Community-acquired pleuropneumonia. What is community-acquired pneumonia, its causes, symptoms and treatment

18.08.2020

INDEPENDENT EXPERTISE, October, 2005

ON THE. GEPPE, Doctor of Medical Sciences, Professor, M.N. SNEGOTSKAYA, Candidate of Medical Sciences, E.M. Evdokimov

Respiratory diseases in children occupy one of the first places in the structure of children's morbidity. In particular, community-acquired pneumonia (CAP), according to the results of studies carried out with proper X-ray control in Russia, affects from 4 to 17 per 1000 children, aged 1 month to 15 years. Most often children under 4-5 years of age suffer from it (40 children per 1000 first years of life).

The incidence of CAP increases during periods of influenza epidemics, and tends to a steady increase with an increase in severe and complicated forms. The prevalence of pneumonia in the pediatric population is facilitated by the immunological, functional and anatomical features of the child's body, as well as a wide range of infectious agents. Even in economically developed countries, pneumonia remains one of the most common causes of death (an average of 13.1 per 100 thousand children). Moreover, mainly young children, as well as children and adolescents with a violation of anti-infectious protection, die.

According to the classification adopted in Russia, pneumonia in children, it is defined as an acute infectious disease of the pulmonary parenchyma, diagnosed by the syndrome of respiratory disorders and / or physical data in the presence of focal or infiltrative changes on the radiograph. The presence of these signs is highly likely to indicate a bacterial etiology of the disease.

The main morphological feature pneumonia is inflammation of the alveoli. The morphological picture of inflammation includes vascular hyperemia and serous edema of the lung stroma, reproduction of the pathogen, protein effusion mainly due to fibrin, leukocyte infiltration, erythrocyte diapedesis, epithelial and leukocytic necrosis.

Diagnostics pneumonia often causes a number of difficulties. In typical situations (WHO criteria), pneumonia is characterized by: infectious toxicosis, persistence of fever for more than 3 days, a syndrome of respiratory disorders - shortness of breath in the absence of bronchial obstruction (in children under 2 months - more than 60 breath / min, 2-12 months - over 50 breaths / min, 1-5 years - over 40 breaths / min); consolidation syndrome of the pulmonary parenchyma (bronchial or weakened breathing, shortening of the percussion sound in the affected area); X-ray syndrome (the presence of focal, segmental changes on the chest x-ray).

On auscultation, it is not always possible to hear crepitant wheezing. quite often, with the simultaneous defeat of the bronchial tree, abundant moist rales with different bubbles are heard, which make it difficult for the child to listen (with abundant wire rales, difficulties also arise with the correct assessment of the auscultatory picture). Depending on the stage of the pathological process, crepitus can be inhaled (the stage of edema and tide), not listened to at all (the stage of red and gray hepatization), or listened to while exhaling (the stage of resolution). It is difficult to hear wheezing when the inflammation is localized in the root zone. Therefore, the doctor sometimes has to focus more on the symptoms of infectious toxicosis, which require a more in-depth examination of the child.

symptomatology

According to numerous studies, the difficulty of diagnosing pneumonia results from the fact that 50% of children with pneumonia do not have shortness of breath; 30% of children have no local physical symptoms; mycoplasma pneumoniae give scattered small-bunched rales resembling crepitus.

If bacterial inflammation is suspected, a general clinical blood test (leukocytosis due to neutrophils, accelerated ESR).

Carrying out X-ray examination lungs in the acute period is indicated for patients with a severe course of the disease, in other cases it can be carried out after the temperature is normalized, provided that antibiotic therapy is adequately selected.

Hospitalization the patient is needed in a serious condition (retraction of the lower chest; grunting, moaning breathing; refusal to drink; refusal to eat; lethargy or agitation; severe pallor; cyanosis), the child's age up to 6 months, social aspects (impossibility of adequate parental behavior, difficulty with regular medical supervision, material problems with parents).

In young children, it is advisable to carry out eNT doctor's consultation to exclude inflammation of the middle ear, which can also give symptoms of severe anxiety and intoxication.

More often, the typical clinical picture is characteristic of pneumonia caused by pneumococcus (the most frequently diagnosed pathogen).

Viral and bacterial pneumonia in children can be distinguished using the following features: viral or mycoplasma the infection is accompanied by a widespread lesion of all mucous membranes of the respiratory tract (rhinitis, laryngitis, pharyngitis, bronchitis, tracheitis). The secret is watery or slimy. Intoxication is not very pronounced, the temperature is often subfebrile. For mycoplasma etiology, a painful, paroxysmal cough is a characteristic feature. Physical examination is scarce - the picture is dominated by multiple wet and / or dry wheezing on both sides. X-ray examination finds shadows of various sizes, shapes and densities in one or more lobes. Pleural effusion is often found, often interlobar, atelectatic or emphysematous areas. X-ray changes persist for quite a long time, despite the improvement in the patient's condition. Myalgia, arthralgia are possible. In a blood test, the picture confirms the non-bacterial nature of the disease - regardless of leukocytosis or leukopenia, lymphocytosis or lymphopenia is detected (depending on the stage of the process) and more often neutropenia in absolute terms, ESR is slightly increased. Mycoplasma pneumonia is accompanied by positive serological reactions to mycoplasma antigens.

Clinically, viral and mycoplasma pneumonia may not differ. Most often, mycoplasma pneumoniae are segmental. It is difficult to distinguish it from a viral one when a single large focus is formed. With diffuse lung damage, when the roots are significantly expanded, indistinctly limited, the vascular pattern in the adjacent zone (severity, focal shadows) is enhanced, a suspicion of a viral etiology of the disease arises. Especially often this picture is characteristic of pneumonia with measles, chickenpox.

It is believed that between 5% and 15% of community-acquired pneumonia is caused by chlamydia, and during an epidemic, these indicators can increase up to 25%. The mortality rate in chlamydial pneumonia is 9.8%. The seasonal pattern of the spread of this infection has not been established.

In contrast to bacterial pneumonia, the onset of the disease in chlamydial pneumonia can be either acute or gradual. With a subacute course, the disease begins with damage to the upper respiratory tract, deterioration of the general condition and chilling. The temperature can be normal or subfebrile for 6-10 days and only then rises to high numbers. With an acute onset of the disease, symptoms of intoxication appear on the first day and reach a maximum by the 3rd day of the disease. In patients with a gradual onset of the disease, intoxication is most pronounced on the 7-12th day from the onset of the disease. The characteristic signs of intoxication for chlamydial pneumonia are moderate headache, myalgia, weakness.

On physical examination, percussion changes may be scarce in patients with chlamydial pneumonia. Weakened breathing and wet rales are auscultated, less often - hard breathing and dry rales.

Chest x-ray revealed both typical pneumonic infiltrations and interstitial changes. In mycoplasma pneumonia, bilateral lung damage with increased pulmonary pattern and peribronchial infiltration is more often observed, in chlamydial pneumonia, on the contrary, polysegmental infiltration is more common and less often interstitial changes.

Pneumonia caused by gram-negative microorganisms occur in no more than 5% of the total number of all pneumonia, are difficult and difficult to treat, which often leads to death. Morbidity haemophilus influenzae increases in the winter and spring months and is more common in young children. Pneumonia is usually preceded by pronounced catarrhal processes from the side of the nasopharynx. The clinical picture of pneumonia does not differ from bacterial pneumonia of other etiology. The lower lobes of the lungs are more often affected. However, there are frequent complications in the form of pleurisy, pericarditis, arthritis, meningitis, sepsis. High leukocytosis (up to 15x10 9 / l) with a shift to the left - no more than 50% of cases. Quite often the course can be long. The epiglottis, small bronchi and bronchioles are always affected, with a picture of laryngotrachobronchitis.

Pneumonia caused by klebsiella, Pseudomonas aeruginosa and Proteus are usually extremely difficult, often fatal. More often, these pneumonia develop against an unfavorable background (immunodeficiency, defects, cystic fibrosis, etc.). These pneumonias are characterized by the secretion of thick, viscous sputum streaked with blood. Often, the infectious process leads to the destruction of lung tissue. The upper lobes of the lungs are usually affected.

Legionella - gram-negative bacilli, which are obligate pathogens, rarely cause pneumonia (2-10%); however, legionella pneumonia is the second most fatal disease after pneumococcal disease.

In practice, despite the listed differences in pneumonia depending on the etiological factor, it is very difficult to clearly determine the etiology of the pathogen only by clinical, laboratory and radiological examination. There are sterile areas in the body - the middle ear cavity, paranasal sinuses, trachea, bronchi and alveoli. The nasal cavity, mouth, oropharynx and nasopharynx are colonized by bacteria. The leading pathogens of infections in sterile parts of the respiratory tract are bacteria living in non-sterile parts. But out of 300 types of bacteria, only pneumococcus, hemophilus influenzae, moraxella catarrhalis, and Staphylococcus aureus can cause disease. The disease can occur when infected with atypical pathogens (chlamydia, mycoplasma, legionella). Therefore, establishing the presence of microorganisms in the secretion from the throat and even sputum does not prove the causative agent of pneumonia, except for cases when rarely detected microorganisms (Klebsiella, Proteus, Pseudomonas aeruginosa) are found in them. Each microorganism found in sputum can be either the causative agent of pneumonia, or a component of the normal microflora in the nasopharynx, or an indicator of carriage. In addition, even if bacteria are present, a virus can be the causative agent. The only reliable way to identify the pathogen is pulmonary puncture, but it is not safe and its use meets with many objections. In the presence of pleural effusion, the detection of microorganisms in it is of great diagnostic value. In bronchoscopy, culture of lavage fluid is also diagnostically significant.

