Pneumonia - treatment and symptoms of the disease in adults and children

2024 Author: James Gerald | [email protected]. Last modified: 2023-12-17 14:00

Pneumonia is an inflammatory disease of the lungs of an infectious nature that affects their various tissues, in particular the interstitial and alveoli. Inflammation of the lungs can occur both with its characteristic symptoms and secretly. Treatment of pneumonia in adults, depending on the severity of the disease, is carried out both inpatiently and outpatiently.

What is pneumonia

Pneumonia (pneumonia) is an acute infectious inflammation of the lung tissue, which can be caused by pathogenic microorganisms of a different nature (bacteria, viruses, fungi, etc.).

In terms of the number of cases, pneumonia is in 4th place after oncological pathologies, cardiovascular diseases and injuries of various nature. In the acute form, the disease is diagnosed in 10-14 people out of 1000, and at the age of 50 years - in about 17.

The danger of pneumonia lies in the high risk of death, especially in patients in childhood. In addition, pneumonia can cause serious complications for all systems of the body.

Causes of the disease

Inflammatory processes in the tissues of the lungs can occur for a variety of reasons. The most common type of pneumonia is bacterial, which develops against the background of acute respiratory infections and is caused by pneumococcal bacteria (Streptococcus pneumoniae).

Also, bacterial pneumonia can be triggered by other types of bacteria, including:

• Haemophilus influenzae (Haemophilus influenzae);
• Mycoplasma pneumoniae (mycoplasma bacteria);
• Staphylococcus aureus (Staphylococcus aureus);
• Legionella pneumophila (bacteria of the genus Legionella);
• Chlamydophila pneumoniae (intracellular gram-negative bacterium);
• Chlamydophila psittaci (an intracellular gram-negative bacterium that causes common diseases in humans and animals).

The last 3 types of bacteria rarely cause pneumonia in humans.

Also, various viruses can be the cause of inflammation of the lower respiratory tract:

• measles;
• parainfluenza;
• adenovirus;
• respiratory syncytial;
• influenza type A and B.

More rare types of viruses that provoke inflammation of lung tissue include:

• coronavirus SARS-CoV-2;
• MERS-CoV coronavirus;
• SARS-CoV virus.

The rarest viruses that cause pneumonia:

• hantavirus;
• cytomegalovirus;
• herpes virus;
• rubella;
• chickenpox.

Viral pneumonia is one of the most common causes of ARVI complications.

Inflammation of the lungs caused by fungal infections is most common in patients with weakened immune systems. Pathogenic organisms that cause pneumonia include:

• Histoplasmacapsulatum is a fungus that affects not only lung tissue, but also other internal organs;
• Coccidioides immitis is a microorganism that affects the lungs, bones and skin;
• Blastomycesdermatitidis is a fungus that causes lung disease not only in humans, but also in animals.

Also, the cause of pneumonia can be getting into them:

• chemical substances;
• smoke;
• foreign bodies (nuts, crumbs and other food particles);
• vomit.

Pneumonia caused by objects or substances that enter the lungs is called aspiration pneumonia.

There are cases of a complex form of pneumonia, in which pathogenic microorganisms belonging to different groups become the cause of the disease. For example, viruses and fungi.

Classification and stages of development of pneumonia

Pneumonia is classified according to various factors that make it possible to identify the cause of its appearance, stage, degree of development and other important characteristics of the disease.

According to the severity of the course, pneumonia is divided into the following types:

• Light degree. The lesion occupies only 1 small area, there is no shortness of breath, intoxication is mild (tachycardia is not more than 90 beats / min., Blood pressure is within normal limits, temperature is not higher than 38 ° C). Mild pneumonia in adults is treated with antibiotics in tablets or capsules.
• Medium. Severe damage to the lung tissue. Tachycardia - 100 beats / min., A slight decrease in blood pressure, temperature up to 39 ° C, severe weakness, sweating, clear consciousness.
• Severe degree. Extensive lung involvement. Cyanosis of the skin and mucous membranes, severe shortness of breath, collapse, tachycardia from 100 bpm, decrease or complete cessation of motor activity, clouding of consciousness, delirium, temperature 39-40 ° C.

