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

Pneumonia is one of the most common acute diseases; it is a group of acute infectious (mainly bacterial) diseases, different in etiology, pathogenesis, and morphological characteristics, characterized by focal damage to the respiratory parts of the lungs with the obligatory presence of intra-alveolar exudation.

Community-acquired pneumonia (synonyms: home, outpatient) is an acute disease that arose in a community setting, accompanied by symptoms of lower respiratory tract infection (fever, cough, chest pain, shortness of breath) and “fresh” focally infiltrative changes in the lungs in the absence of obvious diagnostic alternatives.

The reasons for the development of an inflammatory reaction in the respiratory parts of the lungs can be either a decrease in the effectiveness of the body’s defense mechanisms, or a massive dose of microorganisms and/or their increased virulence. Aspiration of the contents of the oropharynx is the main route of infection of the respiratory parts of the lungs, and therefore the main pathogenetic mechanism for the development of pneumonia. Under normal conditions, a number of microorganisms, such as Streptococcus pneumoniae, can colonize the oropharynx, but the lower respiratory tract remains sterile.

In cases of damage to the “self-cleaning” mechanisms of the tracheobronchial tree, for example, during a viral respiratory infection, favorable conditions are created for the development of pneumonia. In some cases, an independent pathogenetic factor may be the massive dose of microorganisms or the penetration into the respiratory parts of the lungs of even single highly virulent microorganisms that are resistant to the action of the body’s defense mechanisms, which also leads to the development of pneumonia.

The etiology of community-acquired pneumonia is directly related to the normal microflora that colonizes the upper respiratory tract. Of the numerous microorganisms, only a few that have increased virulence are capable of causing an inflammatory reaction when they enter the lower respiratory tract.

Such typical pathogens of community-acquired pneumonia are:

• Streptococcus pneumoniae;
• Haemophilus influenzae.

Atypical microorganisms have a certain significance in the etiology of community-acquired pneumonia, although it is difficult to accurately determine their etiological significance:

• Chlamydophila (Chlamydia) pneumoniae;
• Mycoplasma pneumoniae;
• Legionella pneumophila.

Typical but rare pathogens of community-acquired pneumonia include:

• Staphylococcus aureus;
• Klebsiella pneumoniae, less commonly other enterobacteriaceae;
• Streptococcus pneumoniae is the most common causative agent of community-acquired pneumonia in people of all age groups.

The drugs of choice for the treatment of pneumococcal pneumonia are betalactam antibiotics - benzylpenicillin, aminopenicillins, including protected ones; II-III generation cephalosporins. New fluoroquinolones (levofloxacin, moxifloxacin) are also highly effective.

Macrolide antibiotics (erythromycin, roxithromycin, clarithromycin, azithromycin, spiramycin, midecamycin) and lincosamides have fairly high antipneumococcal activity and clinical effectiveness. But still, macrolide antibiotics for this pneumonia are a reserve remedy for beta-lactam intolerance.

Haemophilus influenzae

a clinically significant causative agent of pneumonia, especially in smokers and patients with COPD (chronic obstructive pulmonary disease). Aminopenicillins (amoxicillin), “protected” aminopenicillins (amoxicillin/clavulanate), cephalosporins of II-IV generations, carbapenems, fluoroquinolones (early ones - ciprofloxacin, ofloxacin and new ones - levofloxacin, moxifloxacin, gatifloxacin) have high natural activity against Haemophilus influenzae.

Chlamydophila (Chlamydia) pneumoniae and Mycoplasma pneumoniae

usually characterized by a mild course. Mycoplasma pneumonia - more common in people under 40 years of age. The drugs of choice for treating these pneumonias are macrolides and doxycycline. New fluoroquinolones are also highly effective.

Legionella pneumophila

usually characterized by a severe course. The drug of choice for the treatment of Legionella pneumonia is macrolide antibiotics (erythromycin, clarithromycin, azithromycin). Early and new fluoroquinolones are also highly effective.

Staphylococcus aureus

It is an infrequent causative agent of community-acquired pneumonia, but its importance increases in older people, in people who take drugs, abuse alcohol, and after suffering from influenza. The drugs of choice for staphylococcal pneumonia are oxacillin; amoxicillin/clavulanate, cephalosporins, and fluoroquinolones are also effective.

Klebsiella pneumoniae

and other enterobacteriaceae are very rare pathogens of community-acquired pneumonia and have etiological significance only in certain categories of patients (old age, diabetes mellitus, congestive heart failure, cirrhosis of the liver). III-IV generation cephalosporins, carbapenems, and fluoroquinolones have the highest natural activity against these pathogens.

Pneumonia should be suspected if the patient has a fever in combination with complaints of cough, shortness of breath, sputum production and/or chest pain. Patients often complain of unmotivated weakness, fatigue, and severe sweating, especially at night.

Signs of pneumonia such as acute fever, chest pain, etc. may be absent - especially in weakened patients and the elderly.

For mild pneumonia, antibacterial therapy can be completed once stable normalization of body temperature is achieved within 3-4 days. With this approach, the duration of treatment is usually 7-10 days. In cases where there is clinical and/or epidemiological evidence of mycoplasma or chlamydial etiology of pneumonia, the duration of therapy should be 14 days. Longer courses of antibacterial therapy are indicated for pneumonia of staphylococcal etiology or caused by gram-negative enterobacteria - from 14 to 21 days.

If legionella pneumonia is indicated, the duration of antibacterial therapy is 21 days. In case of community-acquired pneumonia, it is extremely important to quickly assess the severity of the patients' condition in order to identify patients requiring emergency intensive care. The allocation of patients with severe pneumonia into a separate group seems extremely important, given the high mortality rate, the presence, as a rule, of severe background pathology in patients, the peculiarities of the etiology of the disease and the special requirements for antibacterial therapy.

Late diagnosis and delay in starting antibacterial therapy (more than 8 hours) lead to a worse prognosis of the disease.

Unfortunately, pneumonia can have various complications, such as:

• pleural effusion;
• pleural empyema (accumulation of pus in the pleural cavity);
• destruction/abscessation of lung tissue (formation of limited cavities in the lung tissue);
• acute respiratory failure;
• infectious-toxic shock;
• sepsis;
• pericarditis, myocarditis (heart disease);
• nephritis (kidney disease) and others.

In case of pneumonia, a differential diagnosis must be made with such diseases as:

• pulmonary tuberculosis;
• neoplasms (primary lung cancer, endobronchial metastases, bronchial adenoma, lymphoma);
• pulmonary embolism and pulmonary infarction;
• immunopathological diseases (idiopathic pulmonary fibrosis, eosinophilic pneumonia, bronchocentric granulomatosis, bronchiolitis obliterans with organizing pneumonia, allergic bronchopulmonary aspergillosis, lupus pneumonitis, systemic vasculitis);
• other diseases/pathological conditions (congestive heart failure, drug-induced (toxic) pneumopathy, foreign body aspiration, sarcoidosis, pulmonary alveolar proteinosis; lipoid pneumonia, rounded atelectasis).