With adequate treatment, most uncomplicated pneumonias resolve in 2-4 weeks, complicated ones - in 1-2 months. A protracted course is diagnosed in cases of the absence of positive dynamics of the process (usually segmental) within a period of 1.5 to 6 months.

Given the empirical prescription of antibiotics, the decision with which drug to start treatment is left to the doctor. Most often, treatment begins with amoxicillin with clavulanic acid or sulbactam (a drug that increases resistance to microbes that produce beta-lactamase), 2nd generation cephalosporins, or macrolides. Each antibiotic has a number of features that must be considered when choosing. So, amoxicillin with clavulanic acid quite often causes allergic reactions and dyspeptic syndrome directly related to clavulanic acid (currently a drug with a reduced content of this acid has been created, which has led to a decrease in side effects), cephalosporins (cephalexin, cefixime), according to V. .TO. Tatochenko, should be classified as reserve drugs, although a number of other authors consider their use as a starting therapy justified (in particular, zinacef, cefaclor).

Macrolides are highly effective and at the same time are considered one of the safest groups of antibacterial drugs. They do not have a toxic effect on the organs and tissues of the macroorganism and less often, in comparison with other antibiotics, cause allergic reactions, which is important in the treatment of children. Possessing a bacteriostatic mechanism of antimicrobial action, various macrolide preparations differ in their pharmacokinetic properties, as well as in antimicrobial activity and tolerance.

It has been established that macrolide antibiotics are highly active against a number of pneumotropic bacteria: Streptococcus pneumoniae, Streptococcus pyogenes, Mycoplasma pneumoniae, Chlamydia pneumoniae, Branchamella catarrhalis, Staphylococcus aureus, etc. Azithromycin and clarithromycin have an effect on influenza and influenza. Some strains of bacteria that are resistant to penicillin and other antibiotics remain sensitive to macrolides.

When prescribing macrolides, one must take into account their effect on the enzymes of the cytochrome P450 system in the liver. According to the degree of inhibition of cytochrome P450, they are arranged in the following order: clarithromycin\u003e erythromycin\u003e roxithromycin\u003e azithromycin\u003e spiramycin.

Therefore, a number of drugs, including cardiac glycosides, theophylline and acetylcysteine, should be prescribed with some caution, which limits the use of macrolides in children with bronchial asthma and other broncho-obstructive diseases, since it can increase their concentration in the blood. Midecamycin, unlike erythromycin, is a weak inhibitor of the cytochrome P450 microsomal system, which is probably why it does not have a significant effect on the concentration of theophylline and antihistamines, which allows it to be used according to indications in children with allergic diseases.

Choosing the route of drug administration depends on many factors; of course, if a sick child cannot take the drug by mouth (vomiting, psychological problems, lack of an oral form of the selected antibiotic), the drug should be administered parenterally. It is impractical to start treatment immediately with injectable forms, since along with the psychotraumatic factor, the cost of treatment also rises, the risk of possible transfer of infections increases, and the development of post-injection complications. The reasoning of some doctors about the more frequent development of intestinal dysbiosis has no real evidence, since it is known that regardless of the route of administration of the drug, the antibiotic eventually enters the bloodstream and only in this way causes an effect on the intestinal microbial flora, and does not directly affect it , passing in transit through the entire gastrointestinal tract. With the above problems with taking drugs inside, it is possible to carry out the so-called stepwise antibiotic therapy: treatment begins with parenteral administration of the drug, followed by a switch to taking the oral form of the same drug (if any).

Duration of antibiotic therapy (ABT) for typical pathogens - three days after the temperature has returned to normal (a total of 5-7 days); with atypical - 14 days. If the effectiveness of the therapy is low and the antibiotic is replaced, then the terms of treatment are set according to the same scheme. It is impossible to expect improvement in all symptoms; it is possible that weakness, decreased appetite, and cough persist for several more days. The X-ray picture is resolved more slowly than the clinical recovery occurs - on average 3-4 weeks for typical pneumonia and longer for "atypical" pneumonia. It is very important for the doctor to know that the regular use of antipyretic drugs makes it difficult to assess the effectiveness of ABT.

Assessment of the effectiveness of ABT is carried out after 48 hours. During the first two days, the growth and reproduction of sensitive microorganisms is suppressed, then, in response to a decrease in intoxication, general well-being improves; the temperature is normalized; laboratory parameters are improved.

Preventive administration of antibiotics for ARVI does not prevent the possibility of bacterial complications. Frequent use of antibiotics for viral infections leads to the formation of bacterial resistance to them.

The appointment of aminoglycosides, third-generation cephalosporins and fluoroquinolones as starting therapy is unreasonable. Due to the wide range of antibiotics, monotherapy is currently advisable. If a significant expansion of the spectrum of antibiotic action is required, it is sometimes possible to use "protected" amoxicillin with macrolides.

Currently, it has been convincingly proven that the use of vitamins, biogenic stimulants increases the risk of adverse drug events, increases the cost of treatment, and there is no therapeutic effect. Some doctors prescribe histamine receptor blockers to prevent allergic reactions to antibiotics, although it is known that the allergic process will occur regardless of the intake of antiallergic drugs, but its clinical manifestations can be veiled, which ultimately will lead to more serious consequences. The use of 1st generation drugs is all the more undesirable due to their atropine-like effect, which leads to the formation of hard-to-discharge thick sputum. With properly selected doses and timing of antibiotic therapy, intestinal dysbiosis, as a rule, does not develop and the appointment of nystatin, probiotics is not necessary in the treatment of pneumonia.

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Often in therapeutic practice, a pathology such as community-acquired pneumonia is diagnosed, the treatment of which can be carried out at home. Most often, the disease has an infectious etiology.

Pneumonia occurs in both adults and children. Often it occurs against the background of another serious pathology, for example, HIV infection. The risk of pneumonia largely depends on the level of social well-being, lifestyle, immunity, working conditions, contact with sick people. Hundreds of thousands of new cases of this disease are diagnosed worldwide every year. Severe pneumonia, especially in young children, can be fatal if left untreated. What are the etiology, clinical picture and treatment of community-acquired pneumonia?

Features of community-acquired pneumonia

Currently, pneumonia is an inflammation of the tissues of the lung or both lungs, in which the alveoli and interstitial tissue of the organ are involved in the process. Pneumonia is community-acquired and nosocomial. In the first case, there is an acute infectious pathology that arose outside the hospital or less than 48 hours after the beginning of hospitalization. Depending on the localization of the pathological process, the following types of pneumonia are distinguished: focal, segmental, lobar, total, draining. The most common is lobar pneumonia. In this situation, we are talking about croupous pneumonia.

In adults and children, both one lung and both can be affected. There are 3 types of inflammation: with a decrease in immunity, without it, and aspiration. The development of an infectious form of pneumonia of the lungs is based on the following processes: aspiration of secretions in the oropharynx, inhalation of air contaminated with microorganisms, the ingress of pathogenic microbes from other organs into the lungs and the spread of an infectious agent through the blood.

Etiological factors

If the inflammation develops outside the hospital, there may be several reasons for this. The most common causes of the disease are:

the presence of a viral infection;
contact with sick people;
hypothermia (general and local);
violation of mucociliary clearance;
the presence of foci of chronic infection (septic thrombophlebitis, endocarditis, liver abscess);
penetrating wounds of the chest;
decreased immunity (against the background of HIV infection);
exposure to ionizing radiation and toxins;
exposure to allergens;
weakening and depletion of the body against the background of severe somatic pathology.

Diseases that increase the risk of pneumonia are diseases of the kidneys, heart, lungs, tumors, and epilepsy. The risk group includes people over 60 years old and children. The causative agents of community-acquired pneumonia are different. Most often, they are pneumococci, mycoplasmas, chlamydia, haemophilus influenzae, Staphylococcus aureus, Klebsiella, Legionella. Much less often the disease is provoked by viruses and fungi.

Risk factors for the development of this pathology are chronic alcoholism, smoking, the presence of COPD, bronchitis, overcrowding of collectives (in nursing homes, schools, kindergartens, boarding schools), an unsanded oral cavity, contact with the artificial ventilation system (air conditioners). Aspiration pneumonia should be distinguished into a separate group. In this situation, they arise when foreign objects enter the bronchi. It can be food, vomit. Less commonly, the cause of inflammation is thromboembolism of the small branches of the pulmonary artery.

Clinical manifestations

Symptoms of community-acquired pneumonia include:

increased body temperature;
productive cough;
chest pain;
shortness of breath when working or at rest;
lack of appetite;
weakness;
malaise;
increased sweating.

Sometimes pneumonia proceeds unnoticed by the patient and is detected by chance (during X-ray examination). All of the above symptoms are characteristic of the typical form of the disease. Community-acquired pneumonia can be atypical. At the same time, there is a gradual development of the disease, the appearance of dry cough, headache and muscle pain, sore throat. Inflammation of the lungs can be mild, moderate, or severe. For a mild degree, a slight intoxication of the body is characteristic (an increase in temperature up to 38 ° C), normal pressure, no shortness of breath at rest. When examining the lungs, a small focus is found.

With moderate severity, sweating, weakness are noted, the temperature rises to 39 ° C, the pressure is slightly reduced, and the respiratory rate is increased. High fever, confusion, cyanosis, dyspnea at rest are all signs of severe community-acquired pneumonia. Croupous pneumonia is the most common diagnosis. It occurs acutely after an increase in body temperature, chills. She is characterized by severe shortness of breath, cough. At first it is dry, then phlegm is released. It has a rusty tint. Symptoms may last for more than a week. The course of focal community-acquired pneumonia is more gradual.

