conditions for the proliferation of pathogenic microflora are significantly expressed.

— Hypothermia, physical inactivity (lack of physical activity of the patient), overheating of the body.

— Irrational and unbalanced nutrition, as a result of aggravating hypovitaminosis;

— Non-compliance with the epidemiological regime in children's groups, in particular in preschool and school organizations.

— Aggravating concomitant diseases: kidney pathology (pyelonephritis), heart disease (endocarditis), diabetes mellitus, epilepsy, malignant tumors, cerebrovascular disorders.

- Severe and prolonged stress conditions.

- Previous abdominal surgeries and prolonged horizontal stay in bed rest.

- Elderly or early childhood.

Symptoms of community-acquired pneumonia

The symptomatic complex of community-acquired pneumonia is varied. It is customary to divide by syndrome: pulmonary tissue damage syndrome (respiratory failure), intoxication syndrome, astheno-vegetative syndrome. They are closely intertwined and appear:

- Manifestations in the form of migraines, loss of appetite, night sweats, bluish skin - most often cyanosis in the nasolabial triangle, chest pain during inhalation and exhalation, tingling in the right hypochondrium, aggravated by inhaling air, hyperthermia 38.0 - 39.9 ° C. The cough is dry or constant coughing, then productive, profuse purulent-mucous, viscous or liquid sputum is released, possibly containing streaks of blood.

— One of the manifestations of the symptom complex of community-acquired pneumonia is represented by a lack of air, the nature of the shortness of breath is inspiratory - it is difficult to take a breath. Children are especially panicky about this, since it can appear at rest or at night, the frequency of respiratory movements can reach more than 40 times/min. Occurs when gas exchange fails, when the alveoli are filled with inflammatory infiltrate. Severe symptoms of shortness of breath develop when inflammation affects two segments or lobes of the lung at the same time. Residual symptoms of shortness of breath are an important signaling sign of the progression of destruction of lung tissue.

Performance decreases, drowsiness and poor health, joint and muscle pain appear, consciousness is confused up to a semi-delirious state with disorientation, syncope.

— Additional signs include: nausea, tachycardia, diarrhea, vomiting, decreased blood pressure, possible rash on the face (herpes), conjunctivitis;

- Elderly patients may experience tachycardia, tachypnea, confusion, normothermia or mild low-grade fever, difficulty speaking and hemoptysis due to weakness of the pulmonary vessels.

The symptom complex is divided according to the side of inflammation. The most commonly affected right lung is community-acquired right-sided pneumonia. The right bronchus is wider and shorter than the left, which is why this option is more common, especially often in children. For adults, community-acquired right-sided pneumonia is typical in the presence of complicating diseases: diabetes, diseases affecting the kidney system, or immunodeficiency virus. Right-sided inflammation has a characteristic etiology - the causative agent of community-acquired pneumonia on the right is usually persistent streptococcus, while the lower region of the lungs is affected - community-acquired lower lobe pneumonia. The left-sided process is more dangerous, since anatomically located structures can join inflammatory reactions. Penetration of bacteria into the left lung indicates a significantly damaged human immune system. The main symptoms are cough and pain in the side with the addition of less participation in the process and lag of the left side when breathing.

According to the severity of the symptom complex, it is characteristic:

In a mild form - short-term shortness of breath, which occurs during exercise, low-grade fever, normal blood pressure, clarity of consciousness.

The average severity of community-acquired pneumonia is tachycardia, sweating, fever, mild euphoria.

Signs of a severe form are respiratory failure, which requires oxygen therapy or artificial support, septic shock, and a delirious state of consciousness.

Diagnosis of community-acquired pneumonia

Diagnostic measures include a sequential complex, namely:

— General: collection of anamnestic data. External examination: feverish persistent redness of the face, especially the cheek area, blue lips with pallor of the body skin, tachypnea. Physical methods: auscultation - changes in breathing, vocal tremor, bronchophony, the presence of wheezing. Determination of percussion tones over the entire surface of the lungs.

- The gold standard is an X-ray examination of the lungs in two projections - frontal and lateral. Areas of compaction of lung tissue are identified, in the form of darkening in the image, usually in the lower sections. If the etiopathogenetic agent is a typical microflora, then lobar compaction syndrome manifests itself with the presence of air bronchograms. With atypical infection - bilateral infiltrates, interstitial or reticulonodular. With staphylococcal and mycoplasma pneumonia, foci of parenchyma destruction with abscess formation are formed. False-negative X-ray results can occur with: neutropenia, fulminant dehydration, at an early stage of the disease (up to a day), Pneumocystis pneumonia.

— Fiberoptic bronchoscopy with quantitative assessment of sputum and transthoracic biopsy.

— CT and MRI of the lungs are used when other instrumental and laboratory techniques are ineffective, since both types are highly sensitive.

— Sputum examination is applicable for a detailed precise determination of the pathogen, determination of sensitivity to antibiotics, and exclusion of septicemia.

— In the general blood test: growth of leukocytes, acceleration of ESR, aneosinophilia. In biochemical analysis - an increase in acute phase proteins: fibrinogen, haptoglobulin, ceruloplasmin, C-reactive protein. The severity of the disease can be determined by biochemical tests for glucose and electrolytes.

— Test to determine the gas composition of the lungs, spirometry.

— It is possible to use rapid methods for antigens in urine; the probable accuracy of the tests is 50–85%. PCR and serodiagnosis are also applicable.

Treatment of community-acquired pneumonia

Treatment is carried out at home or inpatient, depending on the severity of the disease. The selection of medications depends on the age category: those under 60 years old and without concomitant diseases, over 60 years old or patients with serious illnesses, regardless of age. They also separate children up to six months, up to five years old and an older children's group.

It is important to select and apply treatment in time. Highlight:

— Antibacterial therapy for community-acquired pneumonia is carried out as a priority. Ideally, an analysis is first carried out to determine the pathogen and its sensitivity to drugs, but in reality, treatment is prescribed empirically, since no medical worker can afford to waste precious time when every day without treatment brings the patient closer to death. When choosing routes of drug administration - orally, parenterally, intrapleurally, endobronchially, intravenous administration is most often preferred. It is with this method that the medicine penetrates into the blood as quickly as possible, a sufficient concentration is accumulated in the foci of inflammation and a sufficient concentration is maintained, circumventing the direct effect on other organ systems. You should start with an antibiotic with broad action and minimal toxicity. These include the following groups: semisynthetic penicillins, cephalosporins, fluoroquinolones, macrolides, aminoglycosides and tetracyclines.

In case of combined etiopathogenesis, and this is 10 - 45% of all cases of community-acquired pneumonia, it is worth relying on sensitivity cultures obtained within a few days and replacing the antibiotic if necessary. Also, knowing the causative agent of community-acquired pneumonia, it is possible to reduce the cost of treatment, minimize the number of prescribed drugs, select resistant strains, and prevent side effects.

