Acute pneumonia – ostroprotekayushchy inflammatory process in a parenchyma and an interstition of lungs in which etiology the defining role belongs to an infectious factor. The acute pneumonia is followed by a fever, persistent fever, cough with a mucopurulent phlegm, an indisposition, a headache, short wind and tachycardia. Pneumonia is diagnosed on a kliniko-radiological picture, auskultativny yielded, to results of laboratory researches. Therapy of an acute pneumonia is directed to all links of an etiopatogenez and includes prescription of antibiotics, mucolytics, bronchodilators, expectorant and antihistamines, infusional therapy, oxygenotherapy, physiotreatment.
Acute pneumonia – the infectious and inflammatory defeat of respiratory departments of lungs proceeding with an intoksikatsionny and bronchopulmonary syndrome, characteristic radiological changes. The acute pneumonia belongs to the most widespread diseases of respiratory system, quite often is followed by complications, causes up to 9% of lethal outcomes that requires the strengthened attention of experts in the field of therapy and pulmonology. On character of a current the acute pneumonia is divided on ostrotekushchy (up to 3 weeks) and long (up to 2 months), developing usually against the background of decrease in immuno-biological reactivity of a macroorganism. Cases of an acute pneumonia considerably become frequent during the winter and spring period, especially at sharp fluctuations of weather, during the epidemic outbreaks of respiratory infections.
Classification of an acute pneumonia
Classification of acute pneumonias relies on distinctions of an etiology, pathogenesis, anatomic and clinical manifestations. On kliniko-morphological properties distinguish parenchymatous and interstitsialny pneumonia; krupozny (lobarny or pleuropneumonia) and focal (bronchial pneumonia); on prevalence of an inflammation - melkoochagovy, focal (in borders of several segments), krupnoochagovy and drain (with coverage of the most part of a share).
Acute pneumonias arise initially or again as complications of infectious diseases (a SARS, flu, measles), chronic pathology of respiratory organs (bronchitis, a tumor), cardiovascular system, kidneys, blood, system diseases, metabolic violations. Taking into account epidemic criteria differentiate extra hospital and hospital forms of an acute pneumonia.
On a causal factor allocate infectious (bacterial, virus, mikoplazmenny, rikketsiozny, fungal, mixed), allergic, stagnant, post-traumatic acute pneumonias, and also the pneumonia caused by chemical or physical irritants. Aspiration pneumonia can develop at inhalation of foreign matters (food parts, emetic masses); a heart attack pneumonia - owing to a thrombembolia of vascular network of lungs.
Reasons of an acute pneumonia
The dominating role in an etiology of an acute pneumonia belongs to an infection, first of all, of bacterial. Usually pneumococci (30-40%), a mycoplasma (6-20%), golden staphylococcus (0,4-5%), Friedlander's stick become causative agents of a disease, is more rare - a hemolytic and not hemolytic streptococcus, sinegnoyny and hemophilic sticks, mushrooms and their associations; among viruses – a flu virus, the RS-virus, adenoviruses. Purely viral acute pneumonias meet seldom, usually SARS facilitate colonization of tissue of lung of endogenous or more rare exogenous bacterial microflora. At ornithosis, chicken pox, whooping cough, measles, a brucellosis, anthrax, salmonellosis development of an acute pneumonia is defined by the specific causative agent of this infection. Microorganisms get to the lower departments of respiratory tract in the bronkhogenny way, and also hematogenic (at infectious diseases, sepsis) and limfogenny (at thorax wound) ways.
The acute pneumonia can arise after impact on respiratory departments of easy chemical and physical agents (the concentrated acids and alkalis, temperature, ionizing radiation), as a rule, in combination with secondary bacterial infection with autogenic microflora from a pharynx and the top airways. Owing to long use of antibiotics in development of acute pneumonias there was more significant a role of opportunistic microflora. There are cases of the allergic (eozinofilny) acute pneumonias caused by helminthoses and reception of medicines. The acute pneumonia can proceed neoslozhnenno and with complications; in easy, average or heavy degree; with absence or development of functional violations.