According to the results of clinical and morphological studies, pneumonia is divided into the following types:

• interstitial;
• focal;
• parenchymal.

Taking into account the presence of complications, pneumonia is characterized as uncomplicated or complicated. Also, pneumonia happens both with the presence of functional disorders, and without them.

By the nature of the flow, it happens:

• chronic;
• acute lingering;
• sharp.

According to the degree of damage to the tissues of the lungs, pneumonia can be:

• central (root);
• sublobular;
• segmental;
• share;
• total;
• bilateral;
• one-sided.

According to the pathogenesis, pneumonia is:

• primary (as an independent disease);
• secondary (as a complication of other diseases);
• heart attack pneumonia (developing due to blockage of small vessels of the pulmonary artery);
• postoperative;
• post-traumatic;
• aspiration.

Depending on the pathogen, pneumonia is classified as follows:

• mixed;
• fungal;
• mycoplasma;
• viral;
• bacterial.

Based on epidemiological studies, the following types of pneumonia are distinguished:

• atypical;
• caused by immunodeficiency conditions;
• nosocomial;
• community-acquired.

All characteristics of pneumonia are of great importance in the diagnosis and prescription of treatment, therefore, each of them must be given attention during the examination.

Risk factors

There are certain groups of people who are more prone to developing pneumonia. At risk are:

• patients with a weakened immune system;
• people with chronic pathologies;
• smokers;
• elderly people;
• preschool children.

Patients with diseases of the following organs are also susceptible to pneumonia:

• kidney;
• liver;
• hearts;
• lungs (in particular cystic fibrosis, asthma and others).

Various factors affect the weakening of the immune system:

• AIDS or HIV;
• drugs taken after organ transplant;
• chemotherapy;
• recent viral diseases.

Also at risk are people who abuse alcohol, lead an inactive lifestyle and have chronic diseases of the respiratory system.

Is pneumonia contagious

Quite often, the cause of the development of pneumonia is pathogenic microorganisms that are transmitted from person to person. But this does not mean that the effect of microbes on the body will be the same as that of a patient with pneumonia. Therefore, this disease is not considered contagious.

How is pneumonia transmitted

Despite the fact that pneumonia is not contagious, the contact person automatically falls into the risk group. This is due to the fact that it is not known how pathogens will behave in the body. With a strong immunity, they can be absolutely safe, and with a weakened one, they can cause inflammatory processes in any internal organs, including the lungs.

They can get to a person in different ways:

• through the birth canal or intrauterinely (through the amniotic fluid);
• through the blood;
• through saliva;
• by airborne droplets.

To reduce the risk of infection, it is necessary to limit contact with a person who has been diagnosed with pneumonia as much as possible.

Symptoms and first signs

The development of pneumonia and the appearance of the first signs primarily depend on the state of the immune system. If it is weakened, then the symptoms are more pronounced. With strong immunity, the disease can be latent for some time.

The first symptoms of the development of acute pneumonia include:

• lack of appetite;
• nausea;
• diarrhea (in some cases);
• confusion of consciousness;
• runny nose;
• pain and / or a sore throat;
• hoarseness of the voice;
• increased fatigue;
• dyspnea;
• feeling short of breath.

The first symptoms do not appear immediately after infection. This usually happens after the incubation period, which lasts 2-4 days, has passed.

The main symptom of pneumonia, which appears one of the first, is coughing. It can be both dry and moist, with a viscous sputum of a greenish or yellowish tint, sometimes containing streaks of blood.

As the disease progresses, the following symptoms join:

• cardiopalmus;
• chills;
• difficulty breathing;
• significant increase in body temperature;
• chest pain.

During adolescence, the symptoms of pneumonia are the same as in an adult. But at the age of 13-17, the disease proceeds much easier and rarely gives complications.

The main difference between pneumonia in old age is a dry cough with a small amount of sputum. Often in elderly patients, the disease proceeds in a latent form and its development can be suspected only by shortness of breath, even at rest.

In children under one year old, in addition to the main symptoms, the following signs can also speak of pneumonia:

• refusal to eat;
• increased sleepiness;
• capriciousness;
• decreased activity;
• pallor of the skin;
• excessive sweating.

