Condition after pneumonia ICD 10. Nosocomial pneumonia. Sputum production in pneumonia

In most cases, pneumonia is caused by the penetration of pathogenic microorganisms into the respiratory tract or the activation of opportunistic flora. The most common infectious agents are the following:

pneumococci;
staphylococci;
hemophilus influenzae;
streptococci;
legionella;
chlamydia;
protozoa (mycoplasma).

Focal pneumonia begins less violently. The temperature rarely exceeds 38.5 °C. Sputum when coughing is mucopurulent in nature. If foci of inflammation merge with each other, the condition of the sick person worsens. During physical examination, it is often possible to identify wheezing and dullness of percussion sound. Pneumonia requires urgent treatment.

Opportunistic microorganisms (Klebsiella, Escherichia coli) are most often isolated from those individuals who suffer from severe somatic pathology. In this case, the disease occurs against the background of a severe weakening of the immune system. Viruses can also be the cause. Initially they cause inflammation of the oropharynx and trachea. In the absence of proper treatment, the infection affects the bronchi and lung tissue.

The following predisposing factors are of great importance in the development of community-acquired pneumonia:

smoking;
decreased body resistance;
long stay in a horizontal position;
presence of chronic bronchitis;
presence of diabetes mellitus;
presence of HIV infection;
oncological diseases;
congestive heart failure;
upper respiratory tract diseases;
regular alcohol consumption;
hypovitaminosis;
influenza and ARVI;
epilepsy;
renal failure;
chest injuries;
inhalation of toxic substances;
harmful occupational factors;
severe vomiting (can lead to vomit entering the respiratory tract).

Pneumonia is a very common inflammatory disease. It primarily affects the alveoli, in which inflammatory exudation develops (the release of inflammatory fluid from the blood into the tissues). According to the international characteristics of diseases, pneumonia code according to ICD 10 corresponds to codes J12-J18, this depends on the type of disease. Below we describe the characteristics of the disease according to ICD 10 codes, factors for development, forms, types and treatment of the disease.

Characteristics of the disease

Pneumonia is a disease characterized by inflammation in the tissues of the respiratory organs with damage to the bronchioles and alveoli. The disease is widespread among adults and young children. The danger lies in the complications that develop against the background of the disease. In some severe cases, the death of the patient may occur.

The pneumonia code, according to ICD 10, is distributed depending on the form of the disease. Pneumonia is divided into 2 types: hospital-acquired, or nosocomial (acquired in a hospital after hospitalization for another disease) and community-acquired (acquired on an outpatient basis, outside the hospital). Nosocomial inflammation of the lung tissue is highly resistant to antibiotics and has a high risk of death. Accounts for 10% of the total number of cases of inflammation of the lung tissue. The community-acquired form is more common than the hospital-acquired form.

Community-acquired pneumonia code according to ICD 10 is determined according to the type of illness. According to the international classification of diseases, the classification of pneumonia has the following categories:

viral, unclassified;
bacterial, unclassified;
streptococcal;
provoked by chlamydia;
provoked by hemophilus influenzae infection;
caused by other ailments;
unknown etiology.

Most often, the disease occurs due to the penetration of various microorganisms into the respiratory system. Children and the elderly are most susceptible to the disease. A common phenomenon is congestive (hypostatic) pneumonia, which occurs when a person’s movement is limited. Due to stagnation of blood in the pulmonary circulation, inflammatory damage to the lung tissue develops.

Forms and types of disease

Pneumonia code according to ICD 10 has the following forms.

Primary – develops after hypothermia or contact with someone who is already sick.
Secondary – occurs due to other health problems of the respiratory system (bronchitis, pharyngitis).
Aspiration pneumonia is an inflammatory lesion of the lung tissue caused by the penetration of foreign bodies or substances into the respiratory system.
Post-traumatic - appears after injury to the thoracic region. Post-traumatic pneumonia is usually diagnosed after car accidents, falls from a height, or beatings.
Thromboembolic – caused by blockage of a pulmonary artery by an infected blood clot.

Inflammation of lung tissue can be unilateral (the tissue of one lung is inflamed) or bilateral (both lungs are inflamed). It can take place in a complex form or not. Judging by the area of damage to the lung tissue, pneumonia occurs:

total (damage to the entire area of the organ);
central (defeat in the center);
segmental (damage to a separate segment);
lobar (damage to a separate lobe);
lobular (inflammation of an individual lobule).

Based on the size of the lesion in the lung tissue, test results, and the presence of complications, 3 stages of severity of the disease are distinguished. There are acute, chronic and protracted forms of the disease.

Typically, inflammation in the lung tissue is caused by the ingestion of various microorganisms (pneumococci, streptococci, mycoplasmas, chlamydia and others) into the respiratory organs or by the intensification of the growth of pathogenic microflora of the human body.

Lung damage does not begin aggressively. The patient's temperature varies in the range of 38-38.5 degrees. When you cough, purulent mucous-type sputum comes out. In the case of fusion of lung lesions, the patient’s condition worsens. Inflammation of the lower respiratory organs requires immediate treatment.

Due to a weakened immune system, it is possible to develop a disease from inflammation of the upper respiratory organs or trachea. If there is no adequate treatment, the disease spreads to the bronchi and lungs.

Factors contributing to the development of the disease

There are factors that contribute to more intense development of the inflammatory process:

staying immobile for a long time;
smoking, alcohol abuse;
diseases of the upper respiratory organs, respiratory infections, influenza;
diabetes;
heart disease, oncology, HIV;
epilepsy;
weakened immunity, hypovitaminosis;
kidney diseases;
injuries and bruises of the thoracic spine;
severe vomiting (vomit may enter the respiratory system);
inhalation of toxic chemicals.

Pneumonia is characterized by the following symptoms:

hyperthermia (high temperature);
productive cough (purulent sputum, possibly with blood);
discomfort in the chest;
shortness of breath, wheezing, chest discomfort;
insomnia;
decreased appetite.

If treatment is not timely, there is a high probability of complications in the form of pleurisy, myocarditis, glomerulonephritis, abscess, and gangrene. For correct diagnosis, blood and urine tests, sputum tests, chest x-rays are prescribed, and the general condition of the respiratory and heart organs is determined. Treatment involves the use of antibiotics, elimination of intoxication of the body, and the use of agents that help liquefy and remove sputum.

Pneumonia is a fairly common disease that requires surgical treatment. Often the cause of the disease is microorganisms that have entered the respiratory organs. They actively develop and provoke an inflammatory process in the lung tissues. The lack of adequate medical intervention leads to complications of the disease and death.

Sources used: infekcionist.com

Forms and types of disease

In accordance with the International Classification of Diseases, Injuries and Causes of Death, 10th revision, pneumonia belongs to class X - respiratory diseases. The class is coded with the letter J.

The modern classification of pneumonia is based on the etiological principle. Depending on the pathogen isolated during microbiological testing, pneumonia is assigned one of the following codes:

J13 P. caused by Streptococcus pneumoniae;
J14 P. caused by Haemophilus influenzae;
J15 bacterial P., not classified elsewhere, caused by: J15. 0 K. pneumoniae; J15. 1 Pseudomonas aeruginosa; J15. 2 staphylococci; J15. 3 group B streptococci; J15. 4 other streptococci; J15. 5 E. coli; J15. 6 other gram-negative bacteria; J15. 7 M. pneumoniae; 15. 8 other bacterial P.; J15. 9 bacterial P. unspecified;
J16 P. caused by other infectious agents, not classified elsewhere;
J18 P. without specifying the pathogen: J18. 0 bronchopneumonia, unspecified; J18. 1 lobar P. unspecified; J18. 2 hypostatic (stagnant) P. unspecified; J18. 8 other P.; J18. 9 P. unspecified.

*P. - pneumonia.

In Russian realities, for material and technical reasons, identification of the pathogen is not always carried out. Routine microbiological studies used in domestic clinics have low information content. The most common class is J18, which corresponds to pneumonia of unspecified etiology.

If a person is diagnosed with community-acquired pneumonia, the ICD-10 code in the medical history will depend on the form of pneumonia. Pneumonia is a very common disease in adults and children. Often this lung pathology leads to various complications and death of the sick person. All pneumonia is divided into 2 types: nosocomial and community-acquired. What is the etiology, clinical picture and treatment of pneumonia?

Features of community-acquired pneumonia

Pneumonia is an acute, predominantly infectious, disease of the lower respiratory tract, in which the bronchioles and alveoli are involved in the process. When community-acquired pneumonia is detected in a person, the ICD-10 code is determined by the type of disease. The International Classification of Diseases divides pneumonia into the following categories:

unclassified viral;
streptococcal;
caused by Haemophilus influenzae;
unclassified bacterial;
caused by chlamydia;
pneumonia caused by other diseases;
unspecified etiology.

The ICD-10 code for pneumonia is J12 - J18. Community-acquired pneumonia is diagnosed most often. The disease received its name due to the fact that the symptoms of the disease develop outside the walls of the medical institution. Sometimes a nosocomial form of pneumonia develops. It is also called hospitalization. A similar diagnosis is made if the disease develops during a person’s stay in a medical facility for 3 days or more. Community-acquired pneumonia develops before a person seeks medical help or no later than 48 hours after hospitalization.