In conclusion, it must be said that only a doctor can make a diagnosis, determine the severity of the disease and the prognosis. If the patient has a fever, dry cough or cough with sputum, shortness of breath, chest pain, unmotivated weakness, fatigue, excessive sweating, especially at night, consult a general practitioner.

SM-Clinic’s own laboratory and instrumental base allows you to quickly diagnose and diagnose pneumonia. You will be prescribed timely treatment for pneumonia, individual for each person, taking into account the severity of the disease, age, and concomitant diseases. A therapist will help you become healthy again.

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Community-acquired pneumonia (CAP) are among the most common acute infectious diseases.

According to official statistics (Central Research Institute for Organization and Informatization of Health Care of the Ministry of Health of the Russian Federation), in 1999 in Russia, 440,049 cases of CAP (3.9 ‰) were registered among persons aged 18 years.

Obviously, these numbers do not reflect the true incidence.

Thus, according to foreign epidemiological studies, the incidence of community-acquired pneumonia in adults varies over a wide range: in young and middle-aged people 1-11.6 ‰; in older age groups – up to 25-44 ‰.

Mortality with CAP is the lowest (1-3%) in young and middle-aged people without concomitant diseases. On the contrary, in patients over 60 years of age with concomitant diseases ( chronic obstructive pulmonary disease (COPD), malignant neoplasms, alcoholism, diabetes mellitus, kidney and liver diseases, cardiovascular diseases, etc.), as well as in cases of severe community-acquired pneumonia (multilobar infiltration, secondary bacteremia, tachypnea 30 per minute, hypotension, acute renal failure) this figure reaches 15-30%.

From a practical point of view, community-acquired pneumonia should be understood as an acute disease that arose in a community setting, accompanied by symptoms of lower respiratory tract infection (fever, cough with sputum, possibly purulent, chest pain, shortness of breath) and radiological signs in the form of “fresh” focally infiltrative changes in the lungs in the absence of an obvious diagnostic alternative.

Pathogenesis

There are 4 pathogenetic mechanisms for the development of pneumonia:

Aspiration of oropharyngeal secretions (autoinfection);
- inhalation of aerosol containing microorganisms;
- hematogenous spread of microorganisms from an extrapulmonary source of infection (endocarditis of the tricuspid valve, septic thrombophlebitis of the pelvic veins);
- direct spread of infection from neighboring affected organs (for example, liver abscess) or as a result of infection from penetrating wounds of the chest.

Aspiration of oropharyngeal contents is the main route of infection of the respiratory parts of the lungs, and therefore the main pathogenetic mechanism for the development of CAP. Under normal conditions, a number of microorganisms, such as Streptococcus pneumoniae, can colonize the oropharynx, but the lower respiratory tract remains sterile.

Microaspiration of oropharyngeal secretions is a physiological phenomenon observed in 70% of healthy individuals, mainly during sleep. However, the cough reflex, mucociliary clearance, antibacterial activity of alveolar macrophages and secretory immunoglobulins ensure the elimination of infected secretions from the lower respiratory tract and their sterility.

When the mechanisms of “self-cleaning” of the tracheobronchial tree are damaged, for example, during a viral respiratory infection, when the function of the cilia of the bronchial epithelium is disrupted and the phagocytic activity of alveolar macrophages is reduced, favorable conditions are created for the development of community-acquired pneumonia. In some cases, an independent pathogenetic factor may be the massive dose of microorganisms or the penetration of even single highly virulent microorganisms into the respiratory sections of the lungs.

Inhalation of microbial aerosol is a less commonly observed route of development of CAP. It plays a major role in infection of the lower respiratory tract with obligate pathogens, such as Legionellapneumoniae.

Of even less importance (in terms of frequency of occurrence) is the hematogenous (for example, Staphylococcus pneumoniae) direct spread of the pathogen from the source of infection.

The spread of infection along the bronchial tree up to the alveoli is facilitated by:

1. Dysfunction of the ciliated epithelium of the respiratory tract, which does not provide evacuation of mucus and particles deposited on them, such as microbes, from the bronchi.

2. Violation of the secretory function of the bronchi with the formation of a large amount of viscous mucus, which creates favorable conditions for the proliferation of microbes.

3. Decreased local immunity in the bronchi.

4. Decreased cough reflex (cough is protective).

5. Impaired bronchial obstruction and chest mobility.

Factors that contribute to the occurrence of pneumonia include:

Frequent acute respiratory viral infections (ARVI);
- smoking;
- hypostasis (for example, due to a long stay in bed due to a serious illness or in the postoperative period) and chest trauma;
- chronic non-obstructive bronchitis and chronic obstructive pulmonary disease;
- immunodeficiency states, accompanied by inferiority of both the B- and T-immune systems, a state of intoxication;
- hypothermia (it precedes the development of the disease in 60-70% of cases, contributes to the development of pneumonia by reducing the body’s defenses).

Taking into account the described features of the pathogenesis of CAP, it is obvious that its etiology is associated with the microflora of the upper respiratory tract, the composition of which depends on the person’s environment, his age and general health.

Etiology

Streptococcuspneumoniae – pneumococcus (30-50% of cases);
- Hemophilus influenzae – hemophilus influenzae (1-3%).

In the etiology of community-acquired pneumonia, atypical microorganisms (with the intracellular location of pathogens) are of a certain importance, which account for from 8 to 25% of cases of the disease:

Chlamydophila pneumoniae;
- Mycoplasma pneumoniae;
- Legionella pneumoniae.

Typical but rare (3-5%) pathogens of community-acquired pneumonia include:

Staphylococcus pneumoniae;
- Klebsiellapneumoniae, less commonly other enterobacteria.

In very rare cases, the etiological agents of CAP may be:

Pseudomonasaeruginosa – Pseudomonas aeruginosa (in patients with cystic fibrosis, bronchiectasis);
- Pneumocystiscarinii (in HIV-infected patients, patients with other forms of immunodeficiency).

Particular attention should be paid to the role of viruses in the etiology of pneumonia. Many authors believe that influenza, by reducing general and local protective reactions, leads to activation of the bacterial flora, and pneumonia is viral-bacterial. Such pneumonia develops in people with the usual course of influenza on the 5-7th day of the disease (post-influenza pneumonia).

Their development and manifestations are caused by a bacterial or mycoplasma infection, for which influenza prepared the way. In very rare cases, true viral pneumonia with influenza is observed, which develops in the first days of the disease and manifests itself as purulent-hemorrhagic panbronchitis with hemorrhagic inflammation in the interstitial tissue.

From a practical point of view, it is advisable to identify groups of patients with community-acquired pneumonia, taking into account age, concomitant pathology and severity of the disease. Between these groups there may be differences not only in the etiological structure of the disease, but also in the prognosis of community-acquired pneumonia (Table 2).