Diagnostic measures

Diagnosis of community-acquired pneumonia includes:

a detailed survey of the patient or his relatives about the development of the disease;
anamnesis of life;
auscultation of the lungs;
ultrasound;
echocardiography;
x-ray examination.

Radiography is the most reliable diagnostic method. In this case, focal or diffuse darkening (less often total), expansion of the roots of the lungs are found. A sputum test is also organized to clarify the pathogen. In the process of auscultation, dullness of the pulmonary sound, crepitus, wheezing are revealed. Additional diagnostic methods include CT, MRI, bronchoscopy, biopsy, urinalysis, and detection of antibodies in the blood. A blood test can show signs of inflammation.

Pneumonia treatment

With community-acquired pneumonia, treatment should be comprehensive. With an uncomplicated course of inflammation, treatment can be carried out at home. In severe cases, hospitalization is required. This also applies to small children.

Pneumonia is treated mainly with antibacterial drugs. Medicines are selected by the doctor, based on the patient's condition, age and type of pathogen. Antibiotics will only be effective against the bacterial form of pneumonia. The drugs of choice for community-acquired pneumonia are protected penicillins (Amoxiclav, Amoxicillin, Ampicillin), cephalosporins (Cefazolin), macrolides (Rovamycin). The drugs can be administered orally or injected (intramuscularly or intravenously).

Treatment is immediate. You should not wait for the results of microbiological research. In severe cases of the disease, it is possible to combine cephalosporins with macrolides (Macropen, Sumamed, Azithromycin) and fluoroquinolones. For severe pneumonia, Cefotaxime or Ceftriaxone is preferred. The duration of therapy is 1-2 weeks. If drugs are ineffective, they are replaced by others. At the end of therapy, a control X-ray examination is performed.

Other therapies

For a successful recovery, the treatment regimen requires the inclusion of agents that stimulate the immune system, expectorant drugs and mucolytics, antihistamines, antipyretics, NSAIDs. Mucolytics and expectorants thin the phlegm and improve its excretion. This helps to improve respiratory function. These drugs include Bromhexine, Ambroxol, Acetylcysteine. Of the NSAIDs, Indomethacin, Aspirin, Ibuprofen are used.

With severe respiratory failure, the doctor may prescribe bronchodilators, oxygen therapy.

Bronchoscopy is indicated for airway obstruction. With the development of infectious-toxic shock, which is the most formidable complication of pneumonia, infusion therapy, normalization of pressure, the introduction of sodium bicarbonate (with acidosis), heart drugs and Heparin, antibiotics are indicated. The prognosis for life and health with adequate treatment is favorable. The most dangerous pneumonia in early childhood (up to 1 year).

Community-acquired pneumonia: diagnosis, treatment. Prevention of community-acquired pneumonia

Community-acquired pneumonia is one of the most common respiratory tract infections. Most often, this ailment is the cause of death from various infections. This occurs as a result of a decrease in people's immunity and the rapid addiction of pathogens to antibiotics.

What is community-acquired pneumonia?

It is an infectious disease of the lower respiratory tract. Community-acquired pneumonia in children and adults develops in most cases as a complication of a previous viral infection. The name of pneumonia characterizes the conditions for its occurrence. A person gets sick at home, without any contact with a medical institution.

Pneumonia in an adult

Adults most often get pneumonia as a result of bacteria entering the body, which are the causative agents of the disease. Community-acquired pneumonia in adults is independent of geographic areas and socio-economic relationships.

What is pneumonia?

This disease is conventionally divided into three types:

Mild pneumonia is the largest group. She is treated on an outpatient basis at home.
The disease is moderate. Such pneumonia is treated in a hospital. The peculiarity of this group is that most patients have chronic diseases.
Severe form of pneumonia. She is treated only in the hospital, in the intensive care unit.

Community-acquired pneumonia is:

Focal. A small area of \u200b\u200bthe lungs is inflamed.
Segmental. Characterized by the defeat of one or several parts of the organ at once.
Equity. Some part of the organ is damaged.
Total. The entire lung is affected.

Community-acquired pneumonia is unilateral and bilateral, right-sided and left-sided.

Symptoms

The body temperature rises.
Chills and weakness appear.
Decreased efficiency and appetite.
Sweating appears, especially at night.
The head, joints and muscles hurt.
Consciousness is confused and orientation is disturbed if the disease is severe.
Pain in the chest.
Herpes may appear.

Abdominal pain, diarrhea and vomiting.
Shortness of breath that occurs during exercise. When a person is at rest, this does not happen.

The reasons

Community-acquired pneumonia develops when microbes enter a weakened human body that cause inflammation. The causes of the disease are as follows:

Hypothermia of the body.
Viral infections.
Concomitant diseases: diabetes mellitus, heart, lungs and others.
Weakened immunity.
Excessive consumption of alcoholic beverages.
Prolonged bed rest.
Transferred operations.
Elderly age.

Causative agents of the disease

Pneumococci (most often the cause of the disease).
Staphylococci.
Atypical pathogens: mycoplasma and chlamydia.
Klebsiella.
Viruses.
Pneumocysts.
Escherichia coli.
Haemophilus influenzae.

Diagnostics

During the examination, it is very important to identify and evaluate the clinical symptoms of the disease, such as fever, chest pain, cough with phlegm. Therefore, if a person has community-acquired pneumonia, a medical history is necessarily started for each patient. In it, the doctor writes down all the patient's complaints and appointments. To confirm the diagnosis, a radiation examination is performed: chest x-ray. Clinical manifestations in community-acquired pneumonia are:

Cough with discharge of mucopurulent sputum, in which blood streaks are present.
Chest pain during breathing and coughing.
Fever and shortness of breath.
Trembling voice.
Wheezing.

Sometimes the symptoms differ from those typical for the disease, making it difficult to make a correct diagnosis and determine the method of treatment.

Radiation examination

The patient is assigned an x-ray if he has community-acquired pneumonia. Diagnostics by the radiation method involves the study of the organs of the chest cavity in the front of it. The picture is taken in frontal and lateral projection. The patient undergoes an X-ray examination as soon as he seeks a doctor, and then half a month after the antibacterial treatment has begun. But this procedure can be carried out earlier if complications arose during the treatment or the clinical picture of the disease changed significantly.

The main symptom of community-acquired pneumonia during an X-ray examination is the compaction of lung tissue, a darkening is determined in the picture. If there are no signs of compaction, then there is no pneumonia.

Lower lobe right-sided pneumonia

Many patients go to the hospital when they are worried about symptoms such as shortness of breath, cough accompanied by mucous sputum, fever up to 39 degrees, pain with a tingling sensation on the right side under the rib. After listening to the patient's complaints, the doctor examines him, listens and probes where necessary. If there is a suspicion that the patient has community-acquired right-sided pneumonia, which, as a rule, occurs much more often (which is why we pay special attention to it), he is assigned a full examination:

Laboratory tests: general, clinical and biochemical blood tests, urine and sputum analysis.
Instrumental studies, which include chest x-ray, fiberoptic bronchoscopy and electrocardiogram. The form of darkening on the X-ray image allows you to clarify the diagnosis, and fibroscopy - to reveal the involvement of the bronchi and trachea in the process of inflammation.

If the results of all tests confirm that the patient has right-sided community-acquired pneumonia, the medical history is supplemented. Before starting therapy, the results of studies for all indicators are recorded in the patient's card. This is necessary in order to adjust it as necessary during treatment.

Laboratory and instrumental studies can show inflammation of the lower right lobe of the lung. This is another case history. Community-acquired lower lobe pneumonia - this will be the diagnosis. When it is accurately established, the doctor prescribes treatment that is individual for each patient.

How is community-acquired pneumonia treated?

Patients with such a diagnosis can be treated both in the hospital and at home. If the patient has community-acquired pneumonia, the history of the disease must be started, regardless of the place of treatment. Outpatients are conventionally divided into two groups. The first group includes people under 60 years of age who do not have concomitant diseases. The second - over 60 or people with concomitant diseases (of any age). When a person has community-acquired pneumonia, treatment is carried out with antibacterial drugs.

For patients of the first group, the following are prescribed:

"Amoxicillin" in a dosage of 0.5-1 g or "Amoxicillin / clavulanate" - 0.625 g at a time. Accepted 3 times a day.
An alternative to these drugs can be: "Clarithromycin" or "Roxithromycin" with a dosage of 0.5 g and 0.15 g, respectively. Take twice a day. Can be prescribed "Azithromycin", which is taken once a day in an amount of 0.5 g.
If there is a suspicion that the disease is caused by an atypical pathogen, the doctor may prescribe "Levofloxacin" or "Moxifloxacin" 0.5 g and 0.4 g, respectively. Both drugs are taken once a day.

If patients of the second group have community-acquired pneumonia, treatment is carried out using the following drugs:

"Amoxicillin / clavulanate" is prescribed three times a day at 0.625 g or twice a day at 1 g, "Cefuroxime" should be taken in an amount of 0.5 g at one time twice a day.
Alternative drugs may be prescribed: "Levofloxacin" or "Moxifloxacin" 0.5 g and 0.4 g, respectively, once a day by mouth. "Ceftriaxone" is prescribed 1-2 g intramuscularly, too, once a day.