The incidence rate is 10 cases per 1000 people. The risk group includes children and the elderly. In most cases, pneumonia is caused by the penetration of various microorganisms into the lungs. So-called congestive pneumonia often occurs. It occurs against the background of other serious diseases that limit the patient’s movement.

Against the background of physical inactivity and being in a supine position, blood stagnation develops in the small circle, which leads to inflammation of the lung tissue. Community-acquired pneumonia is characterized by a high mortality rate. Mortality reaches 50 cases per 100,000 people. In Russia, about 1 million new cases of pneumonia are diagnosed every year.

Types of community-acquired pneumonia

Community-acquired pneumonia is divided into several types. Depending on the mechanism of development, the following forms of the disease are distinguished:

primary;
secondary;
aspiration;
post-traumatic;
thromboembolic.

Primary occurs against the background of absolute health. The provoking factor may be hypothermia or contact with a sick person. Inflammation of the lungs can be unilateral (one lung is affected) or bilateral (both lungs are inflamed). Depending on the size of the inflammatory focus, total, lobar, segmental, lobular and central pneumonias are distinguished. Pneumonia can occur in complicated or uncomplicated forms.

According to the flow, acute, chronic and protracted pneumonia are distinguished. Depending on the pathogen, the following types of community-acquired pneumonia are distinguished: bacterial, chlamydial, mycoplasma, viral fungal, mixed. There are 3 degrees of severity of the disease. This division is based on the following characteristics: the size of the focus of inflammation, the presence of complications, data obtained during physical examination.

Main symptoms of pneumonia

The community-acquired form of pneumonia is manifested by the following symptoms:

high temperature (up to 39 °C and above);
cough with sputum;
shortness of breath;
feeling of discomfort in the chest;
increased sweating;
wheezing;
sleep disturbance.

Children often experience decreased appetite. Lobar pneumonia is most often diagnosed. With it, an entire lobe of the lung can be involved in the process. With lobar pneumonia, the cough is initially dry. After a few days he becomes productive. Often the sputum contains an admixture of blood. The sputum takes on a rusty hue.

In its absence, the following complications may arise:

abscess formation;
development of obstructive syndrome;
pleurisy;
acute respiratory failure;
organ gangrene;
inflammation of the membranes of the brain;
meningoencephalitis;
myocarditis;
glomerulonephritis;

Characteristics of congestive pneumonia

People with severe somatic pathology who stay in bed for a long time may develop congestive pneumonia. This is a secondary form of pneumonia. Pneumonia in this situation is a complication of the underlying disease. The basis is hemodynamic disturbances. Impaired ventilation of the lungs leads to the accumulation of sputum and bronchial obstruction, which is a favorable factor for the activation of microbes.

Often this pathology develops in older people. The causative agents of the infection are cocci and Haemophilus influenzae. The disease is manifested by the following symptoms: a slight increase in body temperature, cough with sputum, weakness, shortness of breath. Sometimes hemoptysis is observed. Symptoms are determined by the underlying disease. With a stroke, there may be impaired consciousness and difficulty speaking.

Diagnostic and therapeutic measures

Diagnosis of pneumonia includes:

general blood and urine analysis;
X-ray examination of the lungs;
percussion and auscultation of the lungs and heart;
conducting computed tomography or magnetic resonance imaging;
patient interview;
sputum examination.

To exclude tuberculosis, the Mantoux test and Diaskintest can be performed. If an atypical form of pneumonia is suspected, the content of specific antibodies to chlamydia, legionella, and mycoplasma in the blood is assessed. Treatment of community-acquired pneumonia is conservative. Treatment includes taking antibiotics (for bacterial etiology), detoxifying the body, using agents that dilute sputum and facilitate its elimination (Lazolvan, ACC, Ambrobene).

Of the antibiotics, the most effective are protected penicillins (Amoxiclav), cephalosporins (Cefazolin), and macrolides (Sumamed).

Physiotherapy is provided during the recovery period. The duration of treatment is determined by the doctor. Treatment is carried out only in consultation with a doctor. Self-medication can lead to complications. In severe cases, hospitalization is required. Thus, community-acquired pneumonia poses a danger to a sick person. If symptoms of the disease appear, you should visit a therapist.

Sources used: stronglung.ru

And the temperature at first is not too high, but there is some kind of weakness, fatigue. Breathing quickens and chest pain appears. And also a cough. Dry, boring, exhausting. We are trying to treat ourselves with improvised means, but there is no improvement. And in the hospital, the doctor, after an examination and a series of tests, makes a diagnosis of “community-acquired pneumonia, ICD code -10.”

Everyone knows that such a disease exists. But what do the other words of the diagnosis mean? How to figure this out and how to get rid of pneumonia?

Definition of disease

Out-of-hospital. If a person falls ill at home, or catches pneumonia in the first two days after being hospitalized for treatment.
Hospital. After staying in hospital for more than two days, the patient develops symptoms of pneumonia.
Aspiration. This category includes patients who, for a number of reasons, have an impaired swallowing reflex and a weakened cough reflex. This can happen to a person in the stage of severe alcohol intoxication, or it can be a consequence of epilepsy or stroke.
Immunodeficiency. Pneumonia develops against the background of loss of immunity or its weakening.

According to the severity of the disease: from mild to extremely severe.

There are also divisions into categories of patients according to the international classification of diseases.

It all depends on the severity of the disease and concomitant diseases, as well as the age of the patient:

The first category includes people whose disease is of viral or bacterial origin, without any pathologies. They easily tolerate the disease, and there are no complications from other organs.
The second category includes patients who also have a mild form of the disease. But this group includes people suffering from chronic diseases of the respiratory system or having disorders of the cardiovascular system. As well as small children under two years old and elderly people.
The third category of patients must be treated for the disease as an inpatient. Since the disease can already be caused by two pathogens. For example, bacteria and viruses and is of moderate severity.
The fourth category of patients are people with a severe form of the disease. They need intensive care and therefore treatment should only take place under the supervision of a doctor in a hospital.

Forms and types of disease

Gram-positive microorganisms
Gram negative bacteria
Viruses,
fungi,
Worms,
Foreign bodies entering the respiratory tract,
Toxin poisoning
Chest injuries
Allergy,
Alcohol abuse
Tobacco smoking.

Constantly nervous, worried,
Poor or unbalanced diet,
Lead a sedentary lifestyle
Cannot get rid of bad habits such as smoking and drinking alcohol,
Suffer from frequent colds,
Have a low level of immunity,
Elderly people.

Symptoms

Temperature rises even to 39 degrees or higher,
Headache,
Dyspnea,
Sleep disturbance,
lethargy,
Increased breathing,
In some cases, the nasolabial triangle becomes bluish in color.

Possible complications

Bacterial (pneumococcal, staphylococcal);
Viral (exposure to influenza viruses, parainfluenza, adenoviruses, cytomegalovirus)
Allergic
Ornithosis
Gribkovs
Mycoplasma
Rickettsial
Mixed
With an unknown cause of the disease

Forms and types of disease

Modern classification of pneumonia, code according to ICD-10

*P. - pneumonia.

In our country, the most common classification at the moment is one that takes into account the location of the disease. In accordance with this symptom, community-acquired pneumonia is distinguished - outpatient, community-acquired and in-hospital (nosocomial) pneumonia. The reason for highlighting this criterion is the different range of pathogens when the disease occurs at home and when patients are infected in a hospital.

Recently, another category has acquired independent significance - pneumonia, which occurs as a result of medical interventions outside the hospital. The appearance of this category is associated with the impossibility of classifying these cases as outpatient or nosocomial pneumonia. Based on the place of origin, they are classified as the first, and based on the pathogens identified and their resistance to antibacterial drugs, they are classified as the second.

Community-acquired	Nosocomial	Related to the provision of medical care
I. Typical. Develops in patients with normal immunity. II. Pneumonia in patients with reduced immune status. III. Aspiration. Occurs as a result of massive intake of vomit into the respiratory tract).	I. Actually nosocomial. II.Fan-associated. III. In patients with reduced immunity.	I. Residents of nursing homes. II. Categories of citizens: those who have received antibiotics in the last 3 months; patients on chronic hemodialysis; patients who have had short-term hospitalization (less than 2 days) over the past 3 months; patients treating wounds at home, etc.

Community-acquired pneumonia is an infectious disease that arose at home or no later than 48 hours from the moment of admission to the hospital in a patient in the hospital. The disease must be accompanied by certain symptoms (cough with sputum, shortness of breath, fever, chest pain) and x-ray changes.

If a clinical picture of pneumonia occurs after 2 days from the time the patient was admitted to the hospital, the case is considered as a nosocomial infection. The need to divide into these categories is associated with different approaches to antibacterial therapy. In patients with nosocomial infection, it is necessary to take into account possible antibiotic resistance of pathogens.

*P. - pneumonia.