Table 2.Groups of patients with community-acquired pneumoniaand probable pathogens

Diagnosis of community-acquired pneumonia

1. Complaints. The most characteristic subjective symptoms of pneumonia are cough, sputum production, shortness of breath, pain in the chest (when breathing, coughing), symptoms of general intoxication: general weakness, sweating, headache, confusion, myalgia, palpitations, loss of appetite, etc.

2. Physical data depend on many factors, including the severity of the disease, the extent of pneumonic infiltration, age, and the presence of concomitant diseases.

Classic objective signs of pneumonia are:

Shortening (dullness) of percussion sound over the affected area of ​​the lung;
- increased bronchophony and vocal tremors;
- locally auscultated bronchial breathing;
- a focus of sonorous fine-bubble rales or crepitus (this is what indicates damage to the alveoli, while wet and dry rales indicate only concomitant damage to the bronchi), often pleural friction noise.

II. Laboratory and instrumental diagnostics

1. Chest X-ray is the most important diagnostic test, which detects limited infiltrative changes in the lungs in combination with the corresponding symptoms of lower respiratory tract infection.

2. General blood test. Data from a clinical blood test do not allow us to talk about a potential causative agent of community-acquired pneumonia. However, leukocytosis more than 10-12x10 9 /l indicates a high probability of bacterial infection, and leukopenia is often observed with viral-bacterial pneumonia; leukopenia below 3x10 9 /l or leukocytosis above 25x10 9 /l are unfavorable prognostic signs. Along with these changes, an increase in ESR and a shift in the leukocyte count to the left are observed.

3. To identify bacterial pathogens, the following is carried out:

Sputum bacterioscopy with Gram stain;
- sputum culture with quantitative determination of the pathogen and sensitivity to antibiotics.

The effectiveness of microbiological diagnostics largely depends on the timeliness and correctness of collection of clinical material. The most commonly tested material is sputum obtained by coughing.

When collecting and examining sputum, the following rules must be observed:

1. Sputum should be collected in the morning before meals (if possible, obtain sputum before starting antibacterial therapy).

2. Before collecting sputum, it is necessary to perform oral hygiene (brush your teeth, rinse your mouth thoroughly with boiled water).

3. Patients should be instructed to cough deeply to obtain contents from the lower respiratory tract rather than the oropharynx.

4. The duration of storage of collected sputum samples at room temperature should not exceed 2 hours.

5. Before bacterioscopic and bacteriological examinations, the obtained sputum must be processed according to the Mulder method, which consists of thoroughly washing a piece of sputum in a sterile isotonic sodium chloride solution sequentially in three Petri dishes for 1 minute in each (to wash the surface layer into which microbes enter from the upper respiratory tract and oral cavity).

Before starting a microbiological study, it is necessary to stain the smear according to Gram; In the vast majority of cases, bacterioscopy of such a smear makes it possible to make a preliminary conclusion about the bacterial causative agent of pneumonia. If there are less than 25 leukocytes and more than 10 epithelial cells in the smear, further research is inappropriate, because in this case, the material being studied is most likely the contents of the oral cavity. The diagnostic value of the bacteriological result of sputum examination can be assessed as high when a potential pathogen is isolated in a concentration of > 10 6 CFU/ml.

The results of bacteriological examination may be distorted by previous antibacterial therapy. Therefore, the most convincing data are from sputum cultures obtained before the start of treatment. Bacteriological research takes time, and its results can be obtained no earlier than in 3-4 days. The indicative method is microscopy of a sputum smear stained with a Gram stain. This technique is generally available, does not take long, and can help when choosing an antibiotic.

Obviously, the interpretation of the results of bacterioscopy and sputum culture should be made taking into account clinical data.

The listed criteria are sufficient for the diagnosis and treatment of pneumonia at the outpatient stage and in the uncomplicated typical course of pneumonia in the hospital.

In severely ill patients, including most hospitalized patients, venous blood cultures (2 blood samples from 2 different veins) should be performed before initiating antimicrobial therapy. When collecting blood, you should follow the classical rules of asepsis and sterilize the collection site first with 70% ethyl alcohol, then with 1-2% iodine solution. In adult patients, at least 20 ml of blood should be collected per sample, as this leads to a significant increase in the percentage of positive results.

However, despite the importance of obtaining laboratory material (sputum, blood) before prescribing antibiotics, microbiological testing should not be a reason for delaying antimicrobial therapy. This especially applies to patients with severe disease.

III. Additional research methods

1. Biochemical blood tests (functional tests of the liver, kidneys, glycemia, etc.) are indicated for severe pneumonia with manifestations of renal and liver failure, in patients with chronic diseases, and with decompensation. They do not provide any specific information, but detected abnormalities may indicate damage to a number of organs/systems, which has a certain clinical and prognostic significance and is taken into account in treatment.

2. Serological tests (determination of antibodies to fungi, mycoplasma, chlamydia, legionella and cytomegaloviruses) are not considered in a number of mandatory research methods, since taking into account the need for repeated blood serum sampling during the acute period of the disease and during the period of convalescence (2 weeks from the onset of the disease) This is not a clinical, but an epidemiological level of diagnosis. They are carried out for atypical cases of pneumonia, in risk groups: alcoholics, drug addicts, immunodeficiency, and the elderly.

Currently, the following tests have become widespread: enzyme immunoassay - with the determination of the specific soluble antigen Legionellapneumoniae (1st serotype) in the urine, as well as immunochromatographic - with the determination of the pneumococcal antigen in the urine. However, these rapid diagnostic methods in our country are carried out only in selected clinical centers.

Polymerase chain reaction (PCR) is promising for the diagnosis of pathogens such as Mycoplasma and Chlamydophilapneumoniae. However, the place of PCR has not yet been determined and this method cannot be recommended for widespread clinical practice.

3. In the presence of pleural effusion and conditions for safe pleural puncture, a study of pleural fluid is performed, counting leukocytes and leukocyte formula in it, determining pH, activity lactadehydrogenase (LDH), specific gravity, protein content; smear staining for Gram and acid-fast bacteria, punctate culture for aerobes, anaerobes and mycobacteria.

4. Fibrobronchoscopy with a quantitative assessment of microbial contamination, cytological examination of the obtained material is carried out in the absence of an effect from adequate treatment of pneumonia, as well as in cases of suspected lung cancer (“obstructive pneumonitis” due to bronchogenic carcinoma), pulmonary tuberculosis (in the absence of a productive cough), foreign body, etc. Therapeutic bronchoscopy for abscess formation is prescribed to ensure drainage and sanitation of the bronchial tree. If necessary, a biopsy is performed.

5. X-ray tomography, computed tomography (in case of damage to the upper lobes, lymph nodes, mediastinum, reduction in the volume of the lobe, suspected abscess formation, if adequate antibacterial therapy is ineffective).

6. Ultrasound examination of the heart and abdominal organs is carried out if sepsis or bacterial endocarditis is suspected.