Treatment of the disease in children

Community-acquired pneumonia in children with an uncomplicated form of the development of the disease, depending on age, is treated with the following drugs:

Children under 6 months are prescribed: "Josamycin" twice a day for a week at the rate of 20 mg per kilogram of body weight. Maybe "Azithromycin" - the daily rate should not exceed 5 mg per kilogram of body weight, the duration of treatment is 5 days.
Children under 5 years of age are prescribed "Amoxicillin" by mouth 25 mg / kg twice a day, the duration of treatment is 5 days. They can prescribe "Amoxicillin / clavulanate" in terms of 40-50 mg per kilogram of body weight or "Cefuroxin axetil" at a dosage of 20-40 mg / kg, respectively. Both drugs are taken twice a day, the duration of treatment is 5 days.
Children over 5 years of age are prescribed "Amoxicillin" at a dosage of 25 mg / kg in the morning and evening. If there is suspicion of atypical pneumonia, "Josamycin" is prescribed by mouth, increasing the dosage to 40 mg / kg per day for a week or "Azithromycin" according to the scheme: 1 day - 10 mg / kg, then 5 mg / kg for 5 days. If there is no positive result in treatment, you can replace "Amoxicillin" at the rate of 50 mg / kg once a day.

Preventive measures to prevent the disease

Prevention of community-acquired pneumonia is carried out using pneumococcal and influenza vaccines. If necessary, they are administered simultaneously, only in different hands. For this purpose, a 23-valent unconjugated vaccine is used. It is introduced:

People over 50 years old.
Persons living in nursing homes.
Adults and children with chronic diseases of the lungs, heart and blood vessels or under constant medical supervision.
Children and adolescents (from six months to the age of majority) taking aspirin for a long time.
Pregnant women 2-3rd trimesters.
Doctors, nurses and other hospital and dispensary staff.
Nursing staff.
Family members of those people who are at risk.
Home-based care providers.

Prevention of community-acquired pneumonia is:

A correct lifestyle, which involves physical exercise, regular long walks in the fresh air, active rest.
A balanced healthy diet with a normalized content of proteins, vitamins and microelements.
An annual flu vaccine for children and adults, which is given before the onset of the cold season. Flu is very often a complication. A person falls ill with pneumonia, which is difficult.
Life without hypothermia and drafts.
Daily cleaning and airing of the room.
Frequent hand washing and rinsing of the nasal passages.
Limitation of contacts with patients with ARVI.
During the period of mass spread of infection, taking honey and garlic. They are excellent immunostimulating agents.
If you or your child are sick with the flu, do not self-medicate, but call a doctor.

Today, community-acquired pneumonia remains widespread and potentially life-threatening.

The disease is common not only among adults but also among children. There are 3 to 15 cases of pneumonia per 1000 healthy people. This range of figures is due to the different prevalence of the disease in the regions of the Russian Federation. 90% of deaths after age 64 are due to community-acquired pneumonia.

If a patient is found to have pneumonia in 50% of cases, doctors will decide to hospitalize him, because the risk of complications and deaths from this disease is too great.

So what is community-acquired pneumonia?

Community-acquired pneumonia is an acute infectious process in the lungs that arose outside a medical institution or within 48 hours from the moment of hospitalization, or developed in people who have not been in long-term medical supervision for 14 days or more. The disease is accompanied by symptoms of lower respiratory tract infection (fever, cough, shortness of breath, sputum, chest pain. Radiographically, it is characterized by "fresh" foci of changes in the lungs, provided other possible diagnoses are excluded.

Symptoms

Pneumonia is difficult to diagnose because there is no specific symptom or combination of symptoms that is unique to this disease. Community-acquired pneumonia is diagnosed by a combination of nonspecific symptoms and physical examination.

Symptoms of community-acquired pneumonia:

fever;
cough with or without phlegm;
difficulty breathing;
chest pain;
headache;
general weakness, malaise;
hemoptysis;
heavy sweating at night.

Less common:

pain in muscles and joints;
nausea, vomiting;
diarrhea;
loss of consciousness.

In elderly people, symptoms from the bronchopulmonary system are not pronounced, in the first place are general signs: drowsiness, sleep disturbances, confusion, exacerbation of chronic diseases.

In young children with pneumonia, the following symptoms are present:

temperature increase;
cyanosis;
dyspnea;
general signs of intoxication (lethargy, tearfulness, sleep disturbance, appetite, breast refusal);
cough (may not be).

In older children, symptoms are similar to those in adults: malaise, weakness, fever, chills, cough, chest pain, abdominal pain, increased respiratory rate. If a child over 6 months of age is free of fever, community-acquired pneumonia can be excluded in accordance with the latest clinical guidelines.

The absence of an increase in temperature in children under 6 months of age in the presence of pneumonia is possible if the causative agent is C. trachomatis.

Treatment in adults and children

The main treatment is antibiotic therapy. At the first stages of outpatient and inpatient treatment, it is carried out empirically, that is, the doctor prescribes a drug based only on his assumptions about the causative agent of the disease. This takes into account the patient's age, concomitant pathology, the severity of the disease, the patient's independent use of antibiotics.

Treatment of mild community-acquired pneumonia is carried out with tablets.

When treating lung pneumonia with a typical course on an outpatient basis in persons under 60 years of age without concomitant diseases, therapy can be started with amoxicillin and macrolides (azithromycin, clarithromycin). If there is a history of allergy to penicillin or an atypical course of pneumonia is observed or the effect of penicillins is not observed, then preference should be given to macrolide antibiotics.

Patients over 60 years of age with concomitant diseases begin treatment with protected penicillins (amoxicillin / clavulanate, amoxicillin / sulbactam). As an alternative, antibiotics from the group of respiratory fluoroquinolones (levofloxacin, moxifloxacin, gemifloxacin) are used.

Severe community-acquired pneumonia requires multiple antibiotics. Moreover, at least 1 of them must be administered parenterally. Treatment begins with 3rd generation cephalosporins in combination with macrolides. Sometimes amoxicillin / clavulanate is prescribed. Alternatively, respiratory fluoroquinolones have been used in combination with 3rd generation cephalosporins.

Every patient with pneumonia must undergo a bacteriological examination of sputum. Based on its results, an antibiotic is selected that is sensitive to the detected pathogen.

If you suspect legionella pneumonia, parenteral rifampicin must be added.

If pneumonia is caused by Pseudomonas aeruginosa, then combinations of cefipime, or ceftazidime, or carbopenems with ciprofloxacin or aminoglycosides are used.

For Mycoplasma pneumoniae pneumonia, macrolides, or respiratory fluoroquinolones, or doxycycline are best.

In Chlamydia pneumoniae, the disease is also treated with fluoroquinolones, macrolides, and doxycycline.

The principles of antibiotic therapy in children differ in antibiotic groups. Many drugs are contraindicated for them.

The selection of an antibiotic is also carried out presumably until the microorganism that caused the disease is identified.

With mild and moderate pneumonia in children from 3 months to 5 years, protected penicillins (amoxicillin / clavulanate, amoxicillin / sulbactam, ampicillin / sulbactam) are prescribed inside. In severe cases in the same age category, they are the same, but parenterally for 2-3 days, followed by a switch to tablet forms. Antibiotics with the "Solutab" prefix are more effective.

If a hemophilic infection is suspected, amoxicillin / clavulanate with a high content of amoxicillin is selected (14: 1 from 3 months to 12 years and 16: 1 from 12 years).

In children over 5 years of age, in the absence of the effect of therapy with amoxiclav, macrolides (josamycin, midecamycin, spiramycin) can be added to the treatment.

The use of fluoroquinolones in children is contraindicated up to 18 years of age. The possibility of their use should be approved only by a council of doctors in a life-threatening situation.

What other antibiotics can be used in children under 3 months of age? If pneumonia is caused by enterobacteria, then aminoglycosides are added to the protected penicillins. In addition to amoxicillin in children of this age, ampicillin and benzylpenicillin can be used parenterally. In severe cases where resistant bacteria are present, carbapenems, doxycycline, cefotaxime, or ceftriaxone can be used.

Antibacterial therapy rules

the earlier antibacterial treatment is started, the better the patient's prognosis;
the duration of taking antibiotics in both adults and children should not be less than 5 days;
with mild pneumonia and prolonged normalization of temperature, treatment can be discontinued ahead of schedule for 3-4 days;
the average duration of antibiotic treatment is 7-10 days;
if pneumonia is caused by chlamydia or mycoplasma, treatment is extended to 14 days;
intramuscular administration of antibiotics is impractical, because their availability is less than with intravenous administration;
evaluation of the effectiveness of treatment can be carried out only after 48-72 hours;
efficiency criteria: temperature reduction, intoxication reduction;
x-ray picture is not a criterion by which the duration of treatment is determined.

Among the child population, community-acquired pneumonia can be caused not by a bacterium, but by a virus. In such cases, the use of antibiotics will not give any result, but will only worsen the prognosis. If pneumonia develops 1-2 days after the initial manifestations of a viral disease (especially influenza), then treatment can be started with antiviral drugs: oseltamivir, zanamivir, umifenovir, inosine pranobex, rimantadine.

In severe cases, in addition to fighting the pathogen, infusion therapy is carried out to eliminate intoxication, high temperature, oxygen therapy, vitamin therapy, and mucolytic treatment.

The most common mucolytic among adults and children is ambroxol. It not only liquefies phlegm and facilitates its excretion, but also promotes better penetration of antibiotics into the lung tissue. It is best used through a nebulizer. Bromhexine can also be used in children from birth. From 2 years old, ACC is allowed, from 1 year - Fluimucil. Carbocisteine \u200b\u200bis allowed for children from 1 month of age.

Forecast

The prognosis for community-acquired pneumonia is generally good. But severe pneumonia can be fatal in 30-50% of cases. The prognosis worsens if:

person over 70 years old;
the patient is on artificial ventilation;
there is sepsis;
pneumonia is bilateral;
there is arrhythmia with increased or decreased heart rate;
pathogen - Pseudomonas aeruginosa;
initial antibiotic treatment is ineffective.

If a high temperature occurs against the background or after a cold illness, you should definitely consult a doctor and take an X-ray of the lungs.