Community-acquired pneumonia in children is treated with the following drugs: up to 6 months, a macrolide group is prescribed, no older than 5 years, penicillin therapy is used, children over 5 years with a typical flora - penicillins, atypical - macrolides.

— Symptomatic treatment includes: antipyretics and NSAIDs, antiallergenic drugs, bronchodilators, mucolytics, expectorants, cardiac medications, vitamin therapy.

— Infusion detoxification, oxygen therapy, connection of artificial respiration devices, plasmapheresis are pathogenetically applicable.

— Physiotherapeutic methods must be included: inhalation using nebulizers, electrophoresis, UHF and UHF therapy, vibration and percussion massage.

— The patient adheres to the following regimen: rest, diet with easily digestible foods, plenty of warm drinks, compresses.

— If a child is being treated at home, then the local doctor can organize a “hospital at home.” It is important to remember that the air in the room should be humidified and well ventilated - this calms breathing and reduces dehydration. The abuse of antipyretics is not recommended - this reduces the effect of antibiotics, and just at temperatures up to 38.5 ° C the body can fully fight back against pathogenic microbes.

Prevention of community-acquired pneumonia

The main form of prevention is vaccination, carried out with pneumococcal and influenza vaccines. It is possible to simultaneously administer two vaccines at once, but into different hands. For this, a twenty-three-valent unconjugated vaccine is used and injected into the deltoid muscles of the arms. It is necessary to vaccinate before the cold weather. The sample for mandatory vaccination includes: older people, those with chronic lung and heart disease, children, pregnant women, medical personnel and caregivers, and family members at risk.

Prevention of community-acquired pneumonia consists of a proper healthy rest and work regimen, exclusion of addictions, physical and sports activity, walking, a balanced diet are indicated, hypothermia, drafts, overheating should be avoided, frequent cleaning of housing, personal hygiene, and limiting contact with viral patients should be carried out . If a person gets sick, it is necessary to visit a doctor in a timely manner without aggravating attempts at self-medication.

Treatment of moderate pneumonia

The drugs of choice are amoxicillin/clavulanate intravenously 1.2 g 3 times a day, or ampicillin intravenously or intramuscularly 1-2 g 4 times a day, or benzylpenicillin intravenously 2 million units 4-6 times a day, or cefotaxime intravenously or intramuscularly 1-2 g 2-3 times a day, or ceftriaxone intravenously or intramuscularly 1-2 g 1 time a day cefuroxime intravenously or intramuscularly 0.75 g 3 times a day. Alternative drugs may be levofloxacin intravenously 0.5 g once a day or moxifloxacin intravenously 0.4 g once a day.

Treatment of severe Pneumonia (Pn):

The drugs of choice are a combination of clarithromycin intravenously 0.5 g 2 times a day, or spiramycin 1.5 million IU intravenously 3 times a day, or erythromycin 0.5-1 g 4 times a day orally with the following antibiotics: amoxicillin/ clavulanate intravenously 1-2 g 3 times a day, or cefepime intravenously 1-2 g 2 times a day, or cefotaxime intravenously 1-2 g 2-3 times a day, or ceftriaxone intravenously 1-2 g 1 time per day. Alternative medications are drugs such as levofloxacin intravenously 0.5 g 1-2 times a day, or moxifloxacin intravenously 0.4 g once a day, or ofloxacin intravenously 0.4 g 2 times a day, or ciprofloxacin intravenously 0.2-0.4 g 2 times a day in combination with cefotaxime 1-2 g intravenously 2-3 times a day, or ceftriaxone intravenously 1-2 g 1 time a day.

Parenterally, the drugs are administered for 7-10 days, the duration of treatment is 14-21 days.

Treatment of nosocomial pneumonia.

Treatment regimens for nosocomial Pneumonia (HAP) with antibacterial agents depend on the presence or absence of associated risk factors. The duration of use of antibacterial agents is determined individually. In the treatment of hospital-acquired (nosocomial) Pneumonia (Pn), taking into account its most common pathogens (Pseudomonas aeruginosa, Staphylococcus aureus), III-IV generation cephalosporins, resistant to betalactamase, fluoroquinolones and imipenem come first.

Antibacterial therapy for hospital-acquired Pneumonia (PN) that occurred in patients without concomitant risk factors. The drugs of choice are amoxicillin/clavulanate intravenously 1.2 g 3 times a day, cefotaxime intravenously or intramuscularly 1-2 g 2-3 times a day, or ceftriaxone intravenously or intramuscularly 1-2 g 1 time a day, cefuroxime intravenously or intramuscularly 0.75 g 3 times a day. Alternative drugs are levofloxacin intravenously 0.5 g once a day, or moxifloxacin intravenously 0.4 g once a day, or a combination of cefepime intravenously 1-2 g 2 times a day with amikacin intravenously 15-20 mg /kg 1 time per day, or gentamicin intravenously 3-5 mg/kg 1 time per day.

Step-by-step methods for treating pneumonia

Pneumonia is a disease that is accompanied by serious symptoms. Treatment of pneumonia is a mandatory process that must be started as soon as possible. This is true for both children and adults who have subtotal and any other form of pathological condition. For this purpose, drugs, traditional methods of treatment and other means are used to ease the respiratory process and quickly reduce inflammation, no matter what classification is used.

Before starting treatment, it is necessary to make a correct diagnosis, because pneumonia can take various forms. Most often it will be the alcoholic variety, hemophilic pneumonia, post-traumatic pneumonia, and its various stages are also identified. In this regard, special attention should be given to the differential method, in which the diagnosis gradually excludes all forms and types of pneumonia and pathogenesis.

This is necessary in order to quickly identify with 100% accuracy how to treat pneumonia and what its psychosomatics, convalescent, and nuances of its course are. Therefore, any treatment begins with determining the diagnosis, after which it may be necessary to define it or clarify details. Pulmonologists pay attention to the following types of pathological conditions that require special treatment at the therapeutic stage:

eosinophilic pneumonia;

nosocomial pneumonia;

paracancrosis pneumonia;

Friedlander's pneumonia;

small-focal of moderate severity.

The differential method by which the diagnosis and all the symptoms are made should be the first step when starting therapy.

This will allow us to identify with maximum accuracy the nuances of the condition, psychosomatics, and also clarify the stages of its development and whether chemotherapy and other methods that require permission from a pulmonologist can be used.

The importance of symptoms

In order to answer the question of how to treat pneumonia, it is necessary to study the symptoms of the condition. This will allow you to start treatment, determine the medicine depending on the severity of pneumonia and what its classification and pathogenesis are. Symptoms begin with minor pain in the lungs and frequent coughing that characterizes the disease. This is formed in the following types of disease: eosinophilic pneumonia, catarrhal pneumonia, toxic pneumonia, lobar pneumonia and some other rare conditions.

Breathing changes, becoming sharper or more jerky. A person at any age, when faced with pneumonia, develops slight shortness of breath and attacks of tachycardia - in the rarest situations, when psychosomatics and convalescence are unclear, but it is necessary to take medications, Eufillin. Shortness of breath does not join the symptoms in all cases in which the diagnosis is made.