Additional methods are mainly carried out in a hospital, where the patient is hospitalized due to the severity of the condition and/or for an atypical course of the disease that requires a diagnostic search.

Thus, the diagnosis of community-acquired pneumonia is definite if the patient has radiologically confirmed limited infiltration of the lung tissue and at least two clinical signs from among the following:

A) acute fever at the onset of the disease (t > 38.0 °C);
b) cough with sputum;
c) physical signs (shortening of percussion sound, harsh or bronchial breathing, focus of crepitus and/or fine rales);
d) leukocytosis > 10x10 9 /l and/or band shift (> 10%).

The absence or insufficiency of radiological confirmation of limited infiltration in the lungs makes the diagnosis of CAP imprecise/uncertain. In this case, the diagnosis of the disease is based on taking into account the epidemiological history, complaints and accompanying symptoms.

Diagnosis of community-acquired pneumonia, based on the results of physical and radiological examination, can only be equated to a syndromic diagnosis; It becomes nosological after identifying the causative agent of the disease. A thorough study of the epidemiological history and risk factors for the development of CAP can play a certain role in the preliminary establishment of etiology (Table 3).

Table 3.Epidemiology and development risk factorscommunity-acquired pneumonia of unknown etiology

Indications for hospitalization

In this regard, knowledge of the indications for hospitalization is of particular importance:

1. Physical examination data: respiratory rate more than 30 per minute; diastolic blood pressure (BP) heart rate (HR) > 125/min; body temperature 40 °C; disturbances of consciousness.

2. Laboratory and radiological data: peripheral blood leukocyte count 20x10 9 /l; SaO 2 50 mmHg when breathing room air; serum creatinine > 176.7 µmol/l or urea nitrogen > 9 mmol/l; pneumonic infiltration localized in more than one lobe; presence of decay cavity(s); pleural effusion; rapid progression of focal infiltrative changes in the lungs (increase in the size of infiltration > 50% over the next 2 days); hematocrit
3. The inability to provide adequate care and follow all medical prescriptions at home.

The question of the preference for inpatient treatment of community-acquired pneumonia may also be considered in the following cases:

1. Age over 60-65 years.

2. Presence of concomitant diseases:

Chronic bronchitis or COPD;
- bronchiectasis;
- diabetes;
- congestive heart failure;
- chronic hepatitis;
- chronic nephritis;
- chronic alcoholism;
- drug addiction and substance abuse;
- immunodeficiencies;
- cerebrovascular diseases;
- malignant neoplasms.

3. Ineffective outpatient treatment for 3 days.

4. Social indications.

5. The wishes of the patient and/or his family members.

In cases where the patient has signs of severe community-acquired pneumonia (tachypnea more than 30 bpm; systolic blood pressure 4 hours; acute renal failure), emergency hospitalization in the intensive care unit/ward is required.

Saperov V.N., Andreeva I.I., Musalimova G.G.

Content

Chest pain, severe wet cough, fever are common signs of pneumonia. In 80% of cases the disease is community-acquired. Every year it affects 5% of the population. At risk are children under 7 years of age and the elderly. Pneumonia develops quickly and can lead to death, so it is important to start treatment at the first symptoms.

What is community-acquired pneumonia

This diagnosis is made when a person has pneumonia and the infection enters the body outside of a medical facility. This also includes situations where symptoms of the disease appeared in the first 48 hours after hospitalization or 2 weeks after discharge. In 3-4% of patients, a severe form of the pathology ends in death. Other complications:

• lung abscess - limited abscess;
• heart failure;
• infectious-toxic shock;
• purulent pleurisy;
• inflammation of the heart muscle.

Classification

ICD-10 codes for community-acquired pneumonia are J12–18. The figure depends on the cause of the disease and the pathogen. In the patient’s card, the doctor indicates the code and features of the diagnosis. According to severity, the disease is divided into 3 forms:

1. Easy. The symptoms of the disease are mild, the patient’s condition is close to normal. Treatment is carried out at home.
2. Moderate weight. In this form, community-acquired pneumonia occurs in people with chronic pathologies. The signs of the disease are pronounced, the patient is admitted to the hospital.
3. Heavy. Up to 30% of patients die due to the high risk of complications. Treatment is carried out in a hospital.

According to the general picture, community-acquired pneumonia is divided into 2 types:

• Spicy. Symptoms of the disease appear suddenly, there are signs of intoxication. The course of the acute form is severe in 10% of cases.
• Protracted. If the disease is not treated, it becomes chronic. Deep tissues are affected, the bronchi are deformed. Relapses occur frequently, and the area of ​​inflammation increases.

On the affected side, the pathology has 3 forms:

• Right-handed. It occurs more often because the bronchus here is shorter and wider. This type of community-acquired pneumonia develops in adults due to streptococci. Right-sided lesions are often lower lobe.
• Left-handed. Here inflammation occurs when the immune system is severely weakened. Pain in the side appears, and respiratory failure develops.
• Double-sided. Both lungs are affected.

Classification of pathology by area affected:

• Focal. The disease affected 1 lobe, the affected area is small.
• Segmental. Several areas are affected. Often this is a middle and lower lobe pathology.
• Upper lobe. A severe form of the disease, the symptoms are pronounced. The blood flow and nervous system suffer.
• Middle lobe. Inflammation develops in the center of the organ and therefore has mild symptoms.
• Lower lobe. Pain appears in the abdomen, and sputum is actively expelled when coughing.
• Total. Inflammation covers the lung completely. This form of pathology is the most dangerous and difficult to treat.

Causes

According to the pathogenesis (mechanism of development) and causes of occurrence, the following types of community-acquired pneumonia are distinguished:

• Airborne. Bacteria and viruses enter the nose and mouth along with the air, where they enter when a sick person coughs or sneezes. The lungs act as a filter and destroy germs. If a failure occurs due to risk factors, bacteria and viruses remain. They settle on the alveoli (lung tissue), multiply, and cause inflammation.
• Post-traumatic. Infection enters the lower respiratory tract due to chest trauma.
• Aspiration. Microbes enter the lungs during sleep with a small amount of mucus. In a healthy person they will not remain there. If immunity is reduced, the functions of defense mechanisms are weak or there are many microbes, inflammation will begin. Less commonly, vomit is thrown into the lungs. In children, a lipoid form of the pathology occurs: liquid (milk, oil drops) enters the lower respiratory tract, which collects in lumps.
• Hematogenous. Chronic infection from the heart, teeth or digestive organs penetrates the blood.

The causative agent of pneumonia

There are always many microbes in the upper respiratory tract. Under the influence of external factors, they become pathogenic and threaten health. From the nasopharynx, pathogens enter the lungs and trigger inflammation.

In 60% of cases, this happens with pneumococcus - the bacterium Streptococcus pneumoniae.