Various factors reducing resistance of a macroorganism contribute to developing of an acute pneumonia: long intoxications (including, alcoholic and nicotinic), overcooling and the increased humidity, the accompanying chronic infections, a respiratory allergy, nervous shocks, infantile and advanced age, a long bed rest. Penetration of an infection into lungs is promoted by violation of passability and drainage function of bronchial tubes, oppression of a kashlevy reflex, insufficiency of mukotsiliarny clearance, defects of pulmonary surfactant, decrease in local immunity, including, fagotsitarny activity, level of a lizotsim and interferon.
At an acute pneumonia the inflammation mentions alveoluses, interalveolar partitions and the vascular course of lungs. And on different sites of the affected lung various phases – inflow, red and gray "opecheneniye", permission can be observed at the same time. Morphological changes at an acute pneumonia are variable depending on a type of the activator. Some microorganisms (staphylococcus, a sinegnoyny stick, a streptococcus) allocate the ekzotoksina causing deep damage of pulmonary fabric with the advent of multiple small, the centers of abstsediruyushchy pneumonia sometimes merging. At acute fridlenderovsky pneumonia extensive infarktopodobny necroses in lungs will be organized. The Interstitsialny inflammation dominates at pneumonia of pnevmotsistny and Cytomegaloviral genesis.
Symptoms of an acute pneumonia
The clinical picture of an acute pneumonia can differ with the level of expressiveness of the general and bronchopulmonary manifestations that substantially is defined by the activator, the state of health of the patient, the course of the accompanying pathology. Constant presence of the general violations is characteristic of the majority of forms of an acute pneumonia: fever, sharp rise in temperature and persistent fever, general weakness, perspiration, headache, tachycardia, excitement or adinamiya, frustration of a dream. Cough at an acute pneumonia has various character, being followed by the allocation of a mucopurulent phlegm which is speeded up by breath (till 25-30 in min.), breast pain or under a shovel. Focal pneumonia (bronchial pneumonia) in most cases begins against the background of bronchitis or sharp Qatar of the top airways. Febrilny fever of the wrong type is typical, at the elderly and weakened faces normal or subfebrilny temperature can keep.
Influenzal pneumonia usually develops sharply in the first - third day of a disease of flu. Proceeding, as a rule, easier bacterial, can sometimes get the hardest current with considerable intoxication and high fever, persistent cough, bystry development of hypostasis of lungs. The late pneumonia arising during recovery from flu is caused by bacterial microflora.
Staphylococcal pneumonia quite often arises as a sepsis complication. Tendency to the abstsedirovaniye which is followed by a serious general condition, febrilny temperature, cough with a purulent or mucopurulent phlegm, and at children and old men - a heavy lightning current is characteristic of it. Development of an empiyema of lungs is possible. The quantity of deaths at this type of an acute pneumonia remains high. Streptococcal pneumonia is observed less often, complicating the course of a SARS, measles, whooping cough, chronic diseases of lungs, being followed by necroses of pulmonary fabric, ekssudativny pleurisy. The pneumonia caused by a sinegnoyny stick proceeds hard: with risk of a dissemination, abstsedirovaniye, and at break of an abscess in a pleura - development of a piopnevmotoraks.
The pronounced clinic of krupozny pneumonia is developed suddenly, being expressed in tremendous oznoba, fever to 39-40 °C, the accruing short wind, cough with a rusty phlegm, (30-40 in min.) and tachycardias (100 - 120 . in min.), severe pains in a thorax (when involving a diafragmalny pleura - with irradiation in an abdominal cavity). High temperature can remain several days, falling down then within 1-3 days. At the heavy course of krupozny pneumonia diffusion cyanosis, hypotonia develops, patients can have an excitement, block, a condition of sharp psychosis; elderly persons with the accompanying pathology have nagnoitelny processes in lungs and a pleura; the risk of a lethal outcome is high.
In the outcome of an acute pneumonia complications from lungs are possible (couple - and metapneumonic pleurisy, sharp respiratory insufficiency, a pneumosclerosis, , lung abscess) and extra pulmonary complications (infectious and toxic shock, purulent and fibrinozny serozita, meningitis, infectious and allergic myocarditis, etc.). In 1-4% of cases transition of an acute pneumonia to a chronic form is probable.