In young children, with pneumonia, breathing becomes more frequent (the number of breaths / exhalations can be more than 50, at a rate of 20-40, depending on age).

Also, each type of pneumonia has its own characteristic symptoms. The most dangerous type of this disease is lobar pneumonia. Its main features include:

• fever;
• pain on one side of the sternum, aggravated by inhalation;
• red spots on the neck, localized on the side of the inflamed lung;
• sometimes loss of consciousness, delirium;
• signs of intoxication (discoloration of the skin, headache, nausea, vomiting, and others);
• brown sputum streaked with blood;
• blue lips;
• dyspnea;
• frequent, gradually worsening dry cough.

The symptoms of SARS differ depending on the type of pathogen.

Mycoplasmas:

• regular nosebleeds;
• swollen lymph nodes;
• muscle pain;
• joint aches;
• dry cough;
• sore throat;
• runny nose.

Chlamydia:

• swelling of the lymph nodes;
• significant increase in body temperature (up to 38-39 ° C).

Against the background of pneumonia caused by chlamydia, the patient develops an allergy (even if there was no previous tendency to it), bronchitis and dermatitis.

Legionella:

• a sharp rise in temperature up to 40 ° C;
• dry cough;
• headache;
• chills.

This type of pneumonia is one of the most dangerous, as it is fatal in 60% of cases.

Chronic pneumonia is characterized by the following symptoms:

• increased sweating at night;
• weight loss;
• poor appetite;
• mild signs of intoxication;
• decreased immunity;
• chronic rhinitis;
• labored breathing;
• dyspnea;
• tachycardia.

During the recurrence of chronic pneumonia, a dry cough appears, and the body temperature rises slightly.

With focal inflammation of the lung tissues, the symptoms increase in waves - fluctuations in body temperature, heart rhythm failures, and bouts of sweating are noted.

How does the disease develop

Any type of pneumonia develops quickly enough. There are 3 stages of disease development, each characterized by different symptoms and severity of the patient.

The first stage or the tide stage (1-2 days after the incubation period):

• a sharp increase in temperature to 39-40 ° C (while antipyretic drugs are ineffective);
• moist fine bubbling rales;
• dyspnea;
• when listening, there is a weakening of vesicular breathing;
• growing signs of intoxication;
• during breathing, a visible lag of the part of the chest, in which the inflamed lung is located, while its symmetry remains;
• exhausting dry cough;
• cyanosis of the skin.

At the 2nd stage (5-10th day), or the stage of hepatization, the following symptoms are added:

• separation of viscous sputum interspersed with pus or blood;
• difficulty breathing;
• heart failure;
• forced lying on its side;
• increased blue skin;
• severe redness of the skin of the face;
• increased breathing rate up to 25-30 breaths / exhalations per minute;
• shortness of breath, accompanied by shortness of breath;
• trembling voice;
• when tapping over the affected area, a dullness of the percussion sound is noted;
• vesicular breathing becomes hard;
• listening to the friction noise of the plerva.

On the 10th day, the stage of resolution begins, which is characterized by the following symptoms:

• lowering the temperature;
• reduction of manifestations of intoxication;
• when tapped, the pulmonary sound is clear;
• elasticity returns to the lung tissue;
• the crunchy sound in the lungs characteristic of the disease disappears;
• breathing is vesicular.

With timely adequate treatment, complete recovery occurs without the development of complications.

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Diagnostics

Diagnosis of pneumonia is carried out only by a specialist and takes place in several stages. It is impossible to independently determine the disease, since in a number of signs it is similar to other pathologies of the lungs.

The survey includes:

• physical methods - interrogating the patient, listening to the lungs, tapping the chest, measuring the temperature;
• laboratory tests - general blood and urine analysis, sputum analysis;
• X-ray examination of the lungs;
• bronchoscopy;
• Ultrasound of the pleural region.

Based on the results of the examination, the type of pneumonia is determined and therapy is prescribed, which, depending on the severity of the disease, is carried out inpatiently or on an outpatient basis. At the same time, when treating pneumonia at home, you must follow the doctor's recommendations.