The long-existing division into 3 degrees of severity (mild, moderate, severe) has now lost its meaning. It did not have clear criteria or significant clinical significance.

It is now customary to divide the disease into severe (requiring treatment in the intensive care unit) and not severe. Severe pneumonia is considered in the presence of severe respiratory failure and signs of sepsis.

Clinical and instrumental criteria of severity:

shortness of breath with a respiratory rate of more than 30 per minute;
oxygen saturation less than 90%;
low blood pressure (systolic (SBP) less than 90 mm Hg and/or diastolic (DBP) less than 60 mm Hg);
involvement of more than 1 lobe of the lung in the pathological process, bilateral damage;
disorders of consciousness;
extrapulmonary metastatic foci;
anuria.

Laboratory criteria for severity:

decrease in the level of leukocytes in the blood test less than 4000/μl;
partial oxygen tension is less than 60 mmHg;
hemoglobin level less than 100 g/l;
hematocrit value less than 30%;
an acute increase in creatinine levels over 176.7 µmol/l or urea levels over 7.0 mmol/l.

To quickly assess the condition of a patient with pneumonia, the CURB-65 and CRB-65 scales are used in clinical practice. The scales contain the following criteria: age over 65 years, impaired consciousness, respiratory rate more than 30 per minute, SBP level less than 90 mmHg. and/or DBP less than 60 mmHg, urea level over 7 mmol/l (urea level is assessed only using the CURB-65 scale).

More often in the clinic, CRB-65 is used, which does not require the determination of laboratory parameters. Each criterion is worth 1 point. If the patient scores 0-1 points on the scale, he is subject to outpatient treatment, 2 points - inpatient, 3-4 points - treatment in the intensive care unit.

The term “chronic pneumonia” is currently considered incorrect. Pneumonia is always an acute disease, lasting an average of 2-3 weeks.

However, in some patients, for various reasons, radiological remission of the disease does not occur for 4 weeks or more. The diagnosis in this case is formulated as “prolonged pneumonia.”

The disease can be complicated or uncomplicated. The present complication must be included in the diagnosis.

Complications of pneumonia include the following conditions:

exudative pleurisy;
lung abscess (abscess pneumonia);
adult respiratory distress syndrome;
acute respiratory failure (1, 2, 3 degrees);
sepsis.

The diagnosis must include the localization of pneumonia on the affected side (right-, left-, bilateral), along the lobes and segments (S1-S10) of the lungs. An approximate diagnosis might sound like this:

1. Community-acquired right-sided lower lobe pneumonia of non-severe course. Respiratory failure 0.
2. Nosocomial right-sided lower lobe pneumonia (S6, S7, S8, S10) of severe course, complicated by right-sided exudative pleurisy. Respiratory failure 2.

Whatever class pneumonia belongs to, this disease requires immediate medical treatment under the supervision of a specialist.

Sources used: lecheniegorla.ru

*P. - pneumonia.

*P. - pneumonia.

*P. - pneumonia.

Possible complications

Pleurisy is inflammation of the membrane surrounding the lungs. Chest pain when inhaling, accumulation of fluid in the pleural cavity.
Pericarditis is inflammation of the pericardium.
Hepatitis, gastrointestinal diseases. They may be caused by the fact that by taking large quantities of antibiotics, the patient kills beneficial microflora.
Chronic bronchitis is damage to the walls of the bronchi.
Asthma is an allergic disease, the main symptom of which is asthma attacks. At the same time, exhalation is difficult.

But with community-acquired pneumonia there will never be such complications, since the disease occurs in mild to moderate form.

Treatment

Currently, most experts believe that patients with community-acquired pneumonia can be treated at home, that is, on an outpatient basis, but under the supervision of a doctor who will prescribe a medication regimen.

Community-acquired pneumonia ICD 10 in children: treatment and recommendations, causative agent.

Community-acquired pneumonia is an inflammatory process in the lungs that occurred in a patient at home or in the first two days after hospitalization.

This is an infectious disease that poses a threat to human health and life.

Spread of community-acquired pneumonia

The incidence of community-acquired pneumonia is directly proportional to age. The disease occurs more often in elderly and senile people than in young people.

Mortality from the pathology is low. Indicators increase with increasing severity of the disease and the age of the patient.

Classification of community-acquired pneumonia

There are three types of community-acquired pneumonia.

Pneumonia is an acute inflammatory disease of the respiratory parts of the lungs, predominantly of bacterial etiology, characterized by intra-alveolar exudation. The diagnosis of “acute pneumonia” is not used in modern literature and is unnecessary, since the diagnosis of “chronic pneumonia” is pathogenetically unfounded and outdated.

The main causes of the disease according to WHO

The respiratory tract of adults and children is constantly attacked by pathogens, but local defense mechanisms in the form of immunoglobulin A, lysozyme and macrophages in healthy people prevent diseases from developing.

Risk factors for developing pneumonia, as defined by WHO in 1995, include:

old age - people over 60 years of age (due to suppression of the cough reflex, the reflex responsible for spasm of the glottis);
the period of newbornhood and infancy (the reason is the incomplete development of the immune system);
conditions accompanied by loss of consciousness (epilepsy, traumatic brain injury, anesthetized sleep, suicide attempts with sleeping pills or drugs, alcohol intoxication);
respiratory diseases (chronic bronchitis, emphysema, acute respiratory distress syndrome), smoking;
concomitant diseases that reduce the activity of the immune system (oncological diseases, systemic connective tissue diseases, HIV infection, etc.);
negative social and living conditions, malnutrition;
keeping the patient in a lying position for a long time.

Modern medicine evolves every day, scientists isolate new microorganisms and discover new antibiotics. Classifications of diseases are also undergoing various changes, which are aimed at optimizing the treatment of patients, triaging patients, and preventing the development of complications.

Currently, WHO identifies several types of pneumonia in adults and children, based on the etiology of the pathogen, localization of the process, timing and conditions of occurrence, and clinical categories of patients.

Classification according to ICD-10 (by forms and timing of occurrence)

Out-of-hospital - occurs at home or in the first 48 hours of stay in a medical institution. The course is relatively favorable, the mortality rate is 10-12%.
Hospital (nosocomial) – occurs after 48 hours of the patient’s stay in the hospital or if the patient has been treated in any medical institution for 2 or more days over the previous 3 months. In modern protocols, the World Health Organization (WHO) includes in this category patients with ventilator-associated pneumonia (who are on mechanical ventilation for a long time), as well as patients with pneumonia who are kept in nursing homes. It is characterized by a high degree of severity and mortality up to 40%.
Aspiration pneumonia - occurs when a large amount of oropharyngeal contents is swallowed by unconscious patients with impaired swallowing and a weakened cough reflex (alcohol intoxication, epilepsy, traumatic brain injury, ischemic and hemorrhagic strokes, etc.). Aspiration of gastric contents may cause a chemical burn of the mucous membrane of the respiratory tract with hydrochloric acid. This condition is called chemical pneumonitis.
Pneumonia developing against the background of immunodeficiencies, both primary (thymic aplasia, Bruton's syndrome) and secondary (HIV infection, oncohematological diseases).

Varieties by pathogen, severity and localization

Classification by pathogen:

Bacterial - the main pathogens are Streptococcus pneumonia, Staphylococcus aureus, Mycoplasmapneumonia, Haemophilus influenza, Chlamydiapneumonia.
Viral - often caused by influenza viruses, parainfluenza, rhinoviruses, adenoviruses, respiratory syncytial virus. In more rare cases, these may be measles, rubella, whooping cough viruses, cytomegalovirus infection, and Epstein-Barr virus.
Fungal - the main representatives in this category are Candida albicans, fungi of the genus Aspergillus, Pneumocystisjiroveci.
Pneumonia caused by protozoa.
Pneumonia caused by helminths.
Mixed - this diagnosis occurs most often with a bacterial-viral association.

Forms of pneumonia by severity:

light;
average;
heavy;
extremely heavy.

Types of pneumonia by localization:

Focal – within the acinus and lobule.
Segmental, polysegmental - within one or several segments.
Lobar (outdated diagnosis: lobar pneumonia) – within one lobe.
Total, subtotal - can cover the entire lung.

The inflammatory process occurs:

one-sided;
bilateral.

From birth to 3 weeks - the etiological agent of pneumonia (more often in premature infants) are group B streptococci, gram-negative bacilli, cytomegalovirus infection, Listeria monocytogenes.
From 3 weeks to 3 months - in most cases, children are affected by a viral infection (respiratory syncytial virus, influenza viruses, parainfluenza, metapneumovirus), Streptococcus pneumoniae, Staphylococcus aureus, Bordetellapertussis, Chlamydiatrachomatis (nasal infection).
From 4 months to 4 years - at this age, the susceptibility of children increases to group A streptococci, Streptococcus pneumoniea, viral infections (parainfluenza viruses, influenza viruses, adenoviruses, rhinoviruses, respiratory syncytial viruses, metapneumoviruses), Mycoplasmapneumoniae (in older children).
From 5 to 15 years - at school age, pneumonia in children is most often caused by Streptococcus pneumoniae, Mycoplasmapneumoniae, Chlamydiapneumoniae.

