Bacterial pneumonia is the microbic infection of respiratory departments of lungs proceeding with development of an intra alveolar ekssudation and inflammatory infiltration of a pulmonary parenchyma. Bacterial pneumonia is followed by fever, weakness, a headache, cough with a mucopurulent or rusty phlegm, short wind, breast pain, a mialgiya and artralgiy, pulmonary insufficiency. The diagnosis of bacterial pneumonia is based on data of fizikalny survey, a X-ray analysis of lungs, the general and biochemical blood tests, microscopy and crops of a phlegm. The basis of treatment of bacterial pneumonia is made by etiotropny antibiotic treatment.
Bacterial pneumonia – the sharp infectious and inflammatory process in pulmonary fabric caused by pathogenic microbic flora and which is characterized by development of feverish, intoksikatsionny syndromes and respiratory insufficiency. Among other etiologichesky forms of pneumonia (virus, parasitic, fungal and so forth) bacterial pneumonia surely keeps the first place. With annually bacterial pneumonia about 1000 people on 100 thousand population get sick. The most vulnerable contingent - children is younger than 5 years and elderly people after 75 years. In pulmonology the problem of pneumonia focuses attention on itself in connection with the steady growth of number of cases of the complicated current and level of a lethality.
Bacterial pneumonia develops at damage of lungs grampolozhitelny and gramotritsatelny bacteria, many of which can be present at normal microflora of the top airways. The range of causative agents of bacterial pneumonia is defined by a disease form. The extra hospital form most often is caused by pneumococci, a hemophilic stick. Intrahospital bacterial pneumonia is usually initiated by multiresistant strains of golden staphylococcus, a sinegnoyny stick, Friedlander's stick, enterobakteriya, a hemophilic stick, anaerobe bacterias. Activators the fan - the associated pneumonia arising when using IVL on early terms (48-96 h) are inhabitants of microflora of a mouth, on late (> 96 hours) – intrahospital strains.
At other bacterial diseases (anthrax, gonorrhea, salmonellosis, a tulyaremiya, a typhoid, whooping cough) of causative agents of pneumonia representatives of specific microflora can serve. At an immunodeficiency as bacterial agents pneumococci, a legionella and a hemophilic stick often act.
Pathogenic microorganisms can get into pulmonary fabric in the direct, airborne and hematogenic way. At patients with neurologic symptomatology and violation of consciousness aspiration of a secret of a mouth and nasopharynx, kontaminirovanny is often observed by bacteria. The hematogenic dissemination of the causative agent of bacterial pneumonia happens to blood current from the extra pulmonary center (at an infectious endocarditis, zaglotochny abscess). The infection can get into lungs at wounds of a thorax, a trachea intubation, from surrounding fabrics at break of poddiafragmalny abscess etc.
In pathogenesis of bacterial pneumonia not only virulence and the mechanism of penetration of the activator, but also level of local and general immunity is defining. The SARS, smoking, alcohol intake, frequent stresses, overfatigue, hypovitaminosis, advanced age, air pollution contribute to development of bacterial pneumonia. Decrease in immune protection happens at the accompanying pathology: stagnant heart failure, congenital defects of bronchopulmonary system, HOBL, a chronic LOR-infection, an immunodeficiency, it is heavy and long the proceeding diseases; owing to surgical intervention and a long immobilization.
On a clinical current allocate focal (bronchial pneumonia) and share (lobarny, krupozny) bacterial pneumonia. At a focal form inflammatory changes affect certain sites of pulmonary fabric and the bronchial tubes adjoining to them; at share – a parenchyma of the whole share of a lung. More often the lower departments of lungs are surprised. Unilateral and bilateral bacterial pneumonia can take place, at simultaneous damage of a pleura the pleuropneumonia develops.
Classification of nosological forms of a disease is based on types of infectious activators according to which distinguish pnevmokokkovy, staphylococcal, streptococcal, meningococcal pneumonia, and also pneumonia caused by a hemophilic stick, klebsiyelly, colibacillus, a sinegnoyny stick, legionelly, etc.
By kliniko-pathogenetic criteria bacterial pneumonia can have character extra hospital (out-patient) or nozokomialny (hospital, intrahospital) infections with development of symptoms in 48-72 hours after the room of the patient in a hospital. Bacterial pneumonia can have a lung, average degree, a heavy and long current.
Symptoms of bacterial pneumonia
Clinical manifestations and weight of a course of bacterial pneumonia are defined by activator type, defeat volume, age and the state of health of the patient. At typical option of bacterial pneumonia there is sudden remittiruyushchy fever, cough of productive character with mucopurulent or a rusty look a phlegm, sometimes pleural thorax pains. Patients are disturbed by strong weakness, a sharp indisposition, a headache, short wind, a mialgiya and an artralgiya, appetite loss. Quite often sinusovy tachycardia, arrhythmia, arterial hypotonia comes to light. Symptoms of a respiratory, heart and renal failure can develop.