Consequences and complications

With timely treatment for medical care, pneumonia is completely cured and is not afraid of any health consequences. Complications of the disease appear most often with self-medication or if the patient has severe chronic pathologies.

Complications of pneumonia in the lungs include:

• broncho-obstructive syndrome;
• pleurisy;
• respiratory failure;
• pulmonary bleeding;
• abscess;
• gangrene.

Non-pulmonary complications include:

• psychical deviations;
• encephalitis;
• meningitis;
• infectious toxic shock;
• DIC syndrome, characterized by thrombus formation;
• diseases of the cardiovascular system.

Also, when toxic substances enter the bloodstream, diseases of the following internal organs can develop:

• pancreas;
• kidney;
• liver;
• pleura;
• pericardium.

The most severe complication of pneumonia is sepsis (blood poisoning), which is often fatal.

Is it possible to treat pneumonia at home

An uncomplicated form of pneumonia in patients with sufficiently strong immunity can be treated at home. In this case, it is necessary to follow all the recommendations of the attending physician. Treating pneumonia at home without a doctor's prescription is extremely dangerous.

Patients with moderate and severe pneumonia, with weakened immunity and in old age are treated for the disease only in a hospital setting.

Pneumonia treatment

For the treatment of pneumonia, complex therapy is used, which includes several methods. The types of drugs selected by the doctor for treatment directly depend on the type of pathogen, stage of the disease and the patient's condition.

Which doctor treats the disease

At the first symptoms of pneumonia, you should seek medical help. The definition of the diagnosis and the appointment of the examination is the responsibility of the therapist. He also prescribes treatment for mild forms of the disease, involving treatment at home.

In case of hospitalization, a pulmonologist deals with treatment tactics and selection of therapy. The same doctor may prescribe additional studies if the causative agent of inflammation has not been previously identified.

When to see a doctor

Medical attention should be sought immediately after deterioration of health. The disease in most cases develops rapidly, therefore, the earlier therapy was started, the higher the likelihood of a successful outcome.

Indications for the disease

In the treatment of pneumonia, an integrated approach is used, which includes different methods. When treating pneumonia, the following are used:

• antimicrobial drugs;
• respiratory support (if necessary);
• non-antibacterial drugs (in case of obvious indications);
• antipyretic (at a temperature of 38 ° C);
• physiotherapy (as an aid).

During the treatment of pneumonia, the doctor closely monitors the patient's condition in order to exclude the risk of complications of chronic pathologies.

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Antimicrobial drugs

The main drug used to treat pneumonia is antimicrobial drugs.

These include:

• respiratory fluoroquinolones;
• macrolides;
• beta-lactam antibiotics related to cephalosporins and penicillins.

In some cases (only if indicated), the following antibiotics are used to treat pneumonia:

• Linezolid;
• Vancomycin;
• lincosamides;
• aminoglycosides;
• tetracyclines.

With pneumonia of a viral nature, provoked by influenza, the following drugs are used:

• Zanamivir;
• Oseltamivir.

When treating at home, your doctor will usually prescribe antibiotics in the form of tablets or capsules for oral use.

In the treatment of pneumonia in adults in a hospital, intravenous administration of the drug is practiced in the first few days. Then, as the patient's condition improves, oral medication is prescribed.

With proper treatment of pneumonia, according to patients' reviews, significant relief of the condition occurs on the 5th day. On average, therapy for pneumonia takes 10 days, but if complications are detected, the course can last 21 days.

Respiratory support

Respiratory support is used in case of signs of respiratory distress. With a weak or moderate lack of oxygen in the blood, oxygen therapy is used, which is performed using a mask with a disposable bag or a nasal mask.

In acute oxygen deficiency, artificial lung ventilation is used. The main indications for mechanical ventilation are:

• loss of consciousness;
• increase in PaCO2> 20% from the initial level;
• respiratory rate more than 35 / min;
• the partial pressure of oxygen in arterial blood is less than 150 mm Hg;
• unstable hemodynamics (heart rate less than 50 / min., blood pressure less than 70 mm Hg);
• psychomotor agitation;
• sopor;
• coma;
• cessation of breathing.