Other main infectious agents:

• Staphylococcus– often cause community-acquired pneumonia in children. The disease is severe, and treatment is difficult to choose. If the drugs are chosen incorrectly, the pathogen quickly develops resistance to them.
• Streptococci– in addition to pneumococcus, there are other, rarer types of bacteria in this group. They cause a disease with an indolent course, but a high risk of death.
• Haemophilus influenzae– accounts for 3–5% of cases of community-acquired pneumonia, often found in older people. It is infected in humid, warm climates.
• Mycoplasma– this bacterium causes pneumonia in 12% of patients, often affecting adults aged 20–30 years.
• Influenza virus– accounts for 6% of cases of pneumonia, dangerous in autumn and winter.

Atypical pathogens of community-acquired pneumonia:

• Klebsiella– dangerous for children 3–10 years old. This microbe causes prolonged mild inflammation.
• Coronavirus– in 2002–2003, it was the causative agent of the epidemic of severe atypical pneumonia.
• Herpes virus– strains of types 4 and 5. Rarely, type 3 causes chickenpox in adults with severe pneumonia. A simple herpes virus, in which blisters appear on the mucous membrane, is almost harmless. It affects the respiratory tract only in people with very weak immune systems.

Risk factors

Community-acquired pneumonia develops when immunity declines. Causes and risk factors:

• Influenza epidemic and frequent ARVI– they do not allow the body to fully recover.
• Frequent hypothermia– it causes vasospasm. Blood flows poorly, and immune cells do not have time to reach the desired area in time to protect the body from infection.
• Chronic inflammation– caries, diseases of the joints or nasopharynx. Bacteria are constantly in the body, moving from the main focus to other organs.
• HIV status– forms persistent immunodeficiency.

Less commonly, the body’s defenses weaken due to the following factors:

• hormonal imbalances;
• alcoholism;
• smoking;
• operations;
• poor oral hygiene;
• stress.

Symptoms

The incubation period of infection lasts up to 3 days. Afterwards, pneumonia develops very quickly. It starts with the following signs:

• Temperature. It rises to 39–40 degrees. Paracetamol doesn't knock it down. After 2-3 days the fever goes away, but then returns.
• Cough. First dry, after 2-3 days - wet. The attacks are frequent and severe. The type of sputum depends on the type of pneumonia. Gray, viscous mucus is often discharged, rarely with pus or streaks of blood.
• Shortness of breath and suffocation. If the disease is severe, the respiratory rate is above 30 breaths per minute.
• Pain behind the sternum. It can be left- or right-handed. It is characterized by aching pain, which intensifies with inhalation and coughing. The symptom rarely extends to the stomach area.

Other signs of community-acquired pneumonia:

• General intoxication. Headaches, weakness, nausea, rarely – vomiting.
• Pain in muscles, joints.
• Abdominal cramps, diarrhea.

Older people do not have fever or cough. Here the main signs of the disease are confusion, speech disturbances, and tachycardia. Community-acquired pneumonia in children can appear in the first weeks of life and has the following course features:

• In infants, the skin turns pale and a bluish triangle appears around the lips. The baby becomes lethargic, sleeps a lot, and is difficult to wake up. He spits up frequently and does not breastfeed well. With severe left- or right-sided damage, the child’s fingers turn blue.
• Children under 3 years old cry a lot and sleep poorly. Clear mucus is released from the nose, which turns yellow or green after 3-4 days. Shortness of breath occurs when coughing and crying. The temperature rises on the first day to 38 degrees, chills occur.
• In children over 3 years of age, the disease progresses as in adults.

Diagnostics

The doctor collects the patient’s complaints and listens to his chest. Moist rales are heard, breathing is changed.

When the area above the diseased lung is tapped, the sound becomes short and dull.

A diagnosis is made and the severity of the disease is determined using the following methods:

• Blood analysis– shows a high erythrocyte sedimentation rate, changes in the level of leukocytes. These are the main markers of inflammation.
• X-ray of the chest is taken straight and from the side. Pneumonia is indicated by darkening in the image. After the procedure, the affected area and the area of ​​inflammation are known. The causative agent of the disease is determined by the nature of the changes in the image. During treatment, x-rays will help evaluate the effect of therapy.
• Sputum examination– identifies the causative agent of the disease, helps prescribe the correct medications.
• Express urine test– needed to identify antigens of pneumococcus or Haemophilus influenzae. The method is expensive, so it is rarely used.
• A CT scan is performed to examine the lungs in more detail. This is important for prolonged community-acquired pneumonia, recurrent or atypical. If there are no changes in the X-ray image, but there are signs of the disease, CT will help clarify the diagnosis.

To separate community-acquired pneumonia from tuberculosis, tumors, allergies and obstructive pulmonary disease, differential diagnosis is carried out:

• An ultrasound of the lungs will show the fluid inside the pleural cavity and its nature, tumors.
• Serodiagnosis will determine the type of microbe that caused the disease.
• A test for tuberculosis will rule out or confirm this disease.

Treatment of community-acquired pneumonia

According to the protocol, therapy begins with antibiotics. They kill germs and help avoid complications. Afterwards, agents are used that remove phlegm and remove the symptoms of the pathology. Features of treatment:

• Community-acquired pneumonia in infants and the elderly requires hospital treatment.
• If the disease is mild, therapy is carried out at home.
• The patient is prescribed bed rest, plenty of warm liquid (2.5–3 liters per day). The basis of the menu is pureed porridge with water, vegetables and fruits.
• Physiotherapy improves the patient’s general condition, relieves symptoms of pneumonia, and speeds up recovery. They are carried out in a course of 10–12 sessions.

• The patient is urgently hospitalized if he has septic shock. This is the main sign of a serious condition. Minor criteria: low blood pressure, impaired consciousness, severe respiratory failure, shortness of breath and temperature below 36 degrees. If there are 2-3 of these signs, the patient is admitted to the hospital.
• If the cause of the disease is not clear, antibiotics are used for 10 days. When the source of infection is outside the lungs, the lesion is in the lower lobe, or the course is complicated, treatment is extended to 2-3 weeks.
• In case of acute respiratory failure, the patient is given oxygen therapy– a special mask is put on the face or nose area, air with a high oxygen content is supplied.

Medication

Etiotropic (eliminating the cause) treatment of community-acquired pneumonia is carried out for 7–10 days with antibiotics of the following groups:

• Penicillins (Amoxicillin). These are the main drugs for infection. Medicines are administered through an IV. After 3-4 days they switch to tablets. In children, penicillins are used for typical flora.
• Macrolides (Azithromycin). They are used against mycoplasma and legionella. The same drugs are used for allergies to penicillin, in children under 6 months and with atypical flora. On an outpatient basis (at home), macrolides are taken orally.
• 3rd generation cephalosporins (Ceftriaxone). They are used in older people and for severe complications. The drugs are administered through a drip or injections.
• Fluoroquinolones (Levofloxacin). They are prescribed to replace other antibiotics for home treatment. The drugs are used in tablets.

