Long pneumonia — an acute inflammation in pulmonary fabric at which, according to kliniko-radiological data, pneumonic infiltrate is allowed slowly, in the extended terms (over 4-6 weeks). Unlike chronic pneumonia, long pneumonia usually comes to the end with recovery of the patient. About 30% of acute pneumonias accept long character of a current. Chronic intoxication or the weakened condition of an organism, irrational antibiotic treatment, the accompanying violation of drainage function of bronchial tubes, advanced age and prematurity, the complicated course of an acute pneumonia can serve as the reasons of it. The medical algorithm at long pneumonia consists of carefully picked up rational antibiotic treatment, the obligatory restoration of drainage function of bronchial tubes all-strengthening and immunokorregiruyushchy treatment.
Long pneumonia — an acute inflammation in pulmonary fabric at which, according to kliniko-radiological data, pneumonic infiltrate is allowed slowly, in the extended terms (over 4-6 weeks). Unlike chronic pneumonia, long pneumonia usually comes to the end with recovery of the patient. About 30% of acute pneumonias accept long character of a current.
Reasons of a long course of pneumonia
The main role in development of long pneumonia belongs to decrease in the immune answer of the organism including changes from specific and nonspecific factors of protection: decrease of the activity of T and V-lymphocytes, reduction of synthesis of interferon, suppression of a complement and fagotsitoz, violation of activity of macrophages. As a result anti-infectious protection of an organism weakens that promotes long, sluggish permission of the inflammatory center in a lung.
Serve as the reasons bringing to the long course of pneumonia:
- irrational antibiotic treatment (incorrectly picked up antibacterial medicine, a late initiation of treatment, early cancellation of an antibiotic, development of resistance of the causative agent of pneumonia to the applied antibiotic);
- the violation of drainage function of a bronchial tree interfering timely permission of an acute pneumonia;
- foreign matters of bronchial tubes;
- development of complications of an acute pneumonia – an empiyema of a pleura, an atelektaz, lung abscess;
- the weakening of an organism and immunosuppression caused chronic bronchopulmonary and others by diseases of internals, some medicinal substances (for example, steroids), the carried-out anti-inflammatory therapy, HIV infection etc.;
- prematurity at children and advanced age at adult patients;
- etiologichesky factor (mikoplazmenny, pnevmotsistny pneumonia);
- chronic intoxication of an organism (production, alcoholic, nicotinic, etc.).
Long pneumonia can develop both at focal, and at a segmentary acute inflammation of lungs. The inflammatory center at long pneumonia can be localized in one segment (segmentary pneumonia), to take several segments of one share of a lung (polysegmentary pneumonia) or all share (share pneumonia).
Polysegmentary pneumonia can be unilateral and strike separate segments in different shares of one lung, or bilateral and strike segments in different shares at once of both lungs. Most often long pneumonia is localized in segments of the lower and average share of the right lung, the lower share of the left lung, and also reed segments of the top shares of lungs.
Symptoms of long pneumonia
Monosegmentary long pneumonia has rather smooth current in comparison with polysegmentary of which a recurrence, heavy manifestations, long regression of the center of an inflammation is characteristic. At merge of the inflammatory centers the condition of the patient is aggravated 2-3 weeks later after initial displays of a disease. Again the subfebrilny temperature, perspiration, fatigue, the general weakness, slackness, cough increase. Distinctive feature of long pneumonia is scarcity of manifestations at pronounced radiological changes in lungs. In a zone of the struck segment damp melkopuzyrchaty rattles are listened, shortening of a perkutorny sound is defined.
Complications of long pneumonia influence an outcome and the subsequent forecast of a disease. Allocate extra pulmonary and pulmonary complications of long pneumonia. Treat extra pulmonary complications of long pneumonia: hypostasis of lungs, bakteriotoksichesky shock, the DVS-syndrome, nonspecific endocarditises and myocardites, meningitis and an encephalomeningitis, anemia, toxic hepatitis, glomerulonefrit, psychoses. Pulmonary complications of long pneumonia are an ekssudativny pleurisy, gangrene and abscess of lungs, an obstructive syndrome, sharp respiratory insufficiency, the pneumosclerosis deforming bronchitis. Often repeating long pneumonia having the same localization, pneumonia of a heavy current, and also the pneumonia developing owing to hit of foreign matters in airways, especially at children leads to development of chronic pneumonia.
Laboratory and kliniko-radiological data form the basis for diagnosis of long pneumonia. At suspicion of long pneumonia enter the program of inspection of patients: the general blood tests and urine, biochemical blood test (the general protein, proteinaceous fractions, sialovy acids, fibrin, seromukoida, S-jet protein), an immunogramma of blood (immunoglobulins M and A, B - and T – lymphocytes), the roentgenogram of lungs (in 2 projections), a bronchography, a phlegm research ( and sensitivity to antibiotics, cytology, atypical cages), a bronkhoskopiya – for an exception of a foreign matter of bronchial tubes.
Serve as diagnostic criteria of long pneumonia:
- long course of pneumonia (over 4 weeks);
- the phenomena of local segmentary endobronchitis which are defined at a bronkhoskopiya;
- radiological the defined peribronkhialny and focal infiltration of segmentary or lobarny (share) localization not regressing over 4 weeks, strengthening of the pulmonary and vascular drawing from defeat;
- laboratory signs of the continuing inflammatory process: , the raised SOE, increase in blood of level of fibrin, sialovy acids, seromukoid;
- signs of immunological violations: decrease in blood of the IgM level and increase in IgA, decrease of the activity of T-limfotsitov-killerov and helper and increase in activity of T-lymphocytes – supressor, etc.;
- clinical, laboratory and radiological recovery of the patient in individual terms (up to 3 - 12 months).
Treatment of long pneumonia
The principles of treatment of long pneumonia have the features. The issue of expediency of continuation of antibacterial therapy at long pneumonia is resolved after the analysis of a technique and results of previous. Need of continuation of antibacterial therapy arises in case of preservation of the expressed infiltrative changes in pulmonary fabric, changes in peripheral blood and symptoms of intoxication. Antibiotics are selected taking into account data of the bacteriological analysis of a phlegm. More often antibiotics of a broad spectrum of activity are appointed (aminoglycosides, tsefalosporina, etc.).
Special attention at long pneumonia is paid on restoration of a drainage and passability of bronchial tubes. Expectorant means, a position drainage, bronchial spasmolytics, massage of a thorax are for this purpose appointed. In some cases (at the resistant phenomena of purulent endobronchitis) for sanitation of a bronchial tree there is a need of carrying out a bronkhoalveolyarny unleavened wheat cake. In treatment of long pneumonia the respiratory gymnastics, LFK, physiotherapeutic treatment, reflexotherapy is widely applied.
At long pneumonia special attention is paid to a research of system of immunity and assessment of factors of nonspecific protection. If necessary medicinal immunocorrection is carried out. A frequent recurrence of long pneumonia with accurate localization is the indication to consultation of the thoracic surgeon for the solution of a question of surgical treatment (a segmentary resection of a lung or lobectomy).
Forecast and prevention
Development of pulmonary and extra pulmonary forms of complications is considered a failure of long pneumonia. Most often at long pneumonia absolute clinical recovery occurs in 2-6 months and is characterized by a rassasyvaniye of the pneumonic center and restoration of ventilating function of lungs. Prevention of long pneumonia comes down to carrying out a full and adequate course of treatment of an acute pneumonia, careful sanitation of a nasopharynx and oral cavity, actions for immunity strengthening, refusal of smoking and alcohol intake.