Clinical categories of patients with community-acquired pneumonia according to ICD-10

Forms of nosocomial inflammation according to WHO

Early - occur during the first 4-5 days from the moment of admission to the hospital, have a relatively favorable diagnosis, microorganisms are generally sensitive to antibiotic therapy.
Late - appear after 6 days of stay in a medical institution, the diagnosis in most cases is questionable or unfavorable, the pathogens are multi-resistant to antibiotics.

Criteria for severe disease

the appearance on the radiograph of “fresh” focal infiltrative changes in the lungs;
temperature over 38°C;
bronchial hypersecretion;
Pa O2/Fi O2 ≤ 240;
cough, tachypnea, locally auscultated crepitations, moist rales, bronchial breathing;
leukopenia or leukocytosis, band shift (more than 10% of young forms of neutrophils);
sputum microscopy reveals more than 25 polymorphonuclear leukocytes in the field of view.

One of the most serious lung diseases is pneumonia. It is caused by a variety of pathogens and leads to a large number of deaths among children and adults in our country. All these facts make it necessary to understand the issues related to this disease.

Definition of pneumonia

Pneumonia- acute inflammatory disease of the lungs, characterized by exudation of fluid in the alveoli, caused by various types of microorganisms.

Classification of community-acquired pneumonia

Based on the cause of pneumonia, it is divided into:

Bacterial (pneumococcal, staphylococcal);
Viral (exposure to influenza viruses, parainfluenza, adenoviruses, cytomegalovirus)
Allergic
Ornithosis
Gribkovs
Mycoplasma
Rickettsial
Mixed
With an unknown cause of the disease

The modern classification of the disease, developed by the European Respiratory Society, allows us to assess not only the causative agent of pneumonia, but also the severity of the patient’s condition.

mild pneumococcal pneumonia;
mild atypical pneumonia;
pneumonia, probably of severe pneumococcal etiology;
pneumonia caused by an unknown pathogen;
aspiration pneumonia.

According to the International Classification of Diseases and Deaths of 1992 (ICD-10), there are 8 types of pneumonia depending on the pathogen that caused the disease:

J12 Viral pneumonia, not elsewhere classified;
J13 Pneumonia caused by Streptococcus pneumoniae;
J14 Pneumonia caused by Haemophilus influenzae;
J15 Bacterial pneumonia, not classified;
J16 Pneumonia caused by other infectious agents;
J17 Pneumonia in diseases classified elsewhere;
J18 Pneumonia without specifying the pathogen.

The International Classification of Pneumonia distinguishes the following types of pneumonia:

Community-acquired;
Hospital;
Aspiration;
Pneumonia accompanying severe diseases;
Pneumonia in persons with immunodeficiency conditions;

Community-acquired pneumonia is a lung disease of an infectious nature that developed before hospitalization in a medical organization under the influence of various groups of microorganisms.

Etiology of community-acquired pneumonia

Most often, the disease is caused by opportunistic bacteria, which are normally natural inhabitants of the human body. Under the influence of various factors, they become pathogenic and cause the development of pneumonia.

Factors contributing to the development of pneumonia:

Hypothermia;
Lack of vitamins;
Being near air conditioners and humidifiers;
Presence of bronchial asthma and other lung diseases;
Tobacco use.

The main sources of community-acquired pneumonia:

Pulmonary pneumococcus;
Mycoplasmas;
Pulmonary chlamydia;
Haemophilus influenzae;
Influenza virus, parainfluenza, adenoviral infection.

The main ways that microorganisms that cause pneumonia enter the lung tissue are ingestion of microorganisms with air or inhalation of a suspension containing pathogens.

Under normal conditions, the respiratory tract is sterile, and any microorganism that enters the lungs is destroyed using the lungs’ drainage system. If the functioning of this drainage system is disrupted, the pathogen is not destroyed and remains in the lungs, where it affects the lung tissue, causing the development of the disease and the manifestation of all clinical symptoms.

Symptoms of community-acquired pneumonia

The disease always begins suddenly and manifests itself with various signs.

Pneumonia is characterized by the following clinical symptoms:

A rise in body temperature to 38-40 C. The main clinical symptom of the disease in people over 60 years of age, an increase in temperature can remain within 37-37.5 C, which indicates a low immune response to the introduction of the pathogen.
Persistent cough characterized by the production of rust-colored sputum
Chills
General malaise
Weakness
Decreased performance
Sweating
Pain when breathing in the chest area, which proves the transition of inflammation to the pleura
Shortness of breath is associated with significant damage to areas of the lung.

Features of clinical symptoms associated with damage to certain areas of the lung. With focal broncho-pneumonia, the disease begins slowly a week after the initial signs of illness. The pathology covers both lungs and is characterized by the development of acute respiratory failure and general intoxication of the body.

For segmental lesions lung is characterized by the development of an inflammatory process in the entire segment of the lung. The disease progresses generally favorably, without fever or cough, and the diagnosis can be made accidentally during an X-ray examination.

For lobar pneumonia clinical symptoms are vivid, high body temperature worsens the condition up to the development of delirium, and if the inflammation is located in the lower parts of the lungs, abdominal pain appears.

Interstitial pneumonia possible when viruses enter the lungs. It is quite rare and often affects children under 15 years of age. There is an acute and subacute course. The outcome of this type of pneumonia is pneumosclerosis.

For acute course Characteristic phenomena are severe intoxication and the development of neurotoxicosis. The course is severe with a high rise in temperature and persistent residual effects. Children aged 2-6 years are often affected.
Subacute course characterized by cough, increased lethargy and fatigue. It is widespread among children 7-10 years of age who have had ARVI.

There are features of the course of community-acquired pneumonia in people who have reached retirement age. Due to age-related changes in immunity and the addition of chronic diseases, the development of numerous complications and erased forms of the disease is possible.

Severe respiratory failure develops it is possible to develop disturbances in the blood supply to the brain, accompanied by psychoses and neuroses.

Types of hospital-acquired pneumonia

Hospital-acquired pneumonia is an infectious disease of the respiratory tract that develops 2-3 days after hospitalization in a hospital, in the absence of symptoms of pneumonia before admission to the hospital.

Among all nosocomial infections it ranks 1st in terms of the number of complications. It has a great impact on the cost of treatment, increases the number of complications and deaths.

Divided by time of occurrence:

Early- occurs in the first 5 days after hospitalization. Caused by microorganisms already present in the body of the infected person (Staphylococcus aureus, Haemophilus influenzae and others);
Late- develops 6-12 days after being admitted to the hospital. The causative agents are hospital strains of microorganisms. It is most difficult to treat due to the development of resistance of microorganisms to the effects of disinfectants and antibiotics.

There are several types of infection due to their occurrence:

Ventilator-associated pneumonia- occurs in patients who have been on artificial ventilation for a long time. According to doctors, one day of a patient being on a ventilator increases the likelihood of contracting pneumonia by 3%.

Impaired drainage function of the lungs;
A small amount of ingested oropharyngeal contents containing the causative agent of pneumonia;
Oxygen-air mixture contaminated with microorganisms;
Infection from carriers of hospital infection strains among medical personnel.

Causes of postoperative pneumonia:

Stagnation of the pulmonary circulation;
Low ventilation;
Therapeutic manipulations on the lungs and bronchi.

Aspiration pneumonia- an infectious disease of the lungs that occurs as a result of the contents of the stomach and oropharynx entering the lower respiratory tract.

Hospital-acquired pneumonia requires serious treatment with the most modern medications due to the resistance of pathogens to various antibacterial drugs.

Diagnosis of community-acquired pneumonia

Today there is a complete list of clinical and paraclinical methods.

The diagnosis of pneumonia is made after the following studies:

Clinical data about the disease
General blood test data. Increased leukocytes, neutrophils;
Sputum culture to identify the pathogen and its sensitivity to an antibacterial drug;
X-ray of the lungs, which reveals the presence of shadows in various lobes of the lung.

Treatment of community-acquired pneumonia

The process of treating pneumonia can take place both in a medical institution and at home.

Indications for hospitalization of a patient in a hospital:

Age. Young patients and pensioners after 70 years of age should be hospitalized to prevent the development of complications;
Disturbed consciousness
Presence of chronic diseases (bronchial asthma, COPD, diabetes mellitus, immunodeficiency);
Inability to leave.

The main drugs aimed at treating pneumonia are antibacterial drugs:

Cephalosporins: ceftriaxone, cefurotoxime;
Penicillins: amoxicillin, amoxiclav;
Macrolides: azithromycin, roxithromycin, clarithromycin.

If there is no effect from taking the drug within several days, it is necessary to change the antibacterial drug. To improve sputum discharge, mucolytics (ambrocol, bromhexine, ACC) are used.

