Pneumonia

Description:

Pneumonia is a widespread acute disease, is more often than bacterial genesis, striking pulmonary fabric with the phenomena of alveolar inflammatory exudation. Pneumonia is eurysynusic among the population, its frequency reaches 10 for 1000 the population. Most urgent the problem of pneumonia costs among the children's population (to 2kh years), elderly people, and also patients with primary or secondary decrease in the immune status. Despite a big variety of modern antibacterial agents, pneumonia belongs to diseases with a high lethality also now, taking at the same time the 4th place for the mortality reasons. About 9% of cases come to an end with a lethal outcome.
Classifications of pneumonia a little. There is a division according to the etiological agent, according to character of a current, localization and the sizes of the center of an inflammation, etc. Division of pneumonia on hospital (intrahospital) and extra hospital is important (extra hospital). Such division does not cover aspects of an etiology of pneumonia, but accurately defines when the patient caught. Extra hospital pneumonia is shown at infection outside the conditions of hospital, and also in 1 month after an extract. If the disease develops in the first 2 days after hospitalization, pneumonia is also considered extra hospital.
Depending on damage of one or two lungs pneumonia can be one - or bilateral. If pneumonia develops against the background of other disease, it is called secondary, otherwise – primary.
On prevalence of pathological process pneumonia can be:
1. Focal;
2. Drain (caused by merge of the centers);
3. Segmented (distribution of an inflammation on 1 or several segments of lungs);
4. Share (distribution of the center on all lung lobe). Treats share pneumonia also croupous at which alveoluses with the adjacent site of a pleura are surprised;
5. Total, covering all lung.

Pneumonia reasons:

Incidence of pneumonia depends on many factors, the condition of immunity of the person, his epidokruzheniye, the social status, the standard of living, a way of life, contact with animal and harmful production substances, etc. matters.

The most widespread pneumonia – bacterial. As the etiological agent streptococci, staphylococcus, pneumococci, a hemophilic stick, mycoplasmas, legionella, chlamydias, colibacillus, Candida, pseudo-monads, aspergilla, cytomegaloviruses and others can act. Also rickettsial pneumonia which is found infrequently is described. To 90% of cases of share and focal pneumonia are caused by a pneumococcus. About 25% of the population are the pneumococcus carrier. The pneumococcus comes to light at bakposeva from a nasopharynx preferential during the winter period. At incidence of pneumonia at children's age up to 5 years the hemophilic stick has bigger value. This gram-negative bacterium strikes preferential smokers and patients with obstructive diseases of respiratory system.
At persons 35 years also often are younger the intracellular parasite – a mycobacterium comes to light.
The etiology of hospital pneumonia is various. It can be gram-negative (klebsiyela, pyocyanic  and hemophilic sticks, enterobakteriya and others), gram-positive (golden staphylococcus) and anaerobic (peptostreptokokk, bacteroids) microorganisms.
When determining an etiology of hospital pneumonia communication with a profile of department where there is a patient is noticed. So, in urology departments pneumonia is caused more often by colibacillus, enterococci; in hematology units – it is klebsiyela, golden staphylococcus; in the postoperative period – the same golden staphylococcus, colibacillus; in dermatovenerologic  department – proteas, pseudo-monads, staphylococcus. The mephitic gangrene is characteristic of aspiration pneumonia which gets into pulmonary fabric together with microflora of a stomatopharynx or a stomach.
The ventilatory associated pneumonia develops at the patients connected to the device IVL. If the disease developed within a week of stay on artificial ventilation of the lungs, it is called early, and most likely is caused by a hemophilic stick, golden staphylococcus, an enterobakteriya. Otherwise pneumonia is considered late.
Pneumocystic, candidosis, Cytomegaloviral pneumonia develops at an immunoskompromentirovanny background – HIV infection, a congenital or iatrogenic immunodeficiency disorder.
Viral pneumonia meets less often. They can develop against the background of flu, a parainfluenza, a respiratory and syncytial and adenoviral infection.
The contributing factors for development of pneumonia in various age groups can be unequal. For children of preschool age it is asphyxia, a birth trauma, the postponed pneumonia vnutriutrobno or in the period of a neonatality, inborn malformations of a lung, a hypovitaminosis, a congenital immunodeficiency disorder, a mucoviscidosis of lungs. In the school period an important role is played by the acquired heart diseases, chronic bronchitis, immunosuppression. At adults pneumonia develops against the background of chronic diseases of lungs, smoking, diseases endocrine and cardiovascular systems, in the postoperative period, etc.

Pathogeny:

Infection at pneumonia can happen in various ways. The greatest value in development of a disease has a bronchogenic way at which causative organisms get by means of microaspiration of contents of a stomatopharynx.
Normal it does not occur since the organism is protected by special mechanisms:
1. When passing a flow of air through the upper nasal courses it is cleared, and pathogenic parts settle on a mucous membrane;
2. Microorganisms which are saprophytes and live in a stomatopharynx cavity, suppress growth of pathogenic bacteriums;
3. Increase in activity of phagocytosis owing to availability of immunoglobulin A;
4. Existence of an epiglottidean reflex causes a mechanical obstacle for passing of bacteria;
5. Reduction of cells of a ciliate epithelium causes the movement of a layer of slime in bronchial tubes. This mechanism is called mukotsiliarny clearance;
6. Cough – the protective mechanism by means of which parts and slime are eliminated;
7. Lymphocytes, phagocytes and factors of macrophages provide so-called alveolar protection.
8. At inefficiency of all above-mentioned mechanisms humoral and cellular immunity, system of a complement, surfactant, reactions of a chemotaxis gets into gear.