Diagnosis of an acute pneumonia
The diagnosis of an acute pneumonia is based on kliniko-radiological yielded, results of assessment of FVD, a research of laboratory indicators. Percussion assessment at krupozny pneumonia reveals obtusion of a shade of a sound in process of strengthening of an ekssudation of alveoluses. Auskultativno on a breath is listened a krepitation, sometimes melkopuzyrchaty rattles, later - bronchial breath, a bronkhofoniya, noise of friction of a pleura.
In blood it is indicative , acceleration of SOE, positive ostrofazovy reactions; in urine - a proteinuria, the tsilindruriya and a mikrogematuriya are possible. In a phlegm at acute focal pneumonia the set of bacteria, leukocytes and a slushchenny epithelium of respiratory tract is found, at a krupozny form – erythrocytes.
At suspicion of an acute pneumonia the X-ray analysis of lungs in two projections in dynamics is appointed (to 7-10 day and 3-4 week). The radiological proof of infiltrative changes at krupozny and krupnoochagovy pneumonia is segmentary or share homogeneous intensive shading of pulmonary fabric; at bronchial pneumonia – non-uniform shading of a part of a share of average and small intensity with occupation of peribronkhialny and perivaskulyarny sites. In case of delay of a rassasyvaniye of infiltrates at an acute pneumonia KT of lungs is shown.
Bakposev of a phlegm, blood, urine allows to establish the activator and its antibiotikochuvstvitelnost. Changes of FVD of restrictive type (decrease in ZhEL, MVL, increase in FASHION) are characteristic of extensive drain focal and krupozny pneumonia. Bronkhoskopiya and the bronchography is carried out at the long course of an acute pneumonia that allows to reveal existence of bronkhoektaz, disintegration cavities in pulmonary fabric. Within the carried-out diagnostics bronchitis, lung cancer, tuberculosis, a lung heart attack, atelektatichesky bronkhoektaza are excluded.
Treatment of an acute pneumonia
Patients with an acute pneumonia need an early initiation of treatment, usually, in the conditions of a hospital. During the feverish period observance of a bed rest, plentiful drink and the easily acquired high-calorie food, vitamins is shown. At an acute pneumonia etiotropny therapy by the antibacterial medicines appointed proceeding from kliniko-radiological features is productive. Semi-synthetic penicillin (ampicillin, amoxicillin), aminoglycosides (gentamycin), tsefalosporina (), macroleads (erythromycin, ), tetratsiklina, as reserve – rifampicin, lincomycin are applied. In a sharp phase and at a heavy current 2-3 antibiotics or a combination of an antibiotic to metronidazole, sulfanylamides can be appointed. Intensity of a course of antibiotic treatment depends on weight and prevalence of damage of lungs.
Bronkholitichesky and expectorant medicines, mucolytics are shown to patients with an acute pneumonia. For elimination of intoxication perform infusions of salt solutions, a reopoliglyukin, in case of short wind and cyanosis demands purpose of oxygenotherapy. At cardiovascular insufficiency warm glycosides, are appointed. In addition to antibiotic treatment are used anti-inflammatory and antihistamines, immunoproofreaders. In a stage of permission of an acute pneumonia physiotreatment is effective (inhalations, an electrophoresis with chloride calcium, UVCh, vibromassage, LFK).
Forecast and prevention of an acute pneumonia
The forecast of an acute pneumonia at early full treatment rather favorable. The centers of a fibrinozny inflammation are exposed to a rassasyvaniye within 2-4 weeks, destructive – within 4-6 weeks. For half a year the residual phenomena can also longer remain. Extremely heavy current meets with complications and death at babies, elderly and the old men weakened patients with serious associated diseases more often.
The refusal of addictions, sports and hardening, good nutrition, sanitation of the chronic centers of an infection, vaccination against flu, the prevention of stresses belong to measures of prevention of an acute pneumonia. Had an acute pneumonia stand on the dispensary account at the pulmonologist within half a year.