Based on this, it is possible to identify the following forms of pathological condition, the treatment of which is necessary: adenoviral pneumonia, total pneumonia, severe pneumonia. This may be hemophilic and confluent pneumonia, lobar pneumonia, the definition of which is necessary.

In the last stages of the disease, when chemotherapy methods, oil equipment and many medications turn out to be ineffective, a depression of the chest on the affected or middle side and the release of bloody sputum appear, a negative pathogenesis that will also cause other complaints. Taking into account the presented symptoms, pulmonologists can begin treatment, which can be considered the only correct one for adults and children and will restore breathing without requiring permission.

At the first stage, which involves treatment, chemotherapy will be prescribed, and after its completion, diagnostics will be required to clarify the psychosomatics. Pulmonologists draw patients’ attention to the following nuances of the recovery process:

if a person has eosinophilic pneumonia, hemophilic or alcoholic pneumonia, treatment can be carried out without strong analgesics;
when types such as small-focal pneumonia, toxic pneumonia, adenoviral pneumonia and postoperative pneumonia are detected, the most powerful drugs are prescribed;
Traditional treatment that restores breathing can only be used after consultation with a pulmonologist.

The use of chemotherapy is justified at every stage of recovery and progression. However, in the initial stage it is necessary to start it with minimal dosages, because in this way, experimentally, it will be possible to calculate the optimal concentration and pathogenesis using Eufillin.

Before using medications, it is necessary to find out the list of contraindications and possible complaints, and the psychosomatics are clarified. This is important for respiratory diseases, when there is a high possibility of allergic reactions from the body in adults and children. In some situations it is the Haemophilus influenzae variety or the mid-location type.

Vitaminization and strengthening of the immune system should be considered an addition to treatment. If you start therapy for pneumonia at an early stage, when the symptoms do not threaten life, it will last no more than 1 month and will be able to exclude the development of recurrent reactions and course.

The presented stage is started if the disease was identified at a late stage or when therapy was carried out incorrectly. Chemotherapy methods in this case are more accelerated and include many medications that directly affect psychosomatics. You can drink the following components: Eufillin, Suprax and other tablets that optimize breathing.

Significant importance must be given to what complaints are present in patients and, depending on this, combined in order to cure pneumonia as soon as possible. The optimal cycle at each stage of the disease should be considered general respiratory agents, antibacterial and analgesic, improving breathing. They allow you to restore respiratory activity, reduce pain, symptoms and minimize the likelihood of developing bacterial components.

In some cases, answering the question of how sluggish pneumonia, septic pneumonia and infarction pneumonia are treated, pulmonologists indicate that this is an operation if the pathogenesis is 100% proven. However, this measure is used extremely rarely - only in exceptional situations, when psychosomatics and convalescence are questionable, and breathing is not restored.

At this stage, it is possible and necessary to use additional techniques, Eufillin, as well as breathing exercises and other exercises, due to which the drugs will “work” much faster in adults and children.

At the third stage of therapy, which is the final stage, we often talk about surgical intervention. In this regard, the following nuances can be noted:

the operation involves the removal of large accumulations of sputum and other negative components that aggravate the normal functioning of the lungs;

in some cases, when the types of pneumonia are aggravated, removal of a segment of the lung or a certain area of it is used;

the recovery stage after surgery is an additional part of therapy, which should be given no less attention.

For this purpose, you need to take drugs such as Eufillin, which activate breathing, relieve pain and swelling, if psychosomatics are obvious. Classification in this case is of key importance, because if the diagnosis of hemophilic, eosinophilic pneumonia, paracancrous pneumonia, Friedlander's pneumonia or post-traumatic pneumonia is identified, stronger analgesic components are used in adults and children. It is important to note that you should also take medications during sanatorium treatment, which is annually indicated for everyone who has ever experienced pneumonia or has similar symptoms.

More about chemotherapy

Speaking about the nuances of chemotherapy, pulmonologists highlight some additional features that everyone needs to know without requiring permission. As part of moderate-duration chemotherapy, pulmonologists recommend paying attention to the fact that you need to drink the medicine, Eufillin, depending on your food consumption schedule and what kind of injections you give.

This approach allows you to more accurately calculate the dosage and determine the effect on breathing, negative symptoms and other reactions from the body, in which psychosomatics and convalescence become clearer. If the diagnosis does not raise suspicion among the pulmonologist, it is necessary to agree on what medications to take with a therapist or other specialized specialists. This will help avoid allergic and other negative reactions, which are dangerous symptoms during chemotherapy.

Use of more than 4-5 medications simultaneously if eosinophilic pneumonia, Legionella pneumonia or postoperative pneumonia are diagnosed. Suspicion of another type of pneumonia implies the use of other methods; in some cases, drugs should be taken based on indicators of a person’s physical activity.

Most often this occurs in diabetes mellitus, when breathing in adults is significantly impaired. Treatment in childhood deserves special attention if the diagnosis is obvious.

Recovery in childhood

If a child is diagnosed with pneumonia and the diagnosis is confirmed, he is prescribed medications that should be taken daily. Pulmonologists draw the attention of parents to the following:

It is permissible to drink the most gentle components - Eufillin in a minimum dosage;

injections and some fortified supplements are allowed;

surgical intervention is prescribed only as a last resort, when no other chemotherapy method helps, aggravating the diagnosis.

Significant importance in the recovery process should be given to the child’s physical activity, special exercises and other techniques. This will activate the body's work, the production and release of phlegm from the body. The recovery process is even more specific in the case of pregnant women.

Therapy in pregnant women

In the case of pregnant women, recovery and the drugs that need to be taken should be the most gentle and in minimal dosages. Injections are not prohibited, but to administer them it is necessary to carefully select the area where the drug will be administered.

In pregnant women, recovery should be carried out under the constant supervision of a pulmonologist, who will monitor any changes in health status.

Pulmonologists also recommend that when taking a break from chemotherapy, special attention should be paid to diet and developing a diet on an individual basis. This will allow for a more complete and rational restoration of the body’s functions. In order for Legionella pneumonia and postoperative pneumonia to be restored, the most thorough preventive intervention is required in adults and children.

Preventive measures

Prevention of pneumonia involves avoiding contact with affected people and avoiding the possibility of frostbite or lingering colds. Additional methods that the classification does not depend on are:

vitaminization of the body, strengthening the immune system and the degree of resistance of the pulmonary parenchyma;

increasing the degree of physical activity and hardening, which significantly strengthens the body;

introduction of a special diet rich in natural proteins, fats and carbohydrates.

In order for recovery to be complete, it is recommended to adhere to the presented measures over a long period of time. This will minimize the potentially negative impact on the lung area in adults and children, the classification of which is different.

Treatment for any form of pneumonia is a complex process that includes many stages. Therapy should be long-term, which will allow for faster restoration and healing of the body and the activity of the lungs, bronchi and other components of the respiratory tract.