Formation of pneumonia can happen one of 4 pathogenetic mechanisms:
A. Bronchogenic mechanism. This way of development of pneumonia is implemented through failure of mechanisms of protection, and enough pathogenic bacteriums gets into lungs. The bronchogenic mechanism also operates when carrying out a bronkhoskopiya and other medical and diagnostic procedures. In this case overcooling plays a supporting role.
B. The congestive (hypoventilating) mechanism happens at cardiovascular disturbances to disturbance of a hemodynamics. In such cases quite often diagnose mitral defects, arhythmic disturbances, acute coronary events. The pneumonia caused by the hypoventilating mechanism of development is characterized by slackness of a current.
B. Aspiration mechanism. Aspiration pneumonia develops against the background of the accompanying pathology of digestive organs with disturbance of their motor function, neurologic frustration with disturbance of consciousness, the act of swallowing owing to various reasons, etc. As a result food and slime get into airways that leads to aspiration.
G. The hematogenous way is justified in the presence of embolization of a lung, thrombophlebitises, arrhythmia. All this leads to development of a parenchymatous infection.

Pneumonia symptoms:

The clinical picture of pneumonia is presented by various symptoms.
In a prodromal stage intoxication phenomena prevail, weakness, passivity, asthenic manifestations increases, there is a rise in body temperature, a headache. At children during this period vomiting, a vomiting syndrome can be observed. The most characteristic of them are fervescence to febrile figures (39-40 C), with periodic oznoba, диспноэ as an inspiratory asthma, wet cough with a characteristic "rusty" phlegm, blood streaks. Диспноэ as an inspiratory asthma it is shown in difficulty to make a deep breath because of pleural pain. Localization of pain usually indicates the site of an inflammation and interest of a pleura.
In the presence of the atypical activator body temperature can reach subfibrilny figures hardly. Atypical microorganisms, for example chlamydias, cause pneumonia with a bronkhoobstruktivny syndrome which is usually not characteristic of pneumonia.
Characteristic oznob and wet cough at atypical pneumonia are not observed. Dry cough, the general symptoms of intoxication disturbs. The symptomatology accrues a melena, gradually, about development of m of a large number of complications.
It is possible to determine weight of a course of pneumonia by existence small and big criterion.
Refer such signs to small criteria: frequency of the respiratory movements 30 and more in a minute, an oxygen saturation less than 90%, the broken consciousness, level of partial pressure of oxygen in an arterial blood, systolic arterial pressure less than 90 mm of mercury., bilateral or multishare damage of lungs, existence of cavities of disintegration or pleural exudate.
Big criteria: bystry progressing of focal and infiltration changes, increase in the amount of infiltration more than for 50% in 2 days, requirement to carrying out IVL, septic shock, need of administration of angiotonic drugs.
In the presence of 2nd small or one big criterion pneumonia is considered heavy.
There is a division of patients with not hospital therapy on groups.
5. Not heavy current which is not demanding hospitalization without the accompanying pathology. As the etiological agent S. Pneumonie, H. Influenzae in that case acts.
6. The same signs which are present at the 1st group. It can be caused by gram-negative flora.
7. Not heavy current demanding hospitalization in department. Except above-mentioned, can act as the activator the atypical or mixed microflora.
8. Heavy current. The state demanding hospitalization.

Diagnosis:

Diagnosis of pneumonia consists of a complex clinical, laboratory and tool methods.
At survey of the patient turns on itself cyanosis (tsianotichnost) of integuments which first of all will be revealed in distal departments of extremities. Development of cyanosis is connected with development of an anoxemia against the background of respiratory insufficiency.
On integuments of the person the flush or herpetic defeat of a red border of lips, nose wings on the party of defeat quite often comes to light. Frequency of respiratory movements increases to 30 and more. This picture is accompanied by percussion and auskultativny phenomena in lungs – a dullness over the inflammation center, strengthening of a bronchophony, weakening of breath, a symptom of a "mute" lung, mixed rattles over the center, a specific phenomenon of crepitation.
In blood test inflammatory reaction – increase in leukocytes (white blood cells), a deviation to the left, increase in the SOE level is observed. For the purpose of detection of a bacterial infection and its identification take the analysis of a phlegm at its expectoration. The research of a phlegm needs to be made soon after its fence. An informative diagnostic method is radiographic at which the inflammation center in the form of blackout of a part of the pulmonary field is visualized.

Treatment of Pneumonia:

Complex treatment of pneumonia allows to eliminate disease symptoms. During the acute period the high bed rest is appointed. Food of patients has to be full, caloric, vitamin-rich. It is reasonable to enrich the diet with fresh fruit and vegetables. The important moment is the plentiful drink including dogrose broth, fruit juice and fruit drinks. Symptomatic therapy includes purpose of febrifugal, nonsteroid protivospalitelny drugs, mucolytic means, etc. From group of Mucolyticums apply Ambroxol, AZZ, the mukobena, etc.

Treatment is carried out taking into account weight classification.
Monotherapy, purpose of amoxicillin, macroleads is shown to patients of the 1st group.
At treatment of patients from the second group apply peroral antibacterial agents – the protected aminopenicillin or cephalosporins of the 2nd generation (tsefuroksy). 3rd group: parenteral administration of aminopenicillin, the protected penicillin, cephalosporins 2-3 generations (tsefuroksy, tsefotaksy, цефтриаксон) in a combination with macroleads. The patient with a heavy current (the 4th group) enter intravenously protected penicillin or cephalosporins of the 3rd generation with macroleads.
Efficiency of the carried-out therapy is estimated within 48 hours.

Therapy duration at pneumonia depends on the feverish period. In the absence of complications antibacterial drugs continue to accept 3 more days after normalization of a temperature curve.