The antibiotic treatment regimen is compiled individually based on test results, age and clinical picture. If after 3 days the patient does not feel better, the medicine is changed. The following drugs help with the symptoms of community-acquired pneumonia:

• Bronchodilators– relieve spasm and shortness of breath. They are not effective for allergies. Administered through a dropper 2 times a day Eufillin. Berodual used through inhalation with a nebulizer 4 times a day.
• Analgesics (Baralgin)– relieve pain. They are used in tablets once.
• Antipyretics- bring down the temperature. Adults are prescribed tablets Ibuprofen, for children - syrups and paracetamol suppositories ( Tsefekon D). These drugs are used once at temperatures above 38.5 degrees: they interfere with the work of antibiotics.
• Expectorants (Lazolvan)– remove phlegm and speed up recovery. They are used in the form of syrups 2-3 times a day. In severe cases of the disease, they are used through a nebulizer.

Physiotherapeutic

When the body temperature becomes normal and the acute symptoms of the disease go away, the patient is prescribed the following procedures:

• Electrophoresis- it is carried out with Eufillin to relieve bronchospasm and swelling. Novocaine used to relieve severe pain. During this procedure, drugs penetrate into the blood faster and in greater volume. The course consists of 10 sessions of 10–20 minutes each day.
• UHF, or high frequency current treatment– relieves swelling, reduces sputum production and stops the proliferation of microbes. The procedure is performed in the acute period, but without fever. The course consists of 10–12 sessions of 8–15 minutes each.

Prevention

To prevent the development of community-acquired pneumonia, follow these recommendations:

• Temper your body: take a contrast shower, douse yourself with cold water.
• Take courses of medications that strengthen the immune system: Immunal, Grippferon.
• Take a walk in the fresh air and play sports.
• Introduce vegetables and fruits into your diet.
• Don't get too cold.
• Treat diseases of the teeth, ear, nose and throat in a timely manner.
• Give up cigarettes and alcohol.
• Do not go to crowded places during ARVI epidemics.

A good measure to prevent community-acquired pneumonia are pneumococcal and influenza vaccines. It is better to make them before the onset of cold weather. The procedure is needed for the following groups of people:

• Elderly, pregnant women, children under 10 years old.
• Persons who have chronic heart and lung diseases.
• Nursing home nurses and hospital staff.
• Family members at risk.

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With the onset of cold and weakened immunity, the body is exposed to various diseases. During the cold season, the respiratory system is the first to suffer, and therefore very often they get pneumonia. And most often in a community-acquired form. So what is community-acquired pneumonia, and how to treat it?

Community-acquired pneumonia is a form of pneumonia to which the body is exposed outside of a hospital setting. A person becomes infected with it at home, or through contact with the outside world, or in institutions with crowded crowds of people. It is accompanied by cough, shortness of breath, sputum and fever. Affects the lower respiratory tract.

Most often, the causative agents are: pneumococci, staphylococci, viruses, and others.

Depending on the location of the disease, it is divided into right-sided pneumonia, left-sided pneumonia and bilateral pneumonia. These forms arise due to infections entering first into the upper respiratory tract, and then into the right, left, or both parts of the lungs, respectively. The most severe forms are and.

There is also a classification of the disease, depending on the size of the lesion:

• Focal - the disease affects a small part of the lung;
• Segmental – involves several foci;
• Totalitarian - affects the whole lung, or even both at once.

Depending on the severity of the disease, there are such forms - mild, moderate and severe. Each of them has a different treatment method. For example, a mild form can be treated on an outpatient basis - at home, but with visits to the doctor. In moderate cases, hospitalization in the therapy department is necessary to prevent pneumonia from becoming chronic. But the severe form requires only treatment in intensive care, and for acute illnesses - even in intensive care.

Important! If you have pneumonia, you should not self-medicate; you should treat the disease only under the supervision of a specialist! The disease can lead to serious and hazardous consequences for health.

Community-acquired pneumonia in an outpatient setting:

Reasons for its appearance

The main cause of the disease is decreased immunity of the body. But the causative agents of pneumonia are bacteria, various viruses and fungi.

The main causative bacteria are: pneumococcus, chlamydia and Pseudomonas aeruginosa.

Viruses that cause the disease are adenovirus, influenza virus, parainfluenza virus.

Among fungi, this could be histoplasmosis, coccidioidomycosis and others.

The main causes of pneumonia include:

• Hypothermia
• Viral infection
• Recent abdominal surgery
• Old age
• Nicotine, alcohol and drug addiction
• Respiratory system diseases
• Prolonged bed rest for another illness

In children, signs of community-acquired pneumonia are most often caused by pneumococcus. But in adults, the most common pathogens are mycoplasma, chlamydia and.

Symptoms and signs

The doctor and the patient suspect the disease if certain symptoms and signs are present. Symptoms of community-acquired pneumonia include:

• weakness;
• lethargy;
• high temperature (may be low in the early stages);
• chills;
• fever;
• heavy sweating;
• chest pain;
• cough;
• strong sputum;
• nausea, feeling unwell;
• in acute form – diarrhea and vomiting;
• decreased appetite
• aching bones;
• severe headaches;
• shortness of breath, even with minimal exertion;
• in severe form - a semi-delusional state with loss of orientation.

If you identify most of the symptoms listed above, you need to consult a therapist for further diagnosis and treatment of the disease.

Important! In people with weakened immune systems or in older people, some symptoms may be absent, so if the main signs of acute community-acquired pneumonia appear - cough, chills, wheezing - you should immediately consult a doctor.

Community-acquired pneumonia in children differs from community-acquired pneumonia in adults. For example, children additionally experience anxiety and irritability, and older people experience confusion.

Of all forms of the disease, community-acquired right-sided lower lobe pneumonia is the most common. Its main symptoms are severe pain and tingling in the right hypochondrium, which intensifies when coughing.

Similar signs in the left hypochondrium with left-sided lower lobe pneumonia.

In right-sided cases, children develop a GNT reaction in areas affected by infection, which leads to difficulty breathing and suffocation.

There is an aspiration form of the disease, which, like nosocomial pneumonia in a child, occurs due to the ingestion of something from the stomach during vomiting. It is easy to recognize, since patients end up in intensive care with respiratory failure and obstruction in the lungs.

Community-acquired bilateral polysegmental pneumonia manifests itself very acutely and has a longer incubation period. This requires prompt hospitalization, due to the fact that it also causes respiratory failure.

Diagnostics

Treatment can be prescribed only when the disease is identified, and most importantly, when the causative agent of pneumonia is detected. That is why serious attention must be paid to diagnosing the disease.

What is diagnostics? First, the patient needs to consult with a doctor about his ailments, then a primary examination with palpation and auscultation of the lungs takes place. In the lungs, the doctor listens for wheezing, trembling of the voice, bronchial breathing and other signs of pneumonia.

The next stage of the examination is. It is done in profile and in full view of the lungs. An x-ray is necessary to detect the area of ​​darkness. It occurs due to thickening of the lung tissue.

Also, to identify the pathogen, urine and blood tests, fibrobronchoscopy and ECG are additionally prescribed.