Complications of community-acquired pneumonia

With untimely treatment or its absence, the following complications may develop:

Exudative pleurisy
Development of respiratory failure
Purulent processes in the lung
Respiratory distress syndrome

Prognosis for pneumonia

In 80% of cases, the disease is successfully treated and does not lead to serious adverse consequences. After 21 days, the patient’s well-being improves, and X-ray images show partial resorption of the infiltrative shadows.

Prevention of pneumonia

In order to prevent the development of pneumococcal pneumonia, vaccination is carried out with an influenza vaccine containing antibodies against pneumococcus.

Pneumonia is a dangerous and insidious enemy for humans, especially if it occurs unnoticed and has few symptoms. Therefore, it is necessary to be attentive to your own health, get vaccinated, consult a doctor at the first signs of illness, and remember what serious complications pneumonia can cause.

Treatment of community-acquired pneumonia code according to ICD 10

Everyone knows that such a disease exists. But what do the other words of the diagnosis mean? How to figure this out and how to get rid of pneumonia?

Definition of disease

Pneumonia, or as it is more often called pneumonia, is an infectious disease that can occur as an independent disease, as well as as a complication of other diseases. The disease affects the lower respiratory tract. It is classified according to forms, as well as timing of occurrence (international classification of the disease or ICD-10). The abbreviation is clear, but the number ten means a class that includes all diseases of the respiratory system. According to MBK-10 indicators, the disease is divided into:

Out-of-hospital. If a person falls ill at home, or catches pneumonia in the first two days after being hospitalized for treatment.
Hospital. After staying in hospital for more than two days, the patient develops symptoms of pneumonia.
Aspiration. This category includes patients who, for a number of reasons, have an impaired swallowing reflex and a weakened cough reflex. This can happen to a person in the stage of severe alcohol intoxication, or it can be a consequence of epilepsy or stroke.
Immunodeficiency. Pneumonia develops against the background of loss of immunity or its weakening.

In addition to these indicators, the disease is classified according to the causative agent of the disease, severity and location. So, the main causative agents of pneumonia can be:

According to the severity of the disease: from mild to extremely severe.

There are also divisions into categories of patients according to the international classification of diseases.

It all depends on the severity of the disease and concomitant diseases, as well as the age of the patient:

The first category includes people whose disease is of viral or bacterial origin, without any pathologies. They easily tolerate the disease, and there are no complications from other organs.
The second category includes patients who also have a mild form of the disease. But this group includes people suffering from chronic diseases of the respiratory system or having disorders of the cardiovascular system. As well as small children under two years old and elderly people.
The third category of patients must be treated for the disease as an inpatient. Since the disease can already be caused by two pathogens. For example, bacteria and viruses and is of moderate severity.
The fourth category of patients are people with a severe form of the disease. They need intensive care and therefore treatment should only take place under the supervision of a doctor in a hospital.

Causes

You can get pneumonia at any age and in any season of the year. And the causes of diseases can be:

Gram-positive microorganisms
Gram negative bacteria
Viruses,
fungi,
Worms,
Foreign bodies entering the respiratory tract,
Toxin poisoning
Chest injuries
Allergy,
Alcohol abuse
Tobacco smoking.

People at risk include people who:

Constantly nervous, worried,
Poor or unbalanced diet,
Lead a sedentary lifestyle
Cannot get rid of bad habits such as smoking and drinking alcohol,
Suffer from frequent colds,
Have a low level of immunity,
Elderly people.

Most often, pneumonia begins with a cold, so it is characterized by almost the same symptoms, but then pink sputum appears when coughing, sharp pain in the chest, which intensifies when inhaling.

The appearance of these symptoms is preceded by the following:

Temperature rises even to 39 degrees or higher,
Headache,
Dyspnea,
Sleep disturbance,
lethargy,
Increased breathing,
In some cases, the nasolabial triangle becomes bluish in color.

Possible complications

Pneumonia is not as dangerous as its complications. Because in severe cases, pulmonary edema and acute respiratory failure may develop. Other possible complications include:

Pleurisy is inflammation of the membrane surrounding the lungs. Chest pain when inhaling, accumulation of fluid in the pleural cavity.
Pericarditis is inflammation of the pericardium.
Hepatitis, gastrointestinal diseases. They may be caused by the fact that by taking large quantities of antibiotics, the patient kills beneficial microflora.
Chronic bronchitis is damage to the walls of the bronchi.
Asthma is an allergic disease, the main symptom of which is asthma attacks. At the same time, exhalation is difficult.

But with community-acquired pneumonia there will never be such complications, since the disease occurs in mild to moderate form.

By medication

The basis of treatment for patients with community-acquired pneumonia is taking antibiotics. For the first category of patients, treatment with Amoxicillin or Azithromycin is possible, which are quite effective agents in the fight against almost all pathogens of the respiratory system.

If first-line antibiotics are ineffective, drugs of this higher order group are prescribed:

Macrolides (Azithromycin, Hemomycin and others),
Cephalosporins (Cefotaxime, Suprax and others),
Aminoglycosides,
Tetracyclines.

Children under six months of age are prescribed predominantly macrolides. From the age of six years, penicillins are used, and in the case of an atypical form, macrolides.

If there is no improvement in the condition after two to three days, the doctor prescribes another antibiotic. The course of antibiotic treatment should be at least ten days.

In addition to antibiotics, treatment includes the use of the following drugs:

Antipyretic. Paracetamol is not recommended for use in this case. It does not have an anti-inflammatory effect. And although there are WHO recommendations that if the temperature is below 38 degrees, then there is no need to bring it down, but in some cases it is necessary to rely on the condition of a particular patient when taking antipyretics. Ibuprofen and Aspirin in combination with Analgin, Nimesulide, and
Antiviral drugs. Used only if it is proven that the disease is caused by viruses. Remantadine, interferons, Cytotect,
Mucolytics. ACC, Lazolvan, Ambrobene are good for thinning sputum,
Expectorants. Mucaltin, Thermopsis and others promote the evacuation of sputum from the body,

If you have pneumonia, it is forbidden to take medications that inhibit the cough reflex. Phlegm must be eliminated from the body.

In addition to the use of medications, the following forms of treatment are included:

Artificial ventilation,
Inhalation using a nebulizer,
Electrophoresis,
Massage.

Due to the fact that there are enough folk proven recipes in the fight against this disease, they can be used quite effectively and in parallel with the use of official medications.

Folk remedies

Undoubtedly, the condition of a patient with pneumonia will be greatly alleviated by the recipes given to us by nature and preserved by many generations of our ancestors. Among the most popular are:

If you take two hundred grams of oat grains, wash them thoroughly, and then pour 1 liter of it. milk and cook for at least an hour, and then, after cooling a little, add a teaspoon of May honey and the same amount of natural butter, this will help with coughing with phlegm to improve its expectoration. You can drink it all day long instead of tea. But do not store it, as such a “medicine” will turn sour quite quickly.
As always, aloe will help with diseases of the respiratory system. To prepare the medicine, you need to take equal amounts by volume of finely chopped agave leaves, linden honey (a glass) and pour a bottle of Cahors wine. Let it sit for a few days. Take a tablespoon three times a day.
Cut off the largest lower leaf of aloe from the bush and, after wiping off dust, chop finely. Add a glass of linden or may honey, and no more than half a glass of water. Let it simmer on the fire for no more than twenty minutes. When it cools down, you can use a tablespoon at least three times a day.
A good medicine for adults will be obtained if 1 liter. boil two tablespoons of lungwort in beer. The volume should be reduced by half. Before use, add a tablespoon of honey to the prepared mixture. The recommended dose is a tablespoon three times a day.
A fairly effective remedy used by people to cure pneumonia is badger fat. It is eaten a tablespoon before meals. To force yourself to swallow pure fat, you can dilute it with honey or drink warm milk with a teaspoon per glass of liquid. Pure fat is rubbed over the chest area for warmth. Then the patient must be wrapped up. Perform the procedure at night.
Drink plenty of fluids constantly. Rosehip compote is especially suitable at this time. Linden tea, chamomile, mint.

Over grated horseradish. Wash the horseradish root thoroughly, grind it in a meat grinder and place the pulp on several layers of gauze. Bring it to your nose and inhale until watery eyes appear.
Over potatoes. Boil a few potato tubers, strain the water and breathe in the hot steam for a few minutes.

Spread honey on the chest or back in the area of the lower lobes of the lungs, then soak a gauze cloth in vodka at room temperature and place it in the indicated place. Cover the top with polyethylene, cotton wool and secure this compress with a long scarf or handkerchief,
Alcohol compress. Dilute pure alcohol by half with water and wet a gauze cloth. Squeeze and place the lungs on your back. Then proceed in layers and so that each layer is a little larger than the previous one: polyethylene, cotton wool, bandage. Or fabric that needs to be secured with adhesive tape.

Apply compresses only if the patient has a low temperature.

Prevention

In order to prevent the occurrence of pneumonia, including community-acquired forms, you need to:

1. Do not visit crowded places during periods of exacerbation of colds and viral diseases.
2. Constantly take care of the state of your immunity.
3. Avoid hypothermia and drafts.
4. Do not carry colds and infectious diseases on your feet.
5. Develop your lungs with simple exercises. For example, every morning, doing a mandatory fifteen-minute exercise, inflate a balloon.
6. Eliminate pockets of infection in the mouth. For example, simply treat carious teeth.
7. Walk in the fresh air more often, using every free minute for this.