Community-acquired pneumonia treatment and symptoms

This disease is one of the leading causes of death in the world. Community-acquired pneumonia is an acute infection of the lung parenchyma caused by viruses, fungi, bacteria outside the hospital walls. Hospital or hospital form of pneumonia, on the contrary, develops in patients who are weakened by treatment or chronic illness, during therapy in a hospital.

Symptoms of the development of community-acquired pneumonia

It is often in the spring that many of us catch a variety of infections: something in between a cold, flu and bronchitis. As a result, it is not uncommon for the lungs to become severely inflamed, resulting in a condition such as pneumonia. The fight against pneumonia occurs quickly with a correct and timely diagnosis of the disease and an effective course of therapeutic treatment. Typical symptoms of the disease in an adult include:

1.the increase in body temperature, which lasts for three days;

2. malaise;

3.weakness;

4. severe headache;

6. nausea, vomiting;

7. cough with pus or blood;

8. labored breathing;

9. shortness of breath;

10. cardiovascular failure.

The most insignificant symptoms of pneumonia oblige every patient to consult a doctor.

Diagnosis of community-acquired pneumonia

The diagnostic symptoms of the disease are:

1.febrile state,

2. dry cough,

3.fine bubbling rales,

4.leukocytosis,

5. as well as identified infiltration.

X-ray diagnostics has low sensitivity and specificity. It is known that infiltrative changes for the first time days of the disease are poorly determined, they are characterized by low intensity in older people. There is a high inconsistency in the interpretation of images by radiologists. The diagnosis is established only against the background of the clinical picture and examination results.

Epidemiological studies show that infectious diseases account for 25% of cases that are associated with respiratory disease. Community-acquired pneumonia is 15 cases per thousand and is characterized by a certain cyclical nature. Mortality is 5%, and in old age up to 20%.

Features of the treatment of community-acquired pneumonia

In case of a mild illness, it is preferable to observe a home regime, preferably bed. To carry out antibacterial treatment for 7-10 days, taking fortified liquids (lingonberry, cranberry, lemon). With pneumonia of moderate and severe severity, immediate hospitalization with the use of vascular drugs, inhalations with humidified oxygen, the use of artificial lung ventilation. Empiric therapy is prescribed no later than 8 hours after the patient is admitted to the department.

The duration of treatment depends on the patient's condition. In uncomplicated pneumonia in adults, antibiotics are prescribed only for the disappearance of the temperature; with a complicated disease, treatment depends on the severity of the disease and the presence of complications.

Treatment involves exposure to the pathogen, elimination of intoxication, expectorants, bronchodilators, vitamins, exercise therapy, physiotherapy. With the development of heart failure, cardiac glycosides are prescribed, and with vascular insufficiency - analeptics.

The goal of physiotherapy for pneumonia in adults is to reduce inflammation and restore impaired perfusion-ventilation relationships in the lungs. The objectives of physiotherapy are:

1.acceleration of the resorption of the inflammatory infiltrate (anti-inflammatory and reparative-regenerative methods),

2.reduction of bronchial obstruction (bronchodilator methods),

3.reduction of manifestations of hyper- and discrimination (mucolytic methods of treatment of community-acquired pneumonia),

4.activation of alveolar-capillary transport (methods of enhancing alveolar-capillary transport),

5. increasing the level of nonspecific resistance of the organism (immunostimulating methods).

Therapy of community-acquired pneumonia in a hospital

The laboratory analysis of blood, sputum, and X-ray examination will help to determine the location of the patient during treatment (hospital or home). Basically, pneumonia is treated within the walls of the hospital and under the strict supervision of the attending physician. Antibiotics of different groups are used (Penicillin, macrolides, antifungal drugs, tetracyclines). Pneumonia without complication can be treated at home only after a doctor's accurate diagnosis.

Common pneumonia in adults is treatable with pills and cough syrups, and complex pneumonia can be treated with antibiotics. Expectorants are prescribed along with antibiotics. During the period of recovery and a decrease in temperature, exercise therapy, massage, breathing exercises can be prescribed, which consolidate the result of pneumonia treatment in an adult. Traditional medicine (decoctions, herbal teas) also help well. Do not forget about humid air in the ward or room, constant ventilation, plenty of drink, bed rest and vitamins (vegetables, fruits). Rest in sanatoriums is recommended after discharge from the hospital.

There are a number of reasons for inpatient treatment:

1.the patient's age (over 60 years old);

2. in the presence of concomitant diseases;

3. ineffectiveness of antibiotic therapy;

4. the desire of the patient.

For hospitalization of the patient, the following factors are also taken into account:

arterial pressure,
heart rate,
disturbances of consciousness,
body temperature,
and inadequate home care.

With the advent of antibacterial drugs with a wide spectrum of action, a high concentration of lung tissue is achieved with oral administration of drugs, and allows the treatment of community-acquired pneumonia on an outpatient basis.

Causes of community-acquired pneumonia

There are five main ways of penetration of pathogens of community-acquired pneumonia into the bronchial tree and alveolar parts of the lungs:

1. aerosol (infected air);

2.aspiration (oropharyngeal secretion);

3. hematogenous (the spread of microorganisms from the extrapulmonary focus of infection along the vascular bed, occurs with sepsis, septic endocarditis, some infectious diseases);

4. lymphogenous (spread of microorganisms from the extrapulmonary focus of infection through the lymphatic system);

5. direct spread of community-acquired pneumonia infection from adjacent affected tissues (abscess of the lungs, tumors, chest injuries).

Normally, protective mechanisms (cough reflex, mucociliary clearance, antibacterial activity of alveolar macrophages and secretory immunoglobulins) ensure the elimination of infected secretions from the lower respiratory tract. With the weakening of the general and local resistance of the organism after the penetration of bacteria into the lower respiratory tract, their adhesion to the surface of epithelial cells, penetration into the cytoplasm and reproduction occur. The adhesion factors for bacterial agents are fibronectin, sialic acids, etc.

Damage to epithelial and endothelial cells, activation of alveolar macrophages, migration of polymorphonuclear leukocytes and monocytes to the inflammation focus as a result of community-acquired pneumonia lead to the formation of a complementary cascade, which in turn enhances migration to the inflammation focus of polymorphonuclear leukocytes and erythrocytes, promotes albumin and other serum factors. This is accompanied by an increased production of pro-inflammatory cytokines, enzymes, procoagulants, increased exudation of the liquid part of the plasma into the alveoli, and ends with the formation of an inflammation focus.

Pneumonia or pneumonia is a very complex and dangerous infectious disease. It's hard to believe, but even today, when medicine seems to be able to cure anything, people continue to die from this disease. Community-acquired pneumonia is one of the types of disease that requires urgent and intensive treatment.

The causes and symptoms of community-acquired pneumonia

Everyone knows that the main cause of pneumonia (regardless of the form of the disease) is harmful viruses and bacteria. These microorganisms are distinguished by their vitality and the ability to adapt to different living conditions. Viruses can easily live even in the human body, but at the same time do not manifest themselves in any way. They pose a danger only when the immune system, for one reason or another, can no longer interfere with their growth and reproduction.

Community-acquired pneumonia is one of the types of pneumonia, which the patient picks up outside the walls of the hospital. That is, the main difference between the disease is in the environment where the infection that causes it began to develop. In addition to community-acquired pneumonia, there are other forms of pneumonia:

Nosocomial pneumonia is diagnosed if the symptoms of pneumonia in a patient appear only after hospitalization (after two or more days).
Aspiration pneumonia is a disease resulting from the penetration of foreign substances (chemicals, food particles, etc.) into the lungs.
Another type of the disease, very similar to community-acquired left- or right-sided pneumonia, is pneumonia in patients with defects in the immune system.

The main symptoms of different forms of pneumonia are practically the same and look as follows:

cough that is difficult to treat;
fever;
painful sensations in the chest;
increased fatigue;
sweating;
pallor;
wheezing in the lungs.

Treatment of community-acquired pneumonia

X-ray examination helps to diagnose pneumonia most reliably. The image clearly shows the darkened areas of the lungs affected by the infection.

The principle of treatment of community-acquired pneumonia, whether it be polysegmental bilateral or right-sided lower lobe form, is to eliminate the infection that caused the disease. As practice has shown, potent drugs - antibiotics - cope best with this task. You also need to be prepared for the fact that hospitalization is required during treatment.

The medication course for each patient is selected individually. Unfortunately, it is very difficult to reliably identify the virus that caused pneumonia from the first time. Therefore, it can be quite difficult to prescribe the right antibiotic the first time.

The list of the most effective drugs for the treatment of pneumonia is quite large and includes the following medicines:

Antibiotics for the treatment of unilateral or bilateral community-acquired pneumonia are most often prescribed in the form of injections for intramuscular or intravenous (in particularly difficult cases) administration. Although some patients are more like drugs in tablets. In any case, the standard course of treatment should not exceed two weeks, but it is strictly forbidden to end it prematurely.

If, two to three days after starting antibiotics, the patient's condition does not improve, and the main symptoms of pneumonia do not disappear, it is necessary to select an alternative antibiotic.

Community-acquired pneumonia is one of the most common diseases and in the structure of mortality in developed countries takes 4-5 place. Mortality in pathology is 2–5%, among elderly and senile people it increases to 15–20%. Antibacterial chemotherapy forms the basis of effective treatment. The decisive factor in choosing a drug should be the correct judgment about the nature of the disease.

Pneumonia is a group of lower respiratory tract diseases caused by infection. In this case, there is a predominant lesion of the alveoli and interstitial tissue of the lung.