A urine test is performed to detect legionella and pneumococcal antigen. The test for these antigens is simple and quick. Legionella is the most common cause of pneumonia; a test for it is prescribed in cases of severe illness, alcohol abuse, resistance to antibiotics, or after recent travel. Testing for pneumococcus is carried out for the same symptoms, but additionally in the presence of severe liver disease.

A blood test is done to detect bacterial pathogens in case of bacteremia.

Fibrobronchoscopy - sputum analysis - taken with smears of the mucous membrane or expectorant fluid. Helps identify viral pathogens. Sputum is also analyzed for mycobacteria and fungi.

When diagnosing pneumonia, the following diseases should be excluded at the same time:

• pulmonary tuberculosis;
• tumors;
• pulmonary embolism;
• pulmonary infarction;
• and other diseases associated with the respiratory system.

Late diagnosis and late initiation of treatment can lead to a severe course of the disease, as well as dangerous complications.

Treatment

After an accurate diagnosis, identification of foci of infection and detection of the causative agent of pneumonia, treatment must be started immediately.

As mentioned earlier, treatment can be outpatient or hospitalized, depending on the severity of the disease.

Treatment of community-acquired pneumonia in adults varies depending on age. Adults are divided into two categories - up to 60 years of age without severe concomitant diseases; and after 60 years or patients with severe concomitant diseases. And, of course, there are separate categories - children and infants. Therefore, the prescription of a specific course of treatment depends on which category the patient is in.

Important! Community-acquired pneumonia in children in the presence of inflammation of the pulmonary parenchyma requires immediate hospitalization, regardless of the severity of the disease.

The basis of treatment for community-acquired pneumonia is antibacterial therapy. Here, depending on the pathogen, empirical antibiotics are prescribed. The disease is treated with this therapy for 7-10 days.

Important! Therapy should be started no later than 8 hours after the disease is detected.

Along with antibiotics, antipyretics, painkillers, penicillin, macrolides, expectorants, immunomodulators and vitamins are prescribed.

In 90% of patients with this therapy, improvements are observed - there is less sputum, shortness of breath disappears, and the temperature returns to normal.

If the condition worsens or treatment is ineffective, antiviral therapy is used. The doctor chooses drugs for the treatment of severe community-acquired pneumonia, depending on the tests. They use Acyclovir, Oseltamivir, etc.

A month and a half after the start of treatment, repeat fluorography is done to monitor the improvement or worsening of the disease.

After improvements, maintenance therapy is carried out with antipyretics, vitamins and immunomodulators.

Prevention

Prevention of community-acquired pneumonia is a responsible precaution. This disease very often causes serious complications, and therefore it is better to protect yourself from it.

This means that you must adhere to the following tips and rules:

1. Healthy and proper nutrition, which should contain all the necessary macro and microelements and vitamins.
2. Healthy sleep and rest
3. Be hardened from an early age
4. For cuts and other wounds, disinfection must be carried out
5. Sports activities
6. Quit drugs, nicotine and alcohol
7. Vaccination

Vaccination is important. Particularly important is the prevention of community-acquired pneumonia in children and people with weak immune systems.

Community-acquired right lower lobe pneumonia is a life-threatening disease. Only preventive actions will help to avoid it.

The prevention described above will help you avoid contracting community-acquired pneumonia. The rules of prevention are absolutely simple, which means that keeping your body in excellent condition is not difficult.

Important! Smoking increases the risk of pneumonia, tuberculosis and cancer.

The lungs are a very important organ, without which the body cannot exist, which means they need to be protected. That is why doctors strongly recommend preventing the disease. And if you identify symptoms of the disease, do not self-medicate, but immediately consult a specialist. Be healthy!

Community-acquired pneumonia is a pathological condition associated with an inflammatory process in the lungs caused by the penetration of pathogenic microorganisms into the body, which occurred outside the walls of a medical institution. Infection occurs by airborne droplets, the disease develops in both children and adults, and has a high risk of dangerous complications. Community-acquired pneumonia is most often a consequence of a respiratory disease and is directly related to the number of infectious diseases.

Community-acquired pneumonia is considered one of the most common airborne diseases. Infection occurs most often in public places with large crowds of people. Spreading rapidly, the disease affects both adults and children.

The causes of infection with community-acquired pneumonia are numerous, but those who have a noticeably reduced level of immunity are more susceptible to it. Violation of the functionality of the body's defense system leads to the rapid penetration of the pathogen and the rapid proliferation of pathogenic bacteria.

As a result, various parts of the lungs are affected by the inflammatory process, breathing and oxygen supply to organs and tissues are disrupted. Children are more susceptible to infection because their immune system is not always able to resist a viral attack. As for the adult part of the population, the decisive factor here is the refusal to seek medical help in a timely manner. The development of community-acquired pneumonia in adults is associated with inadequate treatment of a viral disease.

• old men;
• bedridden patients;
• those who have undergone complex surgery and have had contact with a sick person during the recovery period;
• residents of regions with high air humidity;
• workers of chemical plants, mines, greenhouses.

All this suggests that the development of community-acquired pneumonia is closely related not only to age, but also to the social status of the patient.

The development of community-acquired pneumonia in outpatient settings is associated with the spread of numerous pathogens.

Infection occurs through close contact with a patient under special conditions. This could be a crowd of people on public transport or a long wait in a public reception area where a sick person is among the visitors. Pathogenic microbes enter the human body through the upper respiratory tract.

The most dangerous pathogens of community-acquired pneumonia:

• streptococci;
• Klebsiella;
• staphylococci;
• pneumocystis;
• mushrooms such as candida;
• chlamydia;
• mycoplasma;
• coli;
• Haemophilus influenzae.

Features of the course of the disease are often associated with the characteristics of a particular pathogen. For example, in cases where the cause of community-acquired pneumonia is the penetration of Klebsiella or Escherichia coli into the body, the onset of the disease will proceed as an intestinal infection with inevitable stomach and intestinal upset, diarrhea, nausea and vomiting. Each causative agent of community-acquired pneumonia has its own characteristic features that affect the course of the disease and its severity, but each primarily affects a weakened body.

• those who have undergone complex abdominal operations;
• was subject to severe hypothermia;
• those suffering from heart and vascular diseases;
• people with impaired functionality of the endocrine system;
• forced to remain in bed for a long time;
• heavy smokers;
• persons who abuse alcoholic beverages;
• drug addicts.

Experienced therapists know what community-acquired pneumonia is - left-sided, right-sided or bilateral, how to make an accurate diagnosis and identify the causative agent.

However, to confirm a preliminary diagnosis, not only a detailed examination of the patient is required, but also a full instrumental and laboratory examination.

The existing modern classification allows us to distinguish several types and forms of the disease, which depend on the pathogen, severity and localization of the inflammatory process.