Artificial ventilation of the lungs is used if it is not possible to raise the oxygen level in the blood to the required level with the help of oxygen therapy.

Non-antibacterial therapy

Non-antibacterial medications are prescribed when complications develop. They are also used to stimulate the immune system.

For the treatment of pneumonia with non-antibacterial drugs, the following agents are used:

• immunostimulants;
• immunoglobulins;
• glucocorticosteroids.

To eliminate sepsis and reduce the risk of death, polyclonal immunoglobulins are prescribed.

Contraindications for disease

With pneumonia, it is strictly forbidden to self-medicate, since for adequate therapy it is necessary to establish the causative agent of the disease. The selection of antibiotics should only be made by the attending physician. When prescribing a drug, it takes into account several factors:

• what medications are taken by the patient in connection with chronic diseases;
• the presence of any reactions to previous courses of antibiotics;
• individual intolerance to the components of the drug;
• allergies;
• survey results.

In the acute phase of the disease, it is forbidden to use physiotherapy methods that involve tissue heating.

Community-acquired pneumonia

Community-acquired pneumonia is pneumonia that develops after hospitalization, within 2 days, or outside the hospital. It is installed using various types of research.

What it is

Community-acquired pneumonia is an acute infectious disease that most often develops during the SARS and influenza season. With the course of the disease in a mild form, it is allowed to undergo treatment at home.

Causes of community-acquired pneumonia in adults

Community-acquired pneumonia can develop regardless of the state of the person's immunity. The most common causative agents of the disease include:

• mycoplasma;
• legionella;
• streptococcus;
• haemophilus influenzae;
• Pneumococcus.

Pneumocystis and chlamydia are more rare pathogens of pneumonia. Recently, the risk of developing pneumonia has sharply increased against the background of the influenza virus, coronavirus, etc.

In young patients, pneumonia caused by a single pathogen is most often diagnosed. In old age, several types of pathogenic microorganisms are usually involved in the development of pneumonia, which significantly complicates treatment.

Symptoms of community-acquired pneumonia in adults

Symptoms of community-acquired pneumonia in adults usually appear 2-4 days from the onset of the disease. The main features include:

• dry cough that gradually turns into a wet cough;
• sputum streaked with pus and / or blood;
• an increase in body temperature, in which antipyretics are ineffective;
• pain in the lower chest, which becomes worse when coughing;
• dyspnea;
• noise and wheezing when breathing;
• chills;
• excessive sweating.

Symptoms may vary depending on the affected area. In severe forms of the disease, other signs may be added. These include:

• loss of consciousness;
• problems with the digestive system (nausea, vomiting, loss of appetite, and others);
• malfunctions of the cardiovascular system.

When treating community-acquired pneumonia in adults, antibiotics are given intramuscularly. Especially in severe forms of the disease.

It is noted that due to the structural features of the lower respiratory organ, most often inflammatory processes occur in the right lung.

Prophylaxis

Any disease, especially pneumonia, is much easier to prevent than to cure. If you follow the recommendations of doctors, you can significantly reduce the risk of developing pneumonia. The main rules for the prevention of this disease include:

• observance of personal hygiene (wash your hands after a walk, try not to touch your face with them, use antiseptic agents, etc.);
• regularly ventilate living quarters and do wet cleaning in them;
• give up bad habits, especially smoking;
• arrange daily walks in the fresh air;
• pay sufficient attention to sports training (at least 2 times a week);
• follow the drinking regime;
• normalize the diet;
• do not self-medicate even the usual ARVI;
• avoid overheating or hypothermia;
• during the cold season, wear a medical mask and try to be in public places less often.

You can protect yourself from the risk of developing pneumonia with vaccinations. It is especially relevant for people at risk.

Currently, 2 vaccines with proven high efficacy are used:

• conjugated 13-valent pneumococcal;
• unconjugated 23-valent.

These drugs are used to prevent any infections caused by pneumococcus, including pneumonia.

Outcomes

Inflammation of the lungs is an extremely dangerous infectious disease that quite often leads to the development of complications in different systems of the body. In addition, pneumonia can be fatal. Therefore, at the first symptoms of the disease, it is necessary to seek medical help.