The following, purely pragmatic differentiation of pneumonia is ubiquitous:

community-acquired: develops outside the walls of the hospital;
nosocomial, or hospital: occurs against the background of treatment of other diseases in a medical institution (hospital).

This is a conditional division of pneumonia, however, it is justified, since their etiological agents differ. After collecting the anamnesis, the doctor can make a judgment about the place of development of pneumonia, so that you can more reasonably approach the choice of an antibacterial agent.

Etiology of the development of the disease

The causative agents of community-acquired pneumonia are usually bacteria: pneumococci, streptococci, haemophilus influenzae. In recent years, the epidemiological significance of agents such as chlamydia, mycoplasma, legionella, and pneumocysts has increased. In young patients, pneumonia is more often caused by monoinfection, and in people over 60 years old - by associations of pathogens, most of which are represented by a combination of gram-positive and gram-negative flora.

While in gerontological institutions or some time after discharge from the hospital, the likelihood of developing pneumonia caused by gram-negative rods and staphylococci increases.

Symptoms of pneumonia

The main symptoms of pneumonia are usually:

an increase in body temperature to febrile and subfebrile numbers (above 37.1 ° C);
cough (more often with sputum production).

Less commonly, pleural pain, chills, shortness of breath are noted.

With lobar pneumonia, in particular with lower lobe pneumonia, signs of consolidation of lung tissues are revealed - bronchial breathing, shortening of percussion sound, increased vocal tremor. Auscultation most often reveals local small bubbling rales or a characteristic phenomenon of crepitus. In elderly and senile patients, the classic manifestations of pneumonia may be absent. Other signs of inflammation are possible: shortness of breath, hypothermia, fever, confusion (alone or a combination of these symptoms).

It must be remembered that pneumonia is a dangerous infectious disease, the causative agent of which can be spread by airborne droplets or by contact.

Right-sided pneumonia develops more often than damage to the left lung. This is due to the peculiarities of the anatomical structure of the respiratory tract.

When examining patients, dangerous signs should be carefully recorded: shortness of breath, hypotension, oliguria, severe bradycardia / tachycardia, confusion. The presence of septic foci can significantly affect the diagnosis and nature of therapy: pleural empyema, peritonitis, endocarditis, arthritis, brain abscess, meningitis, pericarditis.

Extrapulmonary manifestations help to understand the nature of the disease. So, polymorphic erythema and bullous otitis media are characteristic of mycoplasmosis, erythema nodosum is often observed in tuberculosis, retinitis is characteristic of toxoplasmosis and cytomegalovirus infection, skin rash - for chickenpox and measles.

Symptoms of Acute Community-Acquired Pneumonia

For acute pneumonia, the following symptoms are characteristic:

bilateral, abscessing or multilobe pneumonia;
rapid progression of the inflammatory process: within 48 hours of observation, the infiltration zone can increase by 50% or more;
severe respiratory and vascular insufficiency (the use of pressor amines may be required);
acute renal failure or oliguria.

Often, against the background of a severe course of pathology, such vital manifestations as multiple organ failure, infectious toxic shock, disseminated intravascular coagulation syndrome, and distress syndrome are diagnosed.

Diagnosis of pathology

In order to identify the pathogen, a bacteriological examination of sputum is traditionally carried out. The most convincing are sputum culture data obtained prior to initiation of therapy.

A bacteriological test takes a certain amount of time, and its results can be obtained after 3-4 days. An indicative method is microscopy of a sputum smear, stained according to Gram. Its main advantages are its general availability and short duration. Thanks to this research, you can determine the choice of the optimal antibiotic.

Determination of the sensitivity of the isolated microflora to an antibacterial agent is especially important in cases where the initial therapy was ineffective. It should be borne in mind that the results of bacteriological research may be distorted due to previous antibiotic therapy.

Despite the widespread use of laboratory diagnostic methods, it is often not possible to identify the causative agent of pneumonia, and in patients with a mild degree of the disease, this indicator is especially high (up to 90%). This is partly due to the known difficulties in the timely receipt of material from the focus of inflammation. Extreme difficulty in the etiological diagnosis of pathology is caused by:

absence of sputum (in 10–30% of patients in the early stages of the disease) and the difficulty of obtaining it in children, especially at the age of one year;
the inability to obtain bronchial secretions by invasive methods due to the severity of the patient's condition, insufficient qualifications of the medical staff or for other reasons;
combining bronchial contents with microflora of the upper respiratory tract and oral cavity;
high level of carriage of S. pneumoniae, H. influenzae and other conditional pathogens.

For the etiological decoding of chlamydial, legionella, mycoplasma, viral pneumonias, so-called non-cultural methods are often used. Currently, it is possible to use kits for the determination of antigens of pneumococcus, legionella, Haemophilus influenzae in urine. Unfortunately, these methods of express diagnostics are quite expensive, and not everyone can afford them.

An x-ray is taken to make a diagnosis. Revealed infiltrative changes can be fractional and multilobal. This is typical for the bacterial etiology of the disease (for pneumococcal, legionella pneumonia, as well as for pathologies caused by anaerobes and fungi).

With lobar pneumonia, in particular with lower lobe pneumonia, signs of consolidation of lung tissues are revealed - bronchial breathing, shortening of percussion sound, increased vocal tremor.

In the presence of diffuse bilateral infiltrations, pathogens such as influenza virus, staphylococcus, pneumococcus, legionella are usually detected. Multi-focal and focal infiltration can be homogeneous (legionella, pneumococcus) or inhomogeneous (viruses, staphylococcus, mycoplasma). The combination of interstitial and infiltrative changes is typical for a disease of a viral, pneumocystis and mycoplasma nature.

Treatment of community-acquired pneumonia

In almost all cases, the physician empirically chooses a first-line antibiotic for the treatment of pneumonia, based on knowledge of the allergic history, clinical and epidemiological situation, and the spectrum of antibiotic exposure.

Possible drugs for therapy:

penicillins and aminopenicillins (Ampicillin, Amoxicillin): for pneumonia caused by pneumococci;
macrolides (Erythromycin, Clarithromycin, Midecamycin, Roxithromycin, Spiramycin) and azalides (Azithromycin): for pneumonia caused by legionella, mycoplasma, chlamydia.

Macrolides are also an alternative treatment for streptococcal (pneumococcal) infection if you are allergic to β-lactam drugs. Instead of macrolides, tetracyclines (Doxycycline) can be prescribed, however, it is necessary to take into account the frequent resistance of gram-positive flora to this group of drugs.

In cases where it is assumed that mixed flora led to the development of community-acquired pneumonia, reinforced aminopenicillins (Amoxicillin / Clavulanate, Ampicillin / Sulbactam) or III generation cephalosporins (Cefotaxime, Ceftriaxone) are prescribed.

In the treatment of pathology caused by gram-negative microorganisms, aminoglycosides (Gentamicin, Amikacin) and fluoroquinolones are usually used. In severe cases, a combination of aminoglycosides and fluoroquinolones may be prescribed.

Despite the widespread use of laboratory diagnostic methods, it is often not possible to identify the causative agent of pneumonia, and in patients with a mild degree of the disease, this indicator is especially high (up to 90%).

Of particular difficulty is the treatment of pneumonia caused by Pseudomonas aeruginosa and other multidrug-resistant microorganisms. In such cases, the use of antipseudomonal cephalosporins (Ceftazidime), fourth-generation cephalosporins (Cefepime), carbapenems (Meropenem), or a combination of the listed antibacterial agents with aminoglycosides or fluoroquinolones is indicated.

In relation to the anaerobic flora, which often leads to aspiration pneumonia, carbapenems, Clindamycin, Metronidazole, Cefepime are active. For pneumocystis disease, it is best to use co-trimoxazole (Biseptol).

In what cases hospitalization is indicated

In severe pathology, hospitalization is indicated for all patients, in particular for infants and the elderly. Antibiotic therapy should be administered exclusively intravenously. For pneumonia with a septic course, which is characterized by a high mortality rate, it is extremely important to start early chemotherapy, in this case, the use of antibacterial agents should be started within one hour from the establishment of the diagnosis.

To stabilize hemodynamics, it is necessary to carry out infusion therapy, the introduction of pressor amines and (according to vital indications) high doses of corticosteroids is indicated.

Blood pressure with unstable hemodynamics, infectious-toxic shock should be increased as soon as possible. This is due to the fact that multiple organ disorders and mortality are directly related to the duration of hypotension.

In the case of severe pneumonia, it is quite justified to use antibiotics of the widest spectrum of action, such as carbapenems or cephalosporins of the III – IV generation in combination with macrolides. Later, after improving the patient's condition, clarifying the clinical situation or the causative agent of the pathology, the amount of antibacterial chemotherapy is reduced to the required minimum.

Possible complications

In adults and children, the most common complications of community-acquired pneumonia are:

acute renal failure;
respiratory failure;
abscess formation;
acute vascular insufficiency;

Prevention

It must be remembered that pneumonia is a dangerous infectious disease, the causative agent of which can be spread by airborne droplets or by contact.

Given that pneumococcus is the cause of up to 76% of pneumonia, vaccination is an effective protection against this common disease. For this purpose, the use of polyvalent polysaccharide vaccines containing antigens of 23 serotypes has been shown, which cause most (up to 90%) of pneumococcal etiology diseases.

Vaccination is carried out once, the subsequent revaccination is necessary for patients belonging to the high-risk group - people over 65 years old, as well as patients with reduced immunity.

Therapy for community-acquired pneumonia is usually done at home. In order for the body to effectively cope with the causative agent of the disease, it is necessary to strictly observe medical prescriptions.

