Extra hospital pneumonia

Description:

Extra hospital pneumonia is one of system, invasive forms of a pneumococcal infection which represents acute infectious defeat of respiratory department of lungs with exudation and neutrophylic infiltration which radiological is characterized as infiltrate and is caused by adhesion of the Personal computer to alveolotsita of the II type and cells дисталыюго department of a bronchial tree. Extra hospital pneumonia is a special nosological form. The contradiction between wide circulation of bacterial inflammatory processes in upper and proximal departments of the lower respiratory tracts at various ORZ and rather low frequency of pneumonia is caused probably by powerful system of protection of distal department of a bronchial tree and alveoluses.

Symptoms of Extra hospital pneumonia:

The diagnosis of pneumonia is considered established if the patient against the background of identification on the roentgenogram of new infiltrate in pulmonary fabric has not less than 2 clinical signs from among the following:

the acute beginning of a disease with body temperature is above 38 °C;
cough with department of a phlegm;
physical signs of consolidation of pulmonary fabric (the obtusion or stupid percussion sound weakened or rigid bronchial breath, focus of ringing small-bubbling rattles or crepitation);
leukocytosis> 10·109/l or quantity of young forms> 10%.
In the absence of a possibility of radiological confirmation the diagnosis "not hospital pneumonia" is inexact or uncertain. In that case the diagnosis of a disease is based on clinical data. However, as results of clinical tests testify, the frequency of confirmation of the diagnosis of pneumonia at X-ray inspection in this group of patients does not exceed ¼ cases.

Reasons of Extra hospital pneumonia:

Pneumonia origins - this qualitatively excellent invasive process are unknown. Most often development of pneumonia is connected with existence of the current pneumococcal diseases of upper respiratory tracts and/or massive planting of respiratory department of lungs. The pilot studies conducted by us demonstrate that pneumonia is caused by only highly virulent serotypes of the Personal computer.
Development of pneumonia is preceded by colonization of the Personal computer of an epithelium of distal department of a bronchial tree and pnevmotsit of the II type that at plentiful reproduction of these bacteria leads to development of bacteremia and a toxaemia since the intact and destroyed cells of these bacteria possess strong toxic action. Inflow of PYaL promotes increase of a toxaemia and damage of an endothelium and microcirculator bed of lungs, increase in permeability of capillaries and development of a toxic fluid lungs and other symptoms of the acute respiratory distress syndrome (ARDS) of adults sometimes before emergence of the first centers of pneumonia. The excessive and directed protective answer of an organism of the patient including the high level of the cellular protection regulated by cytokines is defined by the beginning and an outcome of ORDS. Bacteremia even in the absence of ORDS symptoms sharply makes heavier the course of pneumonia and causes the maximum level of a lethality (30-40%).

Treatment of Extra hospital pneumonia:

Basis of treatment of patients with not hospital pneumonia of all severity is an antibioticotherapia. Establishment of the diagnosis of pneumonia is obligate for prescription of antibiotics. Besides, once again we will emphasize that the delay of the beginning of antibacterial therapy is inadmissible. Lack of results of a bakterioyoskopiya or bacteriology is not the basis for a delay of antibacterial therapy, a little long delay with introduction of the first dose of an antibiotic because of need of an intake of material for a microbiological research is also not justified.

Let's remind that an antibioticotherapia of not hospital pneumonia in most cases is empirichesyoky as at the time of establishment of the diagnosis the disease etiology is most often not known to the doctor. For patients І groups oral administration of antibacterial drugs in out-patient conditions is sufficient. Monotherapy is strongly recommended this patients. In such cases aminopenicillin or a macrolead is applied. And from aminopenicillin only amoxicillin is recommended. Use of ampicillin is wrong in view of its bad absorbability (bioavailability of ampicillin of ≤40% whereas at amoxicillin — 90%). From macroleads at patients І groups one of the most successful antibacterial drugs, from the point of view of the most probable etiology of a disease, is azithromycin.