For quotation: Dvoretsky L.I. PNEUMONIA // BC. 1996. No. 11. S. 1

The article presents modern approaches to the classification of pneumonia based on the clinical-pathogenetic principle, taking into account risk factors. The features of the development and course of various etiological variants of pneumonia are given, which makes it possible to roughly determine the etiology of the disease in a specific situation.

The article presents modern approaches to the classification of pneumonia based on the clinical and pathogenetic principle, taking into account risk factors. The features of the development and course of various etiological variants of pneumonia are given, which makes it possible to roughly determine the etiology of the disease in a specific situation.
Rational antimicrobial therapy for pneumonia is based on adequate selection of the initial drug, taking into account the expected etiological variant and subsequent correction if necessary.

The paper outlines the present-day approaches to classifying pneumonia from the clinical and pathogenetic points of view, by taking into account risk factors. It also describes the specific features of the natural history of various etiological pneumonias, which approximately determines the etiology of a disease in each specific case.
Efficient antibiotic therapy for pneumonia is based on the adequate choice of a first-line drug in view of its presumable etiological type and, if required, subsequent correction.

Moscow Medical Academy
them. THEM. Sechenov, Department of Clinical Hematology and Intensive Care Faculty of Postgraduate Education
(Head-Prof. L.I. Dvoretsky)
J. M. Sechenov, Moscow medical academy, Dept. of clinical hematology and intensive care
(head - prof. L.I. Dvoretsky)

1. Introduction

Timely diagnosis and adequate treatment of pneumonia are one of the pressing problems of clinical medicine.
The proposed book is intended to help the practical doctor develop the skills and abilities of both nosological and tentative etiological diagnosis of pneumonia, taking into account a number of signs (epidemiological situation, the presence and nature of the background pathology, features of the clinical and radiological picture, etc.). Such an approach, based on modern ideas about a fairly limited range of pneumonia pathogens within certain clinical and pathogenetic variants, makes it possible to justify the choice of antibiotic in accordance with the presumed etiological variant of pneumonia, which is the basis for rational antibacterial therapy of the disease.
Of course, the recommendations and guidelines provided cannot be universal and exhaustive, since clinical situations are much more diverse and each of them requires an individual approach when making a decision. Therefore, this manual cannot and should not replace the accumulation of personal experience, the constant improvement of diagnostic and treatment skills, working with literature, etc., which is so necessary for a doctor.
The book consists of the following sections: introduction, definition and basic concepts, classification issues, diagnosis of pneumonia, assessment of severity, diagnosis of complications, identification of the causative agent of pneumonia. At the end of the book you will find clinical situational examples-tasks, the solution of which will allow you to more fully assimilate the material based on typical situations encountered in the clinic.

Table 1. Main differential diagnostic signs of various variants of pneumonia in closely communicating groups

Signs	Pneumococcal pneumonia	Viral pneumonia	Mycoplasma pneumonia	Legionella pneumonia
Epidemiological situation	Usually absent	Epidemics of viral infections	Outbreaks of mycoplasma infections (autumn, winter)	Travel, contacts with closed water systems, team
Presence of underlying disease	Often COPD	Possible COPD, cardiac failure	Not typical	Maybe (immunosuppression)
Extrapulmonary manifestations	Rarely	Myocarditis	Lymphadenopathy, skin rashes, hemolytic anemia	Damage to the kidneys, intestines
Physical signs of pulmonary inflammation	Characteristic	Not typical	Few characteristic	Characteristic
X-ray signs of focal inflammation	Lobar darkening	Strengthening, deformation, reticulation of the pulmonary pattern, focal opacities	Strengthening and thickening the pattern, spotty darkening without clear boundaries	Lobar, segmental, subtotal darkening, often bilateral
Peripheral blood		Leukopenia, relative lymphocytosis	Possible lymphocytosis	Leukocytosis with a shift to the left, lymphocytopenia
ESR	High	Normal or increased	Moderately elevated	High
Effective antibiotic	Penicillin, cephalporinos		Tetracyclines, erythromycin	Erythromycin, tetracyclines, rifampicin

2. Definition and basic concepts

Pneumonia is an acute infectious inflammation of the alveoli with the presence of previously absent clinical and radiological signs of local damage, not associated with other known causes.
This definition emphasizes the infectious nature of the inflammatory process, excluding from the group of pneumonia pulmonary inflammations of other origins (immune, toxic, allergic, eosinophilic, etc.), for which, in order to avoid terminological confusion, it is advisable to use the term “pneumonitis”, traditionally denoting only infectious lesions as pneumonia.
The obligatory involvement of the alveoli in the process - this allows the doctor to understand not only the essence of the process, but also to qualify the disease as pneumonia only in the presence of symptoms of damage to the alveoli: signs of local compaction of the lung tissue, crepitant rales, ventilation-perfusion disorders, radiologically detected parenchymal infiltration. From these positions, the diagnosis of so-called interstitial pneumonia must be approached with great responsibility, although the inflammatory process in pneumonia affects all structures and an interstitial component occurs.
The absence of previous signs of local pulmonary damage excludes the possibility of interpreting the process as an exacerbation of so-called chronic pneumonia (a term used less and less in the domestic literature). Chronic inflammation in the lung tissue is characterized by the presence of periodically recurring acute inflammation against the background of local pneumosclerosis in the same area of the lung.
Since the definition emphasizes the acute nature of inflammation, there is no need to use the term “acute pneumonia”, especially since the International Classification of Diseases adopted by the World Health Organization does not include the heading “acute pneumonia”, and pneumonia is divided according to the pathogen into pneumococcal, staphylococcal and etc.

Table 2. Main pathogens of pneumonia in the elderly

3. Issues of clinical classification of pneumonia

The main property of any clinical classification is its practicality, i.e. the opportunity to provide the doctor with guidelines for diagnosis, development of treatment tactics, determination of prognosis, and optimization of rehabilitation measures. Meanwhile, the widespread division of pneumonia into lobar and focal pneumonia based on pathomorphological characteristics today provides relatively little information for choosing optimal etiotropic therapy.
From a practical point of view, it should be considered more rational to distinguish two classes of pneumonia: “home” and “hospital-acquired”. Each class is characterized not only by the place of origin of the disease, but also has its own significant features (epidemiological, clinical-radiological, etc.), and most importantly, a certain spectrum of pathogens. This division alone makes it possible to justify the “empirical” choice of the initial antibacterial drug. However, clinical practice requires greater detail and differentiation of pneumonia variants, taking into account their diversity and a wide range of pathogens “associated” with one or another variant.