Now there is an international classification of diseases. According to the gradation, pneumonia is in the tenth class along with all diseases of the respiratory system. It can be caused by different pathogens and occur in different forms. And it can be treated both in a hospital and on an outpatient basis. The doctor decides everything by analyzing the patient’s vital signs, test results and identifying the pathogen. He also prescribes a treatment regimen with certain drugs. Proven folk remedies can also be used as complementary, but not alternative, remedies in the treatment of this particular disease.

How to treat community-acquired pneumonia: clinical guidelines

Community-acquired or community-acquired pneumonia – major category of lesions of the alveoli of the lungs that develop outside of medical institutions.

Such inflammatory processes may have different origins, and depending on the etiology of the disease, certain drug treatment and clinical recommendations are prescribed.

What is community-acquired pneumonia?

The ICD-10 catalog code for the disease community-acquired pneumonia is classified depending on the pathogen with designations from J12 to J18.

In more than half of the cases, when such a disease is diagnosed, the patient is hospitalized, since pneumonia is fraught with serious complications and death.

This type of pneumonia is determined based on the period during which the infection develops.

This diagnosis is made if the disease develops in a person who has not been in a medical facility over the next two weeks. The symptoms of the pathology are the same as those of most other forms of pneumonia.

Causes of the disease

Disease caused by the following microorganisms:

The development of such a pathology contribute to various external and internal factors:

long-term bed rest;
hypothermia;
weakened immunity;
some concomitant diseases (pathologies of the lungs, heart, diabetes mellitus);
viral respiratory diseases.

Classifications of the disease

Community-acquired pneumonia is classified according to several signs and characteristics of its course and development:

The acute form develops quickly and is characterized by severe symptoms

If the disease does not go away within a month, it is stated that it has transitioned to a chronic form, which often affects not only the lung tissue itself, but also the intermediate areas.

In this case, deformation of the bronchi is often observed and fibrous (scar) tissue may grow, especially during periods of relapse.

Symptoms of the disease

For community-acquired pneumonia characteristic following general signs and symptoms:

The worse the patient’s immunity works, the more clearly the symptoms appear.

Diagnostics

Microbiological examination of the respiratory tract.
A sputum analysis is carried out to determine the causative agent of the pathology.
Collection of analyzes for laboratory research.
A general blood and urine test is performed, materials are examined for the number of leukocytes, glucose and electrolyte levels.
An increase in these indicators always indicates the development of inflammatory processes characteristic of such pathologies.
Radiography.
This is the main method of radiological diagnostics, which allows us to identify structural changes in the tissues of the respiratory tract (seals, neoplasms, scar tissue).

After completing the course of treatment, x-rays are performed again.

This is necessary to determine the presence of residual pathological processes and to identify possible complications after pneumonia.

Already at the stage of preliminary examination necessary to determine the course of treatment, the doctor prescribes antibacterial treatment using broad-spectrum antibiotics.

This allows you not to waste time and makes it possible to strike a preventive blow against bacterial pathogens.

Basically, for this disease, drugs are used in the form of tablets, and adult patients are most often prescribed claprithromycin, azithromycin or amoxicillin.

In the absence of allergic reactions to drugs of the fluoroquinolone group, drugs are prescribed gemifloxacin, moxifloxacin, levofloxacin.

When do test results come back?– specialists can already prescribe certain medications, active against specific pathogens:

In children, treatment follows similar schemes., but certain drugs are used for this, since many antibiotics in childhood can lead to the development of side effects.

This is ampicillin or a combination of amoxicillin with sulbactam or clavulanate, but such drugs are effective for mild to moderate pneumonia.

In severe cases antibiotics are used flemoxin solutab and amoxicillin, which, with this degree of severity, can be administered intravenously and additionally used for inhalation.

Complications

Community-acquired pneumonia can lead to complications affecting various organs and systems of the body:

The later adequate measures are taken in terms of treatment, the higher the likelihood of such complications, so experts do not recommend ignoring the disease or conducting independent treatment on an outpatient basis.

Prevention

This measure is especially relevant for medical workers who come into contact with patients with infectious diseases, for the elderly and children, and for people with weakened immune systems who are susceptible to seasonal infectious respiratory diseases.

In addition to vaccination, preventive measures may also include:

Useful video

This video presents a 2016 lecture on the diagnosis and treatment of community-acquired pneumonia:

Community-acquired pneumonia considered a dangerous inflammatory disease, which, although fraught with a large number of serious complications, is however, it is easily treatable if you consult a doctor in a timely manner.

Treatment prognosis is favorable even in case of illness in young children, but in order to avoid worsening the situation Do not self-medicate and delay visiting the clinic.

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

ICD 10: community-acquired pneumonia

Definition of pneumonia

Pneumonia is an acute inflammatory disease of the lungs, characterized by exudation of fluid in the alveoli, caused by various types of microorganisms.

Classification of community-acquired pneumonia

Based on the cause of pneumonia, it is divided into:

Bacterial (pneumococcal, staphylococcal);
Viral (exposure to influenza viruses, parainfluenza, adenoviruses, cytomegalovirus)
Allergic
Ornithosis
Gribkovs
Mycoplasma
Rickettsial
Mixed
With an unknown cause of the disease

mild pneumococcal pneumonia;
mild atypical pneumonia;
pneumonia, probably of severe pneumococcal etiology;
pneumonia caused by an unknown pathogen;
aspiration pneumonia.

According to the International Classification of Diseases and Deaths of 1992 (ICD-10), there are 8 types of pneumonia depending on the pathogen that caused the disease:

J12 Viral pneumonia, not elsewhere classified;
J13 Pneumonia caused by Streptococcus pneumoniae;
J14 Pneumonia caused by Haemophilus influenzae;
J15 Bacterial pneumonia, not classified;
J16 Pneumonia caused by other infectious agents;
J17 Pneumonia in diseases classified elsewhere;
J18 Pneumonia without specifying the pathogen.

The International Classification of Pneumonia distinguishes the following types of pneumonia:

Community-acquired;
Hospital;
Aspiration;
Pneumonia accompanying severe diseases;
Pneumonia in persons with immunodeficiency conditions;

Community-acquired pneumonia is a lung disease of an infectious nature that developed before hospitalization in a medical organization under the influence of various groups of microorganisms.

Etiology of community-acquired pneumonia

Factors contributing to the development of pneumonia:

Hypothermia;
Lack of vitamins;
Being near air conditioners and humidifiers;
Presence of bronchial asthma and other lung diseases;
Tobacco use.

The main sources of community-acquired pneumonia:

Pulmonary pneumococcus;
Mycoplasmas;
Pulmonary chlamydia;
Haemophilus influenzae;
Influenza virus, parainfluenza, adenoviral infection.

The main ways that microorganisms that cause pneumonia enter the lung tissue are ingestion of microorganisms with air or inhalation of a suspension containing pathogens.

Under normal conditions, the respiratory tract is sterile, and any microorganism that enters the lungs is destroyed by the lungs' drainage system. If the functioning of this drainage system is disrupted, the pathogen is not destroyed and remains in the lungs, where it affects the lung tissue, causing the development of the disease and the manifestation of all clinical symptoms.

Symptoms of community-acquired pneumonia

The disease always begins suddenly and manifests itself with various signs.

Pneumonia is characterized by the following clinical symptoms:

Increase in body temperature to C. The main clinical symptom of the disease in people over 60 years of age, an increase in temperature can remain within 37-37.5 C, which indicates a low immune response to the introduction of the pathogen.
Persistent cough characterized by the production of rust-colored sputum
Chills
General malaise
Weakness
Decreased performance
Sweating
Pain when breathing in the chest area, which proves the transition of inflammation to the pleura
Shortness of breath is associated with significant damage to areas of the lung.

Features of clinical symptoms are associated with damage to certain areas of the lung. With focal broncho-pneumonia, the disease begins slowly a week after the initial signs of illness. The pathology covers both lungs and is characterized by the development of acute respiratory failure and general intoxication of the body.

With segmental damage to the lung, the development of an inflammatory process in the entire segment of the lung is characteristic. The disease progresses generally favorably, without fever or cough, and the diagnosis can be made accidentally during an X-ray examination.

With lobar pneumonia, the clinical symptoms are vivid, high body temperature worsens the condition up to the development of delirium, and if the inflammation is located in the lower parts of the lungs, abdominal pain appears.

Interstitial pneumonia is possible when viruses enter the lungs. It is quite rare and often affects children under 15 years of age. There is an acute and subacute course. The outcome of this type of pneumonia is pneumosclerosis.

The acute course is characterized by severe intoxication and the development of neurotoxicosis. The course is severe with a high rise in temperature and persistent residual effects. Children aged 2-6 years are often affected.
The subacute course is characterized by cough, increased lethargy and fatigue. It is widespread among children 7-10 years of age who have had ARVI.