1. Focal. In this form of the disease, inflammation affects a small area of ​​lung tissue with an area of ​​1 to 2 cm; such a focus is clearly visible on an x-ray. It may be located in one of the lobes of the right lung, in which case the doctor diagnoses community-acquired right-sided pneumonia.
2. In cases where several areas are affected, we can talk about segmental community-acquired pneumonia, the causative agent of which is most often a virus.
3. In the presence of lobar pneumonia in adults, a large part of the lung is affected, or more precisely, one of its lobes - the upper or lower.
4. The most dangerous process is extensive damage to the entire lung. This is a total form of community-acquired pneumonia, requiring emergency assistance from qualified specialists and carrying the threat of not only various complications, but a sad outcome.

Community-acquired pneumonia occurs quite often, but in most cases, patients turn to doctors at a time when the pathological process is quite well developed.

The fact is that many adults confuse pneumonia with a severe cold, choose their own medications and put off visiting a doctor, hoping for a quick recovery.

• light;
• moderate severity;
• heavy.

1. Primary - when infected after contact with a sick person.
2. Secondary, developing after a viral infection due to inadequate treatment or its complete absence.
3. Aspiration. The reason is a foreign body entering the respiratory tract. Around a small crumb that gets into the lung, if you inhale carelessly, a focus of inflammation forms, in which pathogenic bacteria actively multiply.
4. Post-traumatic. It occurs after a strong blow to the chest area during a fall, as a result of an accident, or a fight. The integrity of the alveoli is disrupted, fluid accumulates, which is an excellent breeding ground for pathogenic microbes.
5. Thromboembolic is the result of a blockage that occurs after a blood clot breaks off. Violations of gas exchange and blood supply lead to the occurrence of inflammation.

Pneumonia that arises and develops outside a medical facility can occur without any complications or in a complicated form.

Symptoms that you need to pay attention to will help determine the presence of such a complex disease as pneumonia.

1. Body temperature changes. The level of its increase depends on the form of inflammation. With lobar pneumonia it reaches critical values. The numbers 40 or 41° will appear on the thermometer. It cannot be brought down with conventional antipyretics. This temperature drops only after starting to take antibacterial drugs. With a focal form of pneumonia, the patient’s body temperature will remain subfebrile, which means it will not exceed 37.2-37.4°. It persists for 5-7 days, causing weakness in the patient.
2. Headaches and dizziness occur against the background of an increase in temperature, and their intensity depends on the severity of the inflammatory process. With severe lobar pneumonia, not only dizziness, but also clouding of consciousness is possible.
3. Nausea, vomiting, and diarrhea can be confusing and suggest food poisoning. In fact, the reason is the presence in the patient’s body of such a dangerous pathogen as Klebsiella. Only a doctor can confirm a preliminary diagnosis after detailed instrumental and laboratory examination.
4. Breathing disorders are often confused with acute bronchitis, so examinations such as auscultation should only be carried out by an experienced therapist. Listening to the patient will help determine the presence of crepitus or asymmetric wheezing and weakening of breathing in the affected area.

Sweating, sleep disturbance, increased weakness, refusal to eat. All these are symptoms of the inflammatory process. One of the most characteristic symptoms that occurs with pneumonia is shortness of breath. It is difficult for the patient to take a breath. The patient complains of severe chest pain when breathing.

Shortness of breath appears with little physical activity and even at rest. The breathing rate increases significantly, reaching 40 times per minute. Breathing is especially difficult in cases where bilateral pneumonia develops.

The therapist can make the correct diagnosis based on an instrumental examination.

If in young children, due to the anatomical features of the development of bronchial branches, inflammation in the right lung more often occurs, then in adult patients, in most cases, left-sided pneumonia is diagnosed.

Community-acquired left-sided focal or segmental pneumonia develops due to impaired oxygen metabolism and accumulation of fluid in the alveoli. When they stick together during inhalation, pain occurs and pronounced wheezing is heard. In the area of ​​inflammation, breathing is noticeably weakened. The x-ray clearly shows the darkening, the presence of which can be confirmed by ultrasound or computed tomography.

No less important studies are sputum analysis and checking the gas composition in the lungs. Spirometry allows you to understand the level of development of the inflammatory process and the degree of oxygen deficiency. Sputum examination is necessary to determine the sensitivity of the pathogen to antibiotics.

Treatment of community-acquired pneumonia is carried out both in a hospital setting and on an outpatient basis, that is, at home under the supervision of a local physician. After confirming that the patient has community-acquired pneumonia, treatment is prescribed depending on the pathogen isolated, the specific location of the source of inflammation, and the severity of the inflammatory process.

Community-acquired left-sided pneumonia deserves special attention, since the most important organs are located in close proximity to the source of inflammation. Before prescribing adequate treatment, the specialist needs to make sure that inflammation does not spread to the heart, blood vessels, or pleura. All medications are selected strictly individually, depending on the characteristics of the patient’s general condition and the presence of concomitant ailments.

Treatment of community-acquired pneumonia in a hospital setting is required for those patients whose condition is assessed as moderate to severe.

In mild cases, all therapeutic measures are carried out under the supervision of a therapist from the district clinic.

• semisynthetic penicillins;
• tetracyclines;
• fluoroquinolones;
• aminoglycosides;
• cephalosporins.

Each drug selected and prescribed by a doctor has a fairly strong effect and is taken strictly according to the specified regimen. It is important to achieve this goal by avoiding direct effects on other organs and tissues.

• taking antipyretic drugs;
• drugs with mucolytic action;
• antiallergic;
• expectorants, thinning mucus and facilitating its removal;
• vitamin complexes.

It is mandatory to prescribe exercise therapy and physiotherapeutic procedures, and take medications that strengthen the immune system. The patient is strongly advised to adhere to the regime and proper nutrition, avoid physical activity, stop smoking and drinking alcoholic beverages.

Preventive measures include, first of all, a healthy lifestyle, exercise, and proper nutrition. If hospital-acquired pneumonia is associated with the penetration of a specific nosocomial infection into the patient’s body, then community-acquired pneumonia occurs more often in those whose body is weakened and the level of immune defense is low. All preventive actions are aimed at strengthening the immune system.

It is important to remember that it is strictly forbidden to make decisions on your own regarding the choice of medications and their administration.

If you have the slightest suspicion of the possibility of developing pneumonia after a viral infection, you should immediately seek help from an experienced therapist, who will refer you for a detailed examination and make the correct diagnosis.

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• Congratulations! You are completely healthy!

  Your health is fine now. Don’t forget to take good care of your body, and you won’t be afraid of any diseases.

• There is reason to think.

  The symptoms that are bothering you are quite extensive, and are observed in a large number of diseases, but we can say with confidence that something is wrong with your health. We recommend that you consult a specialist and undergo a medical examination to avoid complications. We also recommend that you read the article about that.

• You have pneumonia!

  In your case, there are clear symptoms of pneumonia! However, there is a possibility that it could be another disease. You need to urgently contact a qualified specialist; only a doctor can make an accurate diagnosis and prescribe treatment. We also recommend that you read the article about that.

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