Table 3. Main criteria for the severity of pneumonia

Main features	Severity
	light	average	heavy
Temperature, °C	Up to 38	38-39	Above 39
Number of respirations	Up to 25 per minute	25-30 per minute	Above 30 per minute
Heart rate	Up to 90 per minute	90-100 per minute	Above 100 per minute
HELL	Within normal limits	Tendency towards hypertension	Diastolic blood pressure is below 60 mm Hg. Art.
Intoxication	Absent or mildly expressed	Moderately expressed	Sharply expressed
Cyanosis	Usually absent	Moderately expressed	Often expressed
Presence and nature of complications	Usually absent	May be (pleurisy with a small amount of fluid)	Often (empyema, abscess formation, infectious-toxic shock)
Peripheral blood	Moderate leukocytosis	Leukocytosis with a shift to the left to juvenile forms	Leukocytosis, toxic granularity of neutrophils, anemia. Possible leukopenia
Some biochemical blood parameters	CRP++, fibrinogen up to 5 g/l	Fibrinogen below 35 g/l, CRP+++	Fibrinogen above 10 g/l, albumin below 35 g/l, urea above 7 µmol/l, CRP+++
Decompensation of concomitant diseases	Usually absent	Possible exacerbation of bronchial asthma, ischemic heart disease, mental illness	Often (increased heart failure, arrhythmia, decompensation of diabetes mellitus, etc.)
Treatment tolerability and effectiveness	Good, fast effect	Possible allergic and toxic reactions	Often adverse reactions (up to 15%), later effect

From these positions, the following working grouping of pneumonia seems rational, based on the clinical-pathogenetic principle, taking into account the epidemiological situation and risk factors:

Pneumonia in patients in closely interacting teams.

Pneumonia in patients with severe somatic diseases.

Nosocomial (hospital-acquired) pneumonia.

Aspiration pneumonia.

Pneumonia in patients with immunodeficiency conditions.

But even with this division of pneumonia, the difference between “home” and “hospital” pathogens remains and must always be taken into account.
3.1. Pneumonia in patients in closely interacting teams- the most common variant of home pneumonia. The features of this group are:
- Occur mainly in previously healthy individuals, in the absence of background pathology.
- The disease is most common in the winter season (high frequency of infections with influenza A virus, respiratory syncytial virus) in certain epidemiological situations (viral epidemics, outbreaks of mycoplasma infection, Q fever, etc.).
- Risk factors are contact with animals, birds (ornithosis, psittacosis), recent travel abroad, contact with stagnant water, air conditioners (legionella pneumonia).
- Main pathogens: pneumococcus, mycoplasma, chlamydia, legionella, various viruses, hemophilus influenzae.
3.2. Pneumonia in patients with severe somatic diseases:
- Occur against the background of chronic obstructive pulmonary diseases, heart failure of any etiology, diabetes mellitus, liver cirrhosis, chronic alcoholism. The presence of the above pathology leads to disturbances in the local lung defense system, deterioration of mucociliary clearance, pulmonary hemodynamics and microcirculation, and deficiency of humoral and cellular immunity.
- Often found in older people.
- The main pathogens are pneumococcus, staphylococcus, Haemophilus influenzae, Moraxella catharalis, and other gram-negative and mixed microorganisms.
3.3. Nosocomial (hospital-acquired) pneumonia is characterized by the following features:
- Occur after 2 or more days of hospital stay in the absence of clinical and radiological signs of pulmonary damage during hospitalization.
- They are one of the forms of nosocomial (hospital) infections and occupy third place after urinary tract infections and wound infections.
- The mortality rate from hospital-acquired pneumonia is about 20%.
- Risk factors are the very fact that patients are in intensive care wards, intensive care units, the presence of artificial ventilation, tracheostomy, bronchoscopic examinations, the postoperative period (especially after thoracoabdominal operations), massive antibiotic therapy, septic conditions.
The main pathogens are gram-negative microorganisms, staphylococcus.
3.4. Aspiration pneumonia:
- Occur in the presence of severe alcoholism, epilepsy, comatose states, acute cerebrovascular accident and other neurological diseases, swallowing disorders, vomiting, the presence of a nasogastric tube, etc.
- The main pathogens are microphloga oropharynx (anaerobic infection), staphylococcus, gram-negative microorganisms.
3.5. Pneumonia in patients with immunodeficiency conditions has the following distinctive features:
Occurs in patients with primary and secondary immunodeficiencies.
- The main contingent is patients with various tumor diseases, hematological malignancies, myelotoxic agranulocytosis, receiving chemotherapy, immunosuppressive therapy (for example, in the post-transplant period), drug addiction, HIV infection.
- The main pathogens are gram-negative microorganisms, fungi, pneumocystis, cytomegalovirus, Nocardia.
Knowledge of the frequency and specific gravity of various pathogens of the corresponding variant pneumonias allows, with a certain degree of probability, to carry out an approximate etiological diagnosis of pneumonia based on the clinical and epidemiological situation, risk factors, and course characteristics, which in turn serves as the basis for prescribing an appropriate antimicrobial drug.

4. Diagnosis and differential diagnosis of pneumonia

A diagnostic search in patients with suspected pneumonia conventionally includes several stages, each of which involves solving specific practical problems that bring the doctor closer to achieving the final goal - choosing the optimal treatment. These main steps are:
- Establishing the fact of the presence of pneumonia (diagnosis of the nosological form).
Exclusion of syndrome-like diseases (differential diagnosis).
- Approximate determination of the etiological variant.
4.1. Diagnosis of nosological form. The most critical stage of diagnosis is to establish the presence of pneumonia as an independent nosological form that meets the definition.
The diagnosis of pneumonia is based on identifying its pulmonary and extrapulmonary manifestations using clinical and radiological examination.
4.1.1. Pulmonary manifestations of pneumonia:

dyspnea;

cough;

sputum production (mucous, mucopurulent, “rusty”, etc.);

pain when breathing;

local clinical signs (dullness of percussion sound, bronchial breathing, crepitating rales, pleural friction noise);

local radiological signs (segmental and lobar darkening).

4.1.2. Extrapulmonary manifestations of pneumonia:

fever;

chills and sweating;

myalgia;

headache;

cyanosis;

tachycardia;

herpes labialis;

skin rash, mucosal lesions (conjunctivitis);

confusion;

diarrhea;

jaundice;

changes in peripheral blood (leukocytosis, shift of the formula to the left, toxic granularity of neutrophils, increased ROE).