Severe respiratory failure develops, and disturbances in the blood supply to the brain may develop, accompanied by psychoses and neuroses.

Types of hospital-acquired pneumonia

Hospital-acquired pneumonia is an infectious disease of the respiratory tract that develops 2-3 days after hospitalization in a hospital, in the absence of symptoms of pneumonia before admission to the hospital.

Among all nosocomial infections it ranks 1st in terms of the number of complications. It has a great impact on the cost of treatment, increases the number of complications and deaths.

Divided by time of occurrence:

Early - occurs in the first 5 days after hospitalization. Caused by microorganisms already present in the body of the infected person (Staphylococcus aureus, Haemophilus influenzae and others);
Late - develops 6-12 days after being admitted to the hospital. The causative agents are hospital strains of microorganisms. It is most difficult to treat due to the development of resistance of microorganisms to the effects of disinfectants and antibiotics.

There are several types of infection due to their occurrence:

Ventilator-associated pneumonia occurs in patients who have been on mechanical ventilation for a long time. According to doctors, one day of a patient being on a ventilator increases the likelihood of contracting pneumonia by 3%.

Impaired drainage function of the lungs;
A small amount of ingested oropharyngeal contents containing the causative agent of pneumonia;
Oxygen-air mixture contaminated with microorganisms;
Infection from carriers of hospital infection strains among medical personnel.

Causes of postoperative pneumonia:

Stagnation of the pulmonary circulation;
Low ventilation;
Therapeutic manipulations on the lungs and bronchi.

Aspiration pneumonia is an infectious disease of the lungs that occurs as a result of the contents of the stomach and oropharynx entering the lower respiratory tract.

Hospital-acquired pneumonia requires serious treatment with the most modern medications due to the resistance of pathogens to various antibacterial drugs.

Diagnosis of community-acquired pneumonia

Today there is a complete list of clinical and paraclinical methods.

The diagnosis of pneumonia is made after the following studies:

Clinical data about the disease
General blood test data. Increased leukocytes, neutrophils;
Sputum culture to identify the pathogen and its sensitivity to an antibacterial drug;
X-ray of the lungs, which reveals the presence of shadows in various lobes of the lung.

Treatment of community-acquired pneumonia

The process of treating pneumonia can take place both in a medical institution and at home.

Indications for hospitalization of a patient in a hospital:

Age. Young patients and pensioners after 70 years of age should be hospitalized to prevent the development of complications;
Disturbed consciousness
Presence of chronic diseases (bronchial asthma, COPD, diabetes mellitus, immunodeficiency);
Inability to leave.

The main drugs aimed at treating pneumonia are antibacterial drugs:

Cephalosporins: ceftriaxone, cefurotoxime;
Penicillins: amoxicillin, amoxiclav;
Macrolides: azithromycin, roxithromycin, clarithromycin.

If there is no effect from taking the drug within several days, it is necessary to change the antibacterial drug. To improve sputum discharge, mucolytics (ambrocol, bromhexine, ACC) are used.

Complications of community-acquired pneumonia

With untimely treatment or its absence, the following complications may develop:

Exudative pleurisy
Development of respiratory failure
Purulent processes in the lung
Respiratory distress syndrome

Prognosis for pneumonia

Prevention of pneumonia

In order to prevent the development of pneumococcal pneumonia, vaccination is carried out with an influenza vaccine containing antibodies against pneumococcus.

Pneumonia is a dangerous and insidious enemy for humans, especially if it occurs unnoticed and has few symptoms. Therefore, it is necessary to be attentive to your own health, get vaccinated, consult a doctor at the first signs of illness, and remember what serious complications pneumonia can cause.

Community-acquired, acute pneumonia: ICD-10 code:

For a long time in our country the term “pneumonia” was used in a broad sense. This term denoted focal inflammation of almost any etiology. Until recently, there was confusion in the classification of the disease, since the following etiological units were included in the category: allergic pneumonia, caused by physical and chemical influences. At the present stage, Russian doctors use the classification approved by the Russian Respiratory Society, and also code each case of the disease according to the International Classification of Diseases (ICD-10).

What is meant by the term “pneumonia”?

Pneumonia is a large group of acute infectious lung diseases that differ in etiology, development mechanism, and morphology. The main signs are focal damage to the respiratory part of the lungs, the presence of exudate in the cavity of the alveoli. Bacterial pneumonia is the most common, although the causative agents can be viruses, protozoa, and fungi.

In accordance with ICD-10, pneumonia includes infectious inflammatory diseases of the lung tissue. Diseases caused by chemical and physical factors (gasoline pneumonia, radiation pneumonitis) and those of an allergic nature (eosinophilic pneumonia) are not included in this concept and are classified in other headings.

Focal inflammation of the lung tissue is often a manifestation of a number of diseases caused by special, extremely contagious microorganisms. These diseases include measles, rubella, chickenpox, influenza, and Q fever. These nosologies are excluded from the section. Interstitial pneumonia caused by specific pathogens, caseous pneumonia, which is one of the clinical forms of pulmonary tuberculosis, post-traumatic pneumonia are also excluded from the rubric.

Classification according to ICD-10

In accordance with the International Classification of Diseases, Injuries and Causes of Death, 10th revision, pneumonia belongs to class X - respiratory diseases. The class is coded with the letter J.

The modern classification of pneumonia is based on the etiological principle. Depending on the pathogen isolated during microbiological testing, pneumonia is assigned one of the following codes:

J13 P. caused by Streptococcus pneumoniae;
J14 P. caused by Haemophilus influenzae;
J15 bacterial P., not classified elsewhere, caused by: J15. 0 K. pneumoniae; J15. 1 Pseudomonas aeruginosa; J15. 2 staphylococci; J15. 3 group B streptococci; J15. 4 other streptococci; J15. 5 E. coli; J15. 6 other gram-negative bacteria; J15. 7 M. pneumoniae; 15. 8 other bacterial P.; J15. 9 bacterial P. unspecified;
J16 P. caused by other infectious agents, not classified elsewhere;
J18 P. without specifying the pathogen: J18. 0 bronchopneumonia, unspecified; J18. 1 lobar P. unspecified; J18. 2 hypostatic (stagnant) P. unspecified; J18. 8 other P.; J18. 9 P. unspecified.

Classification by place of origin

If a clinical picture of pneumonia occurs after 2 days from the time the patient was admitted to the hospital, the case is considered as a nosocomial infection. The need to divide into these categories is associated with different approaches to antibacterial therapy. In patients with nosocomial infection, it is necessary to take into account possible antibiotic resistance of pathogens.

A similar classification is proposed by WHO (World Health Organization) experts. They propose to distinguish community-acquired, hospital-acquired, aspiration pneumonia, as well as pneumonia in persons with concomitant immunodeficiency.

By severity

The long-existing division into 3 degrees of severity (mild, moderate, severe) has now lost its meaning. It did not have clear criteria or significant clinical significance.

Clinical and instrumental criteria of severity:

shortness of breath with a respiratory rate of more than 30 per minute;
oxygen saturation less than 90%;
low blood pressure (systolic (SBP) less than 90 mm Hg and/or diastolic (DBP) less than 60 mm Hg);
involvement of more than 1 lobe of the lung in the pathological process, bilateral damage;
disorders of consciousness;
extrapulmonary metastatic foci;
anuria.

Laboratory criteria for severity:

decrease in the level of leukocytes in the blood test less than 4000/μl;
partial oxygen tension is less than 60 mmHg;
hemoglobin level less than 100 g/l;
hematocrit value less than 30%;
an acute increase in creatinine levels over 176.7 µmol/l or urea levels over 7.0 mmol/l.

According to the duration of the course and the presence of complications

The term “chronic pneumonia” is currently considered incorrect. Pneumonia is always an acute disease, lasting an average of 2-3 weeks.

However, in some patients, for various reasons, radiological remission of the disease does not occur for 4 weeks or more. The diagnosis in this case is formulated as “prolonged pneumonia.”

The disease can be complicated or uncomplicated. The present complication must be included in the diagnosis.

Complications of pneumonia include the following conditions:

exudative pleurisy;
lung abscess (abscess pneumonia);
adult respiratory distress syndrome;
acute respiratory failure (1, 2, 3 degrees);
sepsis.

Other criteria

1. Community-acquired right-sided lower lobe pneumonia of non-severe course. Respiratory failure 0.

2. Nosocomial right-sided lower lobe pneumonia (S6, S7, S8, S10) of severe course, complicated by right-sided exudative pleurisy. Respiratory failure 2.

Whatever class pneumonia belongs to, this disease requires immediate medical treatment under the supervision of a specialist.

Pneumonia ICD-10 - what is the international classification of diseases

As medical science developed, attempts to classify pneumonia were made repeatedly at different times. Each scientist approached this issue in his own way.

Variety of existing classifications

For example, there is a classification according to the clinical course of the disease: typical, atypical, etc. The classification according to etiology (depending on the pathogen or other causes of the disease) is recognized as the most successful. This approach allows you to select the most effective antibacterial or antiviral therapy.