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Community-acquired pneumonia, or, as it is also called, community-acquired pneumonia, is an infection caused by bacteria. They enter the body from the environment. Briefly answering the question, what is community-acquired pneumonia, then the disease can be defined as pneumonia as a result of infection by airborne droplets, which occurred without contact with medical institutions.

Bacterial out-of-hospital pneumonia is provoked by various microorganisms with reduced immunity. Most often, these are pneumococci, which enter the lungs from the nasopharynx, or Haemophilus influenzae. In young children and patients with chronic pathologies, pneumonia often occurs due to Staphylococcus aureus. The last pathogen - Klebsiella - lives on the surface of the skin and in the digestive tract and also affects humans with weak immune defenses.

The development of microorganisms is facilitated by:

severe hypothermia;
chronic diseases (diabetes, heart failure);
alcohol consumption;
transfer of operations.

Classification

On the side of inflammation

Community-acquired type bacterial pneumonia differs in terms of the inflammatory process. If the lung is affected on the right, then they speak of right-sided pneumonia, and vice versa.

The bronchus on the right side is wider and shorter than the left, so right-sided pneumonia is much more common. This form of the disease with inflammation of the lower lobes is characteristic of adults, especially those with diabetes, kidney disease, or the immunodeficiency virus. Right-sided pneumonia usually occurs with the activity of streptococcus, while the lower lobe region of the lung is affected.
Left-sided pneumonia is more dangerous than right-sided pneumonia. This is due to the anatomical features of the body. If bacteria have already penetrated into the left lung, it means that the person's immunity is very reduced. The main symptoms are cough and pain in the side. If the lesion is very large, the left side of the chest may lag behind when breathing.

By the affected area

Pneumonia can affect different areas. If a small area becomes inflamed, the disease is called focal. When several parts of an organ are infected, we are talking about segmental pneumonia. The total form is observed with inflammation of the entire lung. But if only one lobe of the organ is damaged, lobar pneumonia is diagnosed. She, in turn, is divided into upper lobe, lower lobe and central.

Upper lobe is considered a severe form and manifests itself with vivid symptoms with lesions of the circulatory and nervous systems.
Lower lobe pneumonia is reminiscent of abdominal pain. In this case, fever, chills and sputum discharge occur.
Central lobar pneumonia develops in the depths of the lung parenchyma, so its symptoms are very weak.

By severity

In accordance with the severity of the disease, several forms of its development are distinguished.

Mild bacterial pneumonia is treated with antibiotics at home. With the disease, there is slight shortness of breath during exertion and a slight fever. At the same time, normal pressure and clarity of consciousness are preserved. X-rays show small foci of inflammation in the lung tissue.
Moderate pneumonia differs in that it affects patients with chronic diseases. The disease is treated in a hospital setting. A person has tachycardia, sweating, fever, slight euphoria is possible.
Severe pneumonia usually requires hospitalization and treatment in the intensive care unit. Its main symptoms are respiratory failure and septic shock. Consciousness is very clouded, delirium is possible. Community-acquired pneumonia of a severe course has a high mortality rate, so the course of treatment is chosen with extreme caution.

According to the big picture

On the basis of the clinical course of the disease and its morphological features, acute and chronic pneumonia are distinguished.

Acute community-acquired pneumonia occurs suddenly and is characterized by intoxication of the body. Usually, the disease has a severe course, an intense cough appears with strong sputum in the form of pus and mucus. If acute pneumonia is not treated in time, it will become chronic.

Chronic bacterial pneumonia is characterized by damage not only to the lung, but also to the intermediate tissue. When elasticity decreases, then pathological processes develop. This is the proliferation of connective tissues, deformation of the bronchi and systematic respiratory failure. Constant relapses of inflammation involve new structural elements of the lungs.

Signs

Despite the fact that community-acquired pneumonia has an extensive classification, there are general symptoms of the disease that indicate the presence of an inflammatory process in the lungs:

heat;
dyspnea;
cough with sputum waste;
weakness and chills;
sweating;
headaches and muscle pains;
abdominal cramps;
diarrhea and vomiting.

Elderly people with pneumonia do not have a fever or a coughing fit. They are worried about tachycardia and confusion.

Community-acquired pneumonia in children

The disease can develop in children from 2-4 weeks of age.
In early childhood, streptococcus bacteria become the main cause of inflammation, while pneumococci and Haemophilus influenzae are rarely the causative agents of the disease.
In children over 3 - 5 years old, the conditions for the onset of the disease are the same as in adults. The symptoms of pneumonia also coincide with the signs of the inflammatory process in older patients.
Treatment of uncomplicated forms is carried out with antibiotics on an outpatient basis. The dosage is prescribed by the doctor, taking into account the child's body weight.
Pneumonia in children occurs with varying degrees of severity. Against the background of complications, the appearance of pulmonary abscesses, destruction, as well as cardiovascular failure is possible. Hospitalization is required for treatment.

Diagnostics

Community-acquired pneumonia is detected by specialists during examination. A separate medical history is required and all important clinical symptoms are assessed. Diagnosis of pneumonia on an outpatient basis has several stages.

A radiation exam is a chest x-ray. The organs of the chest cavity in the front part are examined, for which they take pictures in lateral and direct projections. The main sign of inflammation in the images is tissue thickening in the form of darkening. X-rays are used twice: at the beginning of the development of the disease and after antibacterial treatment.
Laboratory diagnostics is carried out by collecting analyzes. The main indicators are studied by a general blood test. This is, first of all, the number of leukocytes. In addition, the severity of the disease is characterized by biochemical tests for glucose and electrolytes. Arterial blood gas analysis is sometimes done.
Several microbiological tests are done to make a diagnosis. The coloration of materials from the lower respiratory tract is evaluated, and the pleural fluid is analyzed. As part of the express method, antigens in the urine are examined.

Accurate diagnosis

To exclude the possibility of other diseases affecting the respiratory tract, the doctor must make a differential diagnosis. It is aimed at separating pneumonia from diseases such as allergies, tuberculosis, tumors, collagenosis, pneumonitis.

The complex for differential diagnostics, in addition to the already mentioned examinations, includes ultrasound of the lungs, invasive methods, serology techniques, and oxygenation assessment.

If the influence of sepsis and endocarditis is possible, abdominal ultrasound and isotropic scanning are performed. To establish the final diagnosis in the early stages of the disease, computed tomography is organized.

Treatment

Getting rid of pneumonia on an outpatient basis is primarily associated with antibiotic therapy. For patients of working age without concomitant diseases, "Amoxicillin", "Clarithromycin" or "Roxithromycin" are prescribed. For the elderly and patients with other pathologies, they are prescribed "Cefuroxime", "Levofloxacin", "Ceftriaxone".
When phlegm starts to drain during a cough, expectorants are required. On an outpatient basis, vitamins, antipyretics and immunomodulators are also prescribed.
Treatment of community-acquired pneumonia should be accompanied by the use of large volumes of fluids - up to three liters per day. These can be juices and vitamin infusions. Only easily digestible foods should be left in the diet.
Severe pneumonia, as well as an average degree of the disease and a focal type, are treated in a hospital setting. Until the fever has passed, the patient should be kept to bed.

Official provisions

In 2014, the Russian Respiratory Society issued clinical guidelines for the diagnosis, treatment and prevention of community-acquired pneumonia in adults. The document contains provisions that help doctors choose a treatment strategy, and allow patients to make the right decisions about therapy and preventive measures.

Special criteria are used to determine the need for hospitalization. Among them are pronounced respiratory failure, septic shock, uremia, hypotension, impaired consciousness. According to clinical guidelines, it is enough to have more than one of these criteria in order to carry out treatment not on an outpatient basis, but in a hospital.
To identify the etiology of severe community-acquired pneumonia, a culture study of venous blood, bacteriological analysis of sputum and rapid tests for the detection of antigenuria of various bacterial nature are used.
The duration of antibacterial treatment for pneumonia with an unclear etiology is 10 days. If the focus of infection is located outside the lungs or there are complications, a long course of up to 2-3 weeks is needed.
In an inpatient setting, the patient requires respiratory support or non-invasive ventilation.
Clinical practice guidelines also describe prevention methods. The most popular are pneumococcal and influenza vaccines. First of all, they are recommended for patients with chronic pathologies and the elderly.

Prevention

As mentioned in the clinical guidelines, prevention of community-acquired pneumonia is vaccination. Family members of patients, nurses, adolescents, and even pregnant women may be given the 23-valent unconjugated vaccine.
A healthy lifestyle plays an important role in protecting against pneumonia. You need to be in the fresh air regularly, move a lot and eat a balanced diet.
In the fight against pneumonia at the preliminary stage, even a flu shot helps, because it is this disease that gives complications more often than others. Avoid drafts, wash your hands often and rinse your nose.

Summing up

Pneumonia of this type occurs in people of different ages as a result of the development of various bacteria in the lungs. They enter the body from the environment against the background of reduced immunity or other diseases.
There are different types of community-acquired pneumonia. Most often, the right bronchus is affected due to the anatomical features of a person. In this case, focal and lobar forms of the disease are observed. Lower lobe pneumonia is easier than upper lobe pneumonia and heals faster.
Inflammation is indicated by coughing up phlegm, fever, fever, and chest pain. The disease is diagnosed on the basis of ultrasound, X-rays and blood tests, urine and sputum.
The Russian Respiratory Society issues clinical guidelines for doctors and patients. According to them, you can establish the severity of the disease and choose the necessary treatment tactics.
Pneumonia of moderate and high severity is treated in a hospital setting. Disposal methods are the same as outpatient. This is the appointment of antibiotics and drugs to relieve local symptoms. Pneumonia in children is also treated.
The main form of prevention of out-of-hospital pneumonia is vaccination against infectious agents. Having a flu shot and maintaining a healthy lifestyle also helps.