One form of Legionella infection accounts for about 5% of all household pneumonia and 2% of hospital-acquired pneumonia. Risk factors are: excavation work, living near open water bodies, contact with air conditioners (legionella forms part of natural and artificial aquatic ecosystems and in air conditioners they live in the moisture condensed during cooling), immunodeficiency states. Characterized by an acute onset, severe course, relative bradycardia, signs of extrapulmonary damage (diarrhea, liver enlargement, jaundice, increased transaminase levels, urinary syndrome, encephalopathy). X-ray - lobar darkening in the lower parts, possible presence of pleural effusion. Destruction of lung tissue is rare. There is no effect from penicillins.
4.3.5. Chlamydia pneumonia.
They account for up to 10% of all household pneumonias (according to serological studies in the USA). The risk factor is contact with birds (pigeon breeders, bird owners and sellers). Epidemic outbreaks are possible in closely interacting teams. Clinically they are characterized by an acute onset, non-productive cough, confusion, laryngitis, sore throat (in half of the patients).
4.3.6. Staphylococcal pneumonia.
It accounts for about 5% of household pneumonias and is much more common during influenza epidemics. A risk factor is chronic alcoholism, which can occur in elderly patients. Usually there is an acute onset, severe intoxication, and x-ray reveals polysegmental infiltration with multiple foci of decay (staphylococcal destruction). With a breakthrough into the pleural cavity, pyopneumothorax develops. In the blood - neutrophil shift, toxic granularity of neutrophils, anemia. It is possible to develop sepsis with foci of septicopyemia (skin, joints, brain).
4.3.7. Pneumonia caused by anaerobic infection.
They arise as a result of anaerobic microorganisms of the oropharynx (bacteroides, actinomycetes, etc.) usually in patients with alcoholism, epilepsy, with acute cerebrovascular accidents, in the postoperative period, in the presence of a nasogastric tube, swallowing disorders (diseases of the central nervous system, dermatomyositis, etc.). Radiologically, pneumonia is usually localized in the posterior segment of the upper lobe and the upper segment of the lower lobe of the right lung. The middle lobe is rarely affected. It is possible to develop a lung abscess and pleural empyema.
4.3.8. Pneumonia caused by Klebsiella (Friedlander's bacillus).
They usually occur in patients with chronic alcoholism, diabetes mellitus, cirrhosis of the liver, after major operations, and against the background of immunosuppression. Characterized by an acute onset, severe intoxication, respiratory failure, jelly-like sputum with the smell of burnt meat (not a permanent sign). X-ray - often a lesion of the upper lobe with a well-emphasized interlobar groove and convexity downwards. A single abscess may develop.
4.3.9. Pneumonia caused by Escherichia coli.
Often occur in patients with diabetes mellitus with chronic pyelonephritis, epicystoma, in patients with senile dementia with urinary and fecal incontinence (patients in nursing homes). They are often localized in the lower lobes and are prone to the development of empyema.
4.3.10. Pneumonia caused by Pseudomonas aeruginosa.
One of the forms of hospital-acquired pneumonia that occurs in seriously ill patients (malignant tumors, operations, the presence of a tracheostomy), usually in intensive care units, intensive care units, undergoing artificial ventilation, bronchoscopy, other invasive studies, in patients with cystic fibrosis with the presence of purulent bronchitis, bronchiectasis.
4.3.11. Fungal pneumonia.
They usually occur in patients with malignant tumors, hematological malignancies, receiving chemotherapy, as well as in people treated for a long time with antibiotics (often recurrent infections), immunosuppressants (systemic vasculitis, organ transplantation). There is no effect from penicillin, cephalosporin and aminoglycoside antibiotics.
4.3.12. Pneumocystis pneumonia.
They are caused by the microorganism Phneumocystis carinii, which belongs to the class of protozoa (according to some sources, fungi). It occurs mainly in patients with primary and secondary immunodeficiencies, against the background of immunosuppressive therapy after organ transplantation, in patients with hemoblastosis, and with HIV infection. There is a discrepancy between the severity of the condition and objective data. Radiologically, bilateral hilar lower lobe mesh and mesh-focal infiltrates, prone to spread, are characteristic. Cyst formation is possible.
4.3.13. Viral pneumonia.
They usually occur during viral infections (influenza A epidemics, etc.). The clinical picture is dominated by manifestations of the corresponding viral infection (influenza, adenoviral infection, respiratory syncytial virus infection). Physical and radiological symptoms of viral pneumonia are scanty. The presence of purely viral pneumonia is not recognized by everyone. It is assumed that viruses cause disturbances in the local lung defense system (T-cell deficiency, disturbances in phagocytic activity, damage to the ciliary apparatus), which contribute to the occurrence of bacterial pneumonia. Viral (or “post-viral”) pneumonia is often not recognized; even in patients who have a “protracted” course of acute respiratory viral infections, signs of bronchial obstruction develop and changes in the blood are observed. The diagnosis is often made: residual effects of a previous acute respiratory viral infection.
In closely communicating groups, pneumococcal, mycoplasma and viral pneumonia are most common. In table Table 1 shows the main differential diagnostic features of these variants of pneumonia.
4.4. Identification of the causative agent of pneumonia. An accurate etiological diagnosis is the basis for successful treatment of a patient with pneumonia. About 30% of cases of pneumonia remain etiologically unidentified, despite the use of adequate research methods.
4.4.1. The reasons for the lack of an etiological diagnosis of pneumonia may be:
- - lack of microbiological research;
- incorrectly collected material for research;
- previous treatment with antibiotics (before collecting material for research);
- absence of an etiologically significant pathogen at the time of the study;
- uncertain clinical significance of the isolated pathogen (carriage, contamination of the oropharynx with bacteria, superinfection during antibacterial therapy);
- the presence of new, not yet identified pathogens;
- use of an inadequate research method.
4.4.2. Basic methods for verifying pneumonia pathogens:
- microbiological examination of sputum, bronchial lavage, bronchoalveolar pleural effusion, blood with quantitative assessment of microflora content;
- immunological studies: identification of bacterial agents using immune sera in the latex agglutination reaction, counter immunoelectrophoresis (depends on the sensitivity of the immune sera used); detection of specific antibodies using enzyme immunoassay (the most sensitive method), indirect immunofluorescence reaction (the most effective method), indirect hemagglutination reaction, complement fixation; immunofluorescence method for detecting viral components.
4.4.3. Along with conducting microbiological and other studies or if this is not possible, bacterioscopy of Gram-stained sputum is necessary (available at any medical institution). Gram-positive microorganisms are stained blue-violet. This study makes it possible to roughly determine whether the pathogen is a gram-positive or gram-negative microorganism, which to a certain extent facilitates the choice of antibiotic.
Criteria for the adequacy of drugs (sputum belonging) stained by Gram:
- the number of epithelial cells (the main source is the oropharynx) is less than 10 per 100 cells counted;
- predominance of neutrophils over epithelial cells; the neutrophil count should be 25/100 or higher;
- predominance of microorganisms of one morphological type (80% of all microorganisms in or around neutrophils);