The rough beginning, jump of temperature to 40 °C with recidivous oznoba, the general serious condition connected with destruction of lungs, emergence of the centers of a necrosis, cavities, an abstsedirovaniye of pulmonary fabric is characteristic of staphylococcal pneumonia. Fridlenderovsky pneumonia reminds krupozny pneumonia, has a long current and is followed by fever (39-40 °C), persistent cough, allocation of a viscous brown phlegm with an unpleasant smell, the general intoxication, bystry development of extensive necroses of pulmonary fabric, single abscesses, pleurisy, heart attack of a lung, septic complications. Hard proceeding pneumonia caused by a sinegnoyny stick is characterized by the high level of a lethality. At pnevmokokkovy pneumonia the necrosis and an abstsedirovaniye develop seldom.
Atypical forms of pneumonia arise at infection of lungs with anaerobe bacterias of an oral cavity, legionelly. As their feature serves gradual development of symptomatology, domination of extra pulmonary manifestations. For example, legionellezny pneumonia is followed by neurologic manifestations, liver dysfunction, diarrhea. At elderly persons bacterial pneumonia differs in a long current with a long subfebrilitet, noticeable deterioration in health, the expressed short wind, an exacerbation of associated diseases, TsNS dysfunction.
Damage of airways with inflammatory infiltration of a parenchyma of lungs is peculiar to bacterial pneumonia; syndrome of irritation of a pleura and pleural exudate. The formation of the centers of a necrosis of pulmonary fabric with formation of a cavity which is complicated by necrotic pneumonia, lung abscess is possible. Also complications of bacterial pneumonia can become an empiyema of a pleura, lung gangrene, at the expressed DN - a respiratory distress syndrome. Generalization of a bacterial infection is dangerous by development of a glomerulonefrit, meningitis, infectious and toxic shock, sepsis.
At survey of the patient with bacterial pneumonia pallor, cyanosis, heavy breath is noted; at a palpation – strengthening of voice trembling from defeat; at percussion – shortening and obtusion of a pulmonary sound; at an auskultation - strengthening of a bronkhofoniya, rigid or bronchial breath, damp melkopuzyrchaty rattles and noise of friction of a pleura. The inflammation syndrome at bacterial pneumonia is confirmed leykotsitozy with shift of a formula to the left, a limfopeniya, moderate or substantial increase of SOE, emergence of S-jet protein.
The X-ray analysis of lungs in direct and side projections defines existence, localization and extent of sites of an inflammation and destruction of pulmonary fabric, existence of a pleural exudate. The microscopy, and also cultural crops of a phlegm and washing waters of bronchial tubes helps to establish the potential causative agent of bacterial pneumonia. Crops of blood on sterility, the analysis of a pleural exudate, IFA are in addition carried out. At short wind and chronic pulmonary pathology FDV is studied, at the heavy complicated course of bacterial pneumonia the gas composition of arterial blood for assessment of level of a gipoksemiya and a giperkapniya, saturation of Hb is investigated by oxygen.
Spiral KT and MPT of lungs are applied at differentiation of the diagnosis. At diagnosis of bacterial pneumonia it is required to exclude infiltrative tuberculosis, lung cancer, a lung heart attack, eozinofilny infiltrate, stagnant heart failure, a lung.
Treatment of bacterial pneumonia
Treatment of bacterial pneumonia depending on severity is carried out on an outpatient basis or in the conditions of a hospital, in need of office of IT. During the feverish period the bed rest, plentiful drink, easily acquired good nutrition is recommended.
Etiotropny antimicrobic therapy is appointed empirically with correction after identification of the activator and receiving an antibiotikogramma. At bacterial pneumonia aminopenicillin, macroleads, tsefalosporina in the form of monotherapy or a combination of several antimicrobic medicines are applied. At not heavy extra hospital pneumonia oral and intramuscular forms of medicines are appointed, at a heavy current their intravenous administration is expedient; duration of treatment makes 10-14 days. At the pneumonia caused by stafilokokka, enterobakteriya and legionelly longer course of antibiotic treatment making 14-21 days is necessary. At aspiration and hospital bacterial pneumonia ftorkhinolona, karbapenema, combinations with aminoglycosides, linkozamida and metronidazole are in addition used.
In the complicated cases also the immunotherapy, correction of microcirculator violations and a disproteinemiya, a kislorodoterapiya is carried out dezintoksikatsionny. Febrifuges, analgetics, glucocorticoids, heart medicines can be appointed. The aerozolterapiya with bronkho-and mukolitichesky means is shown to patients with bronkhoobstruktivny pathology. At an abstsedirovaniye the sanatsionny bronkhoskopiya with use of solutions of anti-septic tanks, antibiotics, mucolytics is carried out. Breathing exercises, massage, physiotherapy are recommended. Observation of the therapist and pulmonologist, sanatorium treatment is shown.
Forecast and prevention
The forecast of bacterial pneumonia is caused by weight of process, adequacy of antibiotic treatment. The lethality at bacterial pneumonia reaches 9% (at a nozokomialny form - 20%, at elderly patients are 30%, in the complicated cases - to 50%). Prevention consists in sanitation of the purulent centers of ENT organs, observance of rules and the principles of carrying out IVL, increase in immune responsiveness. Composed adequate antibiotic treatment of various infections is important.