To relieve the general intoxication syndrome at home, you can drink infusions of various herbs. This is a mother-and-stepmother, an agave with honey and cahors. You can consume a mixture of boiled milk, lard, honey and raw eggs internally. All these solutions are required to be drunk three times a day.
Inhalation helps with bronchitis, pneumonia and angina. You can rub a piece of gauze with onions, carry garlic beads with you. Vietnamese balm, which is sold in pharmacies, helps well for this purpose.
If a child is being treated for pneumonia at home, the room should always have humid and slightly cool air. It soothes breathing and reduces water loss in the body.
Sick children are not recommended systematic intake of antipyretic drugs. First, it reduces the effect of antibiotics. Secondly, at elevated temperatures, the body can give a full-fledged immune response to microorganisms, and they will die.

Community-acquired pneumonia (CAP) is an acute infectious disease that arose in an out-of-hospital setting, or that arose in the first 48 hours (2 days) after hospitalization and manifests itself as symptoms of an infectious lesion of the lower respiratory tract (cough, sputum production, shortness of breath, chest pain , fever) and radiographic signs of "fresh" focal and infiltrative changes in the lungs in the absence of an obvious diagnostic alternative

EPIDEMIOLOGY

Unfortunately, until now there is no "gold standard" for diagnosis and differential diagnosis of community-acquired pneumonia and other (non-pneumonic) community-acquired infections of the lower respiratory tract (LRTI), which cannot be ignored when analyzing individual epidemiological studies devoted to the study of the incidence of LRTI. In addition, to date, we have limited information on the prevalence of non-severe clinical forms of LRTI, since most estimates are based on an analysis of the population's demand for medical care.

Despite the great advances in modern medicine - the use of effective vaccines for prevention and antibacterial agents for treatment, the incidence of community-acquired pneumonia remains high in many countries of the world. So, for example, the incidence of community-acquired pneumonia in most countries is 10-12 per 1000 population, (most often children under 5 years old and people over 65 years old are sick), and the mortality rate for pneumonia is 50-60 per 100,000 of the US population and takes 6 th place among the causes of death. If we take the official statistics of the Ministry of Health of the Russian Federation (Central Research Institute for Organization and Informatization of Healthcare of the Ministry of Health of the Russian Federation) in 1999 in Russia among persons aged\u003e 18 years, more than 440,000 cases of community-acquired pneumonia were registered (which is 3.9% 0) ... However, it is obvious that these indicators do not reflect the true morbidity, which, according to calculations, reaches 14-15% 0, and the total number of patients in Russia annually exceeds 1,500,000.

List of references

1.National Center for Health Statistics. Health, United States, 2006, with chartbook on trends in the health of Americans. Available at: www.cdc.gov/nchs/data/hus/hus06/pdf.

2.Woodhead M, Blasi F, Ewig S, et al., Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26: 1138-1180.

Etiology and pathogenesis of community-acquired pneumonia

Pneumonia is caused by various pathogens. Thus, up to 100 types of microorganisms can be isolated from the tissue of a deceased patient from pneumonia, however, the number of pathogens that cause pneumonia is actually limited.

Local protection of the respiratory tract includes mechanical factors (aerodynamic filtration, branching of the bronchi, epiglottis, coughing and sneezing, oscillatory movements of the cilia of the ciliated epithelium of the bronchial mucosa), as well as the mechanisms of nonspecific and specific immunity, which, in turn, are subdivided into cellular and humoral. The reasons for the multiplication of an infectious agent in the respiratory parts of the lungs can be both a decrease in the effectiveness of the protective mechanisms of a macroorganism, and a massive dose of microorganisms and / or their increased virulence.

Four pathogenetic mechanisms can be distinguished, with different frequencies causing the development of pneumonia:

oropharyngeal aspiration... This mechanism is the main route of infection in the lower respiratory tract. In a relatively healthy person, under normal conditions, the oropharynx is colonized most often Streptococcus pneumoniae, while the lower parts of the respiratory tract remain sterile due to a number of protective mechanisms of the body and the respiratory system (cough reflex, mucociliary clearance, antibacterial activity of macrophages, secretory immunoglobulin). In case of violation of defense systems (for example, with a viral infection that affects the respiratory system or with massive reproduction Streptococcus pneumoniae) the infection of the lower respiratory tract occurs.;

inhalation of aerosolcontaining microorganisms. It is much less common and basically this infection mechanism plays an important role in infection with such atypical pathogens as Legionella spp... and C. pneumoniae;

hematogenous spread microorganisms from the extrapulmonary focus of infection (tricuspid valve endocarditis, septic pelvic vein thrombophlebitis);

direct spread of infection from adjacent affected organs (eg, liver abscess) or infection from penetrating chest wounds.

Despite significant progress in the field of microbiology, the etiology of community-acquired pneumonia seems to be possible to establish only in 50% of cases. In the same cases when the pathogen is sown (for example, S. pneumoniae), it is not possible to prove that it was he who caused the pneumonia, since this microorganism could simply be an "observer" of the infectious process, and not its cause. On the other hand, many new pathogens that cause pneumonia (such as L. pneumophila, C. pneumoniae, SARS-associated coronavirus, Hantavirusand others), therefore, perhaps we still have to isolate a number of microorganisms responsible for the development of pneumonia.

The most common causative agents of community-acquired pneumonia are:

Streptococcus pyogenes, Chlamidia psittaci, Coxiella burnetti, Legionella pneumophila, etc. (rarely).

And very rarely, the cause of community-acquired pneumonia can be Pseudomonas aeruginosa (often in patients with bronchiectasis, cystic fibrosis).

Outpatient patients:

Non-severe CAP in persons over 60 years of age and / or

with concomitant pathology

Enterobacteriaceae

Hospitalized patients (general department):

VP of a mild course

Enterobacteriaceae

Hospitalized Patients (ICU):

EP of severe course

Enterobacteriaceae

The etiological structure of the causative agents of pneumonia also depends on various factors (Table 2).

Risk factors for the development of community-acquired pneumonia of a certain etiology

Risk factor	Probable pathogens
Alcoholism
Chronic bronchitis, COPD, smoking
Decompensated diabetes mellitus
Stay in nursing homes
The presence of bronchiectasis, cystic fibrosis
Intravenous drug addicts
An outbreak of the disease in a closely interacting group (for example, schoolchildren, military personnel)

In addition, for the empirical choice of an antibacterial agent, it is of no small importance to know the structure of probable pathogens, as well as their sensitivity profile in a particular geographic region. So, on the territory of Russia, large-scale studies of PeGAS I, II (1999-2005) were carried out, in Ukraine - PARUS (Pneumococcus Antibacterial Resistance in Ukraine, with the support of the pharmaceutical company SANDOZ in 2008-2010)

According to the results of studies by some foreign authors, the resistance of pneumococci to penicillin, which is often combined with resistance to cephalosporins of I – II generations, tetracyclines, co-trimoxazole, is becoming a big problem and reaches 60%. Fortunately, on the territory of the post-Soviet space, such a problem has not yet been observed and the resistance of pneumococci to penicillins is no more than 10%, to macrolides - 0-8%. Respiratory fluoroquinolones still have high resistance to pneumococci (resistance of pneumococci to levofloxacin in 2003-2005 was 0.1%)

table 2... Resistance of S. pneumoniae to various antibacterial drugs (according to the PeGAS study, 1999-2005)

Antibacterial a drug	The share of moderately resistant / resistant strains,%
Antibacterial a drug	1999-2000 (n \u003d 210)	2001-2003 (n \u003d 581)	2003-2005 (n \u003d 919)
Benzylpenicillin
Amoxicillin
Amoxicillin + clavulanic acid
Ceftriaxone
Erythromycin
Azithromycin
Clarithromycin
Midecamycin
Clindamycin
Levofloxacin
Tetracycline
Co-trimoxazole
Chloramphenicol
Vancomycin

List of references:

Chuchalin A.G., Sinopalnikov A.I., Struchunsky L.S. and other Community-acquired pneumonia in adults: practical recommendations for diagnosis, treatment and prevention. Wedge Microbe Antimicrobial Chimother 2006; 8: 54-86.

Lieberman D, Schlaeffer F, Boldur I, et al. Multiple pathoges in adults patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients. Thorax 1996; 51: 179-184.

Features of community-acquired pneumonia

Etiological factors

Clinical manifestations

Diagnostic measures

Pneumonia treatment

Other therapies

Community-acquired pneumonia: diagnosis, treatment. Prevention of community-acquired pneumonia

What is community-acquired pneumonia?

Pneumonia in an adult

What is pneumonia?

Symptoms

The reasons

Causative agents of the disease

Diagnostics

Radiation examination

Lower lobe right-sided pneumonia

How is community-acquired pneumonia treated?

Treatment of the disease in children

Preventive measures to prevent the disease

Symptoms

Treatment in adults and children

Antibacterial therapy rules

Forecast

Community-acquired pneumonia treatment and symptoms

Symptoms of the development of community-acquired pneumonia

Features of the treatment of community-acquired pneumonia

Causes of community-acquired pneumonia

The causes and symptoms of community-acquired pneumonia

Treatment of community-acquired pneumonia

Etiology of the development of the disease

Symptoms of pneumonia

Symptoms of Acute Community-Acquired Pneumonia

Diagnosis of pathology

Treatment of community-acquired pneumonia

In what cases hospitalization is indicated

Possible complications

Prevention

Video

Classification

On the side of inflammation

By the affected area

By severity

According to the big picture

Signs

Community-acquired pneumonia in children

Diagnostics

Accurate diagnosis

Treatment

Official provisions

Prevention

Summing up

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