5. Pneumonia in the elderly

In connection with increasing life expectancy, the problem of pneumonia in late age acquires special medical and social significance. In the United States, per 1000 elderly people living at home, the incidence of pneumonia is 25 - 45 per year, among those in geriatric institutions - 60 - 115 cases, and the incidence of hospital-acquired pneumonia reaches 250 per 1000. In approximately 50% of cases, pneumonia in the elderly leads to fatal outcome and occupy the fourth place among the causes of death in patients over 65 years of age. In addition, pneumonia in old age has its own clinical characteristics, which are often associated with difficulties and errors in diagnosis and ineffective treatment.
Factors predisposing to the development of pneumonia in the elderly:
- heart failure;
- chronic obstructive pulmonary diseases;
- diseases of the central nervous system (vascular, atrophic);
- oncological diseases;
diabetes mellitus, urinary tract infections (source of infection);
- recent surgical interventions;
- stay in hospital, intensive care wards;
- drug therapy (antibacterial drugs, glucocorticosteroids, cytostatics, antacids, H2 blockers, etc.), reducing the immune response;
- acute respiratory viral infections (influenza, respiratory syncytial infection);
- physical inactivity (especially after operations), creating “local conditions” for the development of infection.
The proportion of various microorganisms in the development of pneumonia in the elderly is presented in Table. 2.
Clinical features of pneumonia in elderly patients are:
- minor physical symptoms, frequent absence of local clinical and radiological signs of pulmonary inflammation, especially in dehydrated elderly patients (impaired exudation processes);
- ambiguous interpretation of detected wheezing (can be heard in the lower parts of the elderly and without pneumonia as a manifestation of the phenomenon of airway closure), areas of dullness (it is difficult to distinguish pneumonia from atelectasis);
- frequent absence of acute onset, pain syndrome;
- frequent disorders of the central nervous system (confusion, lethargy, disorientation), occurring acutely and not correlating with the degree of hypoxia (may be the first clinical manifestations of pneumonia and are often regarded as acute cerebrovascular accidents);
- shortness of breath as the main symptom of the disease, not explained by other reasons (heart failure, anemia, etc.);
- isolated fever without signs of local pulmonary inflammation (75% of patients have a temperature above 37.5°C);
- deterioration of general condition, decrease in physical activity, sudden and not always explainable loss of self-care skills;
- unexplained falls, often preceding the appearance of signs of pneumonia (it is not always clear whether the fall is one of the manifestations of pneumonia or whether the latter develop after the fall);
- exacerbation and decompensation of concomitant diseases (intensification or appearance of signs of heart failure, heart rhythm disturbances, decompensation of diabetes mellitus, signs of respiratory failure, etc.). Often these symptoms come to the fore in the clinical picture;
- long-term resorption of pulmonary infiltrate (up to several months).

6. Assessing the severity of pneumonia

Based on the clinical picture, X-ray data and some laboratory parameters, it is necessary to assess the severity of pneumonia in each specific case. The main clinical criteria for the severity of the disease are the degree of respiratory failure, the severity of intoxication, the presence of complications, and decompensation of concomitant diseases. An adequate assessment of the severity of pneumonia is of important practical importance when prescribing treatment (choice of antibiotic, nature and extent of symptomatic therapy, need for intensive care, etc.).
In table Table 3 provides the main criteria that determine the severity of pneumonia.

7. Complications of pneumonia

A complication of pneumonia should be considered the development of a pathological process in the bronchopulmonary or other systems, which is not a direct manifestation of pulmonary inflammation, but is etiologically and pathogenetically associated with it, characterized by specific (clinical, morphological and functional) manifestations that determine the course, prognosis, and mechanisms of thanatogenesis.
7.1. Pulmonary complications:
- parapneumonic pleurisy;
- pleural empyema;
- abscess and gangrene of the lung;
- multiple destruction of the lungs;
- broncho-obstructive syndrome;
- acute respiratory failure (distress syndrome) in the form of a consolidative variant (due to massive damage to the lung tissue, for example in lobar pneumonia) and an edematous variant (pulmonary edema).
7.2. Extrapulmonary complications:
- acute cor pulmonale;
- infectious-toxic shock;
- nonspecific myocarditis, endocarditis, pericarditis;
- sepsis (often with pneumococcal pneumonia);
- meningitis, meningoencephalitis;
- DIC syndrome;
- psychosis (in severe cases, especially in the elderly);
- anemia (hemolytic anemia with mycoplasma and viral pneumonia, iron redistribution anemia);

8. Formulation of the diagnosis of pneumonia

When formulating a diagnosis of pneumonia, it must necessarily reflect:
- nosological form indicating the etiology (approximate, most probable, verified);
- presence of background pathology;
- localization and prevalence of pulmonary inflammation (segment, lobe, unilateral or bilateral lesion);
- severity of pneumonia;
- presence of complications (pulmonary and extrapulmonary);
- phase (height, resolution, convalescence) and dynamics (outcomes) of the disease.
The formulation of the diagnosis should begin with the nosological form of pneumonia that meets clinical, radiological, epidemiological and other criteria that exclude syndromic diseases (tuberculosis, tumors, pulmonary vasculitis, etc.).
In connection with the established tradition, doctors use the term “acute pneumonia” when formulating a diagnosis, although the term “acute pneumonia” is absent in the International Classification of Diseases.
In each specific case, the causative agent of pneumonia should be indicated, if possible. In the absence of precise verification, an approximate etiological variant should be indicated, taking into account clinical, radiological, epidemiological and other features or sputum Gram stain data. The etiological approach determines the choice of empirical antimicrobial therapy.
If there is a background pathology, it is necessary to indicate it in the diagnosis, emphasizing the secondary nature of the disease (the presence of chronic obstructive pulmonary diseases, heart failure, diabetes mellitus, lung tumors, immunodeficiency state, etc.). This component of the diagnosis is important in choosing an individual treatment and rehabilitation program, since most so-called secondary pneumonias acquire a complicated and protracted course.
Localization and prevalence. Based on clinical and, mainly, radiological data, the doctor must indicate the number of affected segments (1 or more), lobes (1 or more), unilateral or bilateral lesions.
The severity of pneumonia should be reflected in the diagnosis, since it determines not only the nature of antimicrobial therapy, but also the characteristics of symptomatic treatment, the need for intensive care, and the prognosis of the disease.
Complications of pneumonia. Both pulmonary and extrapulmonary complications should be reported.
Disease phase. Indicating the phase of the disease (height, resolution, convalescence, protracted course) is important for determining the tactics of treatment and rehabilitation measures. So, if a patient with pneumonia is in the resolution phase and microbial aggression is suppressed with the help of antibacterial therapy (disappearance of intoxication, normalization of temperature), then further antibacterial therapy is not indicated. Often during the recovery period, low-grade fever (low-grade fever of convalescents), asthenia, and an increase in ESR are observed, which do not require antibacterial therapy and are, apparently, a reflection of the processes of sanogenesis.
The protracted course of pneumonia should be understood as situations in which, after 4 weeks from the onset of the disease, against the background of generally positive clinical and radiological dynamics (or a tendency towards it), such signs as non-productive cough, low-grade fever, asthenic syndrome, increased pulmonary pattern on X-ray remain. research. It is not always easy to draw a clear line between the natural process of convalescence and the protracted course itself due to disturbances in the local lung defense system, immunodeficiency, against the background of chronic pulmonary pathology, chronic alcoholism, the presence of segmental bronchitis in the post-pneumonic zone (a common cause), etc. Each of these factors must be promptly identified and taken into account for targeted correction (immunostimulation, endobronchial sanitation, etc.).

Literature:

1. Acute pneumonia. Round table discussion. Ther Arch 1988;3:9-16.
2. Nonnikov V. E. Antibacterial therapy of pneumonia in persons over 60 years of age. Clinical Pharmacology and Therapeutics 1994;3:49-52.
3. Chuchalin A. G. Pneumonia. Clinical Pharmacology and Therapy 1995;4:14-17.
4. Montgomery G. Pneumonia. Post grade med 1991;9(5):58-73.

Pneumonia is considered one of the most dangerous diseases of our time. It ranks 4th in terms of deaths. An accurate classification and diagnosis of the degree and stage of pulmonary inflammation in the affected area is required. The causative agents of the disease are bacteria, viruses, and fungi. There are 3 degrees of severity and 4 stages of the pathological condition.

The most common form of pneumonia is classic; atypical pneumonia is less commonly diagnosed. The main sets of signs of damage include fever, disturbances in the functioning of the respiratory system and intoxication.

Thanks to the development of medicine in the field of treatment and diagnosis of the disease, the risk of death from pneumonia is constantly decreasing. Most often, the worst prognosis occurs in patients who are critically ill or suffering from immunodeficiency.

In accordance with the circumstances of infection, pneumonia is classified into the following types:

Nosocomial – which develops within 2 days after admission to the hospital or 72 hours after discharge.
Community-acquired – infection and progression of the disease does not correlate with hospital-acquired strains of pathogens.
Aspiration – develops due to the penetration of various liquids or other substances into the lower respiratory organs.
Diseases in patients with immunodeficiency.

Pathogens that provoke inflammation in the lungs can be:

Viruses – usually measles, influenza or enteroviruses.
Bacteria – pneumococci, chlamydia, mycoplasma, hemophilus influenzae, etc.
Fungi - candida.
Mixed forms are the most severe.

Based on the extent of damage to lung tissue, pneumonia is classified into the following forms:

Focal: one or more parts are affected - segmental or polysegmental, perhaps the bronchial tree is involved in the pathology - bronchopneumonia.
Lobar or lobar: the inflammatory process covers an entire lobe.
Interstitial – inflammation of tissues near the bronchi.

Depending on the part of the lung in which inflammation occurs, upper, middle or lower lobe pneumonia is distinguished.

When pneumonia occurs in a healthy person, it is considered primary, and if it occurs as a complication of another disease, it is considered secondary.

In addition, the abortive course of pneumonia is classified. Thus, regression of symptoms occurs in a short time, the disease ends in the first stages of the lesion. This occurs due to timely treatment measures and the correct selection of antibiotics, as well as due to the proper functioning of the immune system.

If the course of pneumonia is protracted, then therapy takes 4 weeks or longer. During treatment, mild residual symptoms persist, such as asthenia and cough. On the X-ray image, the lesion does not appear, but an enhanced pulmonary pattern is noted.

Classification of the disease by severity

According to the strength of severity, taking into account the criteria for the severity of pneumonia and its clinical signs, it is classified into three degrees of damage:

In a mild form of pneumonia, the temperature does not rise above 38 degrees, the respiratory rate is 25 movements, consciousness remains clear, and blood pressure is normal.

Inflammation of moderate severity is detected with moderate manifestations of intoxication of the body. The patient's temperature is no more than 38 degrees, the respiratory rate reaches 30 movements, and the pulse increases. The patient begins to sweat heavily, the blood pressure level decreases, the concentration of leukocytes in the bloodstream increases with a shift in the formula to the left.

Severe pneumonia is characterized by severe intoxication, the temperature can exceed 39 degrees, the respiratory rate is more than 30 movements, and the pulse is greatly increased. The disease is accompanied by clouding of reason, delirium, and a strong drop in blood pressure. At the same time, respiratory failure and leukocytosis may develop.

A type of division of stages of the disease

When pneumonia develops, the stages of its development are characterized by a general pattern. The duration of each stage depends on many influences, the main ones include:

age group;
concomitant pathologies;
state of immunity;
pathogen type;
duration of defeat;
time of diagnosis;
primary or secondary lung damage.

In accordance with the severity of the pathology, pneumonia goes through 4 stages.

First stage

The first stage of the disease, or hot flash, is often poorly expressed, so it is easily confused with a cold. Its duration is short, because pneumonia continues to progress, injuring new parts of the lung tissue.

The tide period is approximately 3 days. At this stage, the capillaries in the lung expand, blood flows to the tissues of the organ, and stagnation occurs. The patient may complain of a weak nonproductive cough, shortness of breath during exercise, pain when inhaling and exhaling, and fever.

The patient's condition is moderate in severity, and occasionally severe. With rapid forms, already at the stage of high tide, delusional states, hallucinations, and clouding of consciousness occur.

During diagnosis, the doctor may see cyanosis of the lips and tip of the nose with simultaneous redness of the cheeks. The movement of the chest during breathing is asynchronous, because the affected half is prevented from working normally by swelling.

Second stage

The second stage is red hepatization. It lasts 1 – 3 days. In this case, the alveoli are filled with sweating blood plasma, which causes the organ tissue to become denser. The alveoli cease to be airy, the lungs turn red.

Clinical characteristics of the second stage are:

The pain becomes much stronger.
The temperature remains steadily elevated.
There may be sputum of a “rusty” hue.

Third stage

The third stage of pneumonia is called gray hepatitis and lasts 4–8 days. The breakdown of red blood cells in the alveoli occurs, and the same thing happens with the hemoglobin in them. The lung takes on a gray tint. The cough becomes productive, mucous or purulent sputum is coughed up. The pain subsides, shortness of breath decreases, and the temperature gradually normalizes.

Resolution stage

In the resolution stage, a full recovery occurs, sputum comes out, pathological symptoms decrease, and well-being is restored. The permit lasts about 12 days.

Pneumonia at the resolution stage is a long process, but it does not cause pain. Even with incomplete resorption, the symptoms appear less, coughing is not difficult, the temperature is normal.

Additional Research

If pneumonia is suspected, the doctor must prescribe the following types of examinations to the person:

general analysis of urine and blood;
radiography for the organs of the respiratory system in the chest with an increase in the number of projections according to the doctor’s indications;
blood biochemistry;
sputum tests, including to determine the sensitivity of microbes to antibiotics;
CT and bronchoscopy for special indications, usually to identify the location of oncology, abscess, decay cavity, etc.

The most common and informative diagnostic method for pneumonia is radiography. At different stages of the disease, the results in the images also change. This is important for the doctor, as it helps to monitor the success of treatment and, if necessary, change tactics. Sometimes, even after recovery, an enhanced pulmonary pattern remains. In such a situation, the specialist prescribes x-rays again after some time.

After analyzing all the data collected as a result of diagnosis, identifying the stage and extent of pneumonia, the doctor develops an appropriate treatment strategy. In addition, a forecast is made based on the research results. All of these components are extremely important for successful recovery.