Etiological classification

With modern laboratory diagnostic methods, it is possible to determine the causative agent of the disease 1-2 days after taking the material for culture. The difficulties lie in the fact that in approximately 30% of cases it is not possible to reliably determine the causative microorganism for various reasons:

insufficient amount of biomaterial (non-productive cough with insufficient amount of sputum produced);
impossibility of determining intracellular culture using standard methods;
It takes too long to get culture results;
problems in the differential definition and differentiation of microbes of the “causative agent” and the “witness” (i.e., an associated infection, which itself is not the etiological cause of pneumonia);
taking powerful antibacterial drugs before seeing a doctor.

It turns out that in every third case it is not possible to determine the pathogen in the early stages of the disease, which makes the etiological classification useless for use in practical medicine.

Syndromic classification

There have been attempts to divide pneumonia into “typical” and “atypical”, but this approach was also unsuccessful. Pneumonia caused by atypical pathogens often clinically manifest themselves as typical. Conversely, typical pneumonia can mimic atypical clinical manifestations.

The division into acute, subacute and chronic pneumonia has also not received positive recognition from practicing doctors. Pneumonia is already initially understood as an acute disease. The chronic recurrent course of respiratory diseases requires a thorough examination of the patient to establish a valid diagnosis. The definition of “chronic pneumonia” is nonsense.

Modern classification

Currently, doctors prefer to subdivide pneumonia according to the time of development of the disease and taking into account the conditions of infection:

community-acquired pneumonia;
nosocomial (nosocomial) pneumonia;
aspiration;
pneumonia due to immunodeficiency.

Nosocomial pneumonia manifests itself after the patient is hospitalized in a hospital in the absence of characteristic radiological and clinical signs at the time the patient is admitted to the hospital.

Aspiration (associated with the ingestion of food, liquid, saliva into the respiratory tract) pneumonia is typical for people suffering from mental disorders, alcoholics and drug addicts, and toxic poisoning.

Immunodeficiency can cause pneumonia in cancer patients who receive immunosuppressive treatment, in HIV-infected people and drug addicts.

Recently, it has been customary to define pneumonia as a separate group, the occurrence of which is associated with the provision of medical care, for example, stay in nursing homes or other long-term medical institutions (boarding schools, sanatoriums, boarding houses, nursing homes).

Community-acquired pneumonia is characterized by the following risk factors:

alcoholism;
smoking;
Chronical bronchitis;
diabetes mellitus during decompression;
living in nursing homes, homes for the disabled, and other long-term medical institutions;
flu;
unsanitized oral cavity;
cystic fibrosis;
addiction;
bronchial obstruction (for example, cancer of the bronchi, esophagus, lung);
long stays in rooms with air conditioners and humidifiers;
outbreaks of a specific infection in a limited group.

Community-acquired pneumonia is a common disease even in countries with developed healthcare systems. Statistically, the incidence is 10 people per 1000. Children and the elderly are most susceptible to the disease. Mortality is 50 people per population (6th place among all causes of death).

International Classification of Diseases (ICD), 10th revision

According to ICD-10, each respiratory disease has its own code from J00 to J99. Each type of pneumonia according to ICD-10 has a code from J12 to J18.

More recently, in the countries of the former USSR they used the classification of N. S. Molchanov (1962) as amended by E. V. Gembitsky (1983). Now this approach is practically no longer used; the ICD-10 classification has become generally accepted.

Treatment of community-acquired pneumonia code according to ICD 10

Everyone knows that such a disease exists. But what do the other words of the diagnosis mean? How to figure this out and how to get rid of pneumonia?

Definition of disease

Out-of-hospital. If a person falls ill at home, or catches pneumonia in the first two days after being hospitalized for treatment.
Hospital. After staying in hospital for more than two days, the patient develops symptoms of pneumonia.
Aspiration. This category includes patients who, for a number of reasons, have an impaired swallowing reflex and a weakened cough reflex. This can happen to a person in the stage of severe alcohol intoxication, or it can be a consequence of epilepsy or stroke.
Immunodeficiency. Pneumonia develops against the background of loss of immunity or its weakening.

In addition to these indicators, the disease is classified according to the causative agent of the disease, severity and location. So, the main causative agents of pneumonia can be:

Bacteria,
Viruses,
fungi,
Helminths.

According to the severity of the disease: from mild to extremely severe.

There are also divisions into categories of patients according to the international classification of diseases.

It all depends on the severity of the disease and concomitant diseases, as well as the age of the patient:

The first category includes people whose disease is of viral or bacterial origin, without any pathologies. They easily tolerate the disease, and there are no complications from other organs.
The second category includes patients who also have a mild form of the disease. But this group includes people suffering from chronic diseases of the respiratory system or having disorders of the cardiovascular system. As well as small children under two years old and elderly people.
The third category of patients must be treated for the disease as an inpatient. Since the disease can already be caused by two pathogens. For example, bacteria and viruses and is of moderate severity.
The fourth category of patients are people with a severe form of the disease. They need intensive care and therefore treatment should only take place under the supervision of a doctor in a hospital.

Causes

You can get pneumonia at any age and in any season of the year. And the causes of diseases can be:

Gram-positive microorganisms
Gram negative bacteria
Viruses,
fungi,
Worms,
Foreign bodies entering the respiratory tract,
Toxin poisoning
Chest injuries
Allergy,
Alcohol abuse
Tobacco smoking.

People at risk include people who:

Constantly nervous, worried,
Poor or unbalanced diet,
Lead a sedentary lifestyle
Cannot get rid of bad habits such as smoking and drinking alcohol,
Suffer from frequent colds,
Have a low level of immunity,
Elderly people.

Symptoms

Most often, pneumonia begins with a cold, so it is characterized by almost the same symptoms, but then pink sputum appears when coughing, sharp pain in the chest, which intensifies when inhaling.

The appearance of these symptoms is preceded by the following:

Temperature rises even to 39 degrees or higher,
Headache,
Dyspnea,
Sleep disturbance,
lethargy,
Increased breathing,
In some cases, the nasolabial triangle becomes bluish in color.

Possible complications

Pneumonia is not as dangerous as its complications. Because in severe cases, pulmonary edema and acute respiratory failure may develop. Other possible complications include:

Pleurisy is inflammation of the membrane surrounding the lungs. Chest pain when inhaling, accumulation of fluid in the pleural cavity.
Pericarditis is inflammation of the pericardium.
Hepatitis, gastrointestinal diseases. They may be caused by the fact that by taking large quantities of antibiotics, the patient kills beneficial microflora.
Chronic bronchitis is damage to the walls of the bronchi.
Asthma is an allergic disease, the main symptom of which is asthma attacks. At the same time, exhalation is difficult.

But with community-acquired pneumonia there will never be such complications, since the disease occurs in mild to moderate form.

Treatment

By medication

If first-line antibiotics are ineffective, drugs of this higher order group are prescribed:

Macrolides (Azithromycin, Hemomycin and others),
Cephalosporins (Cefotaxime, Suprax and others),
Aminoglycosides,
Tetracyclines.

Children under six months of age are prescribed predominantly macrolides. From the age of six years, penicillins are used, and in the case of an atypical form, macrolides.

If there is no improvement in the condition after two to three days, the doctor prescribes another antibiotic. The course of antibiotic treatment should be at least ten days.

In addition to antibiotics, treatment includes the use of the following drugs:

Antipyretic. Paracetamol is not recommended for use in this case. It does not have an anti-inflammatory effect. And although there are WHO recommendations that if the temperature is below 38 degrees, then there is no need to bring it down, but in some cases it is necessary to rely on the condition of a particular patient when taking antipyretics. Ibuprofen and Aspirin in combination with Analgin, Nimesulide, and
Antiviral drugs. Used only if it is proven that the disease is caused by viruses. Remantadine, interferons, Cytotect,
Mucolytics. ACC, Lazolvan, Ambrobene are good for thinning sputum,
Expectorants. Mucaltin, Thermopsis and others promote the evacuation of sputum from the body,

If you have pneumonia, it is forbidden to take medications that inhibit the cough reflex. Phlegm must be eliminated from the body.

In addition to the use of medications, the following forms of treatment are included:

Artificial ventilation,
Inhalation using a nebulizer,
Electrophoresis,
Massage.

Due to the fact that there are enough folk proven recipes in the fight against this disease, they can be used quite effectively and in parallel with the use of official medications.

Folk remedies

Undoubtedly, the condition of a patient with pneumonia will be greatly alleviated by the recipes given to us by nature and preserved by many generations of our ancestors. Among the most popular are:

If you take two hundred grams of oat grains, wash them thoroughly, and then pour 1 liter of it. milk and cook for at least an hour, and then, after cooling a little, add a teaspoon of May honey and the same amount of natural butter, this will help with coughing with phlegm to improve its expectoration. You can drink it all day long instead of tea. But do not store it, as such a “medicine” will turn sour quite quickly.
As always, aloe will help with diseases of the respiratory system. To prepare the medicine, you need to take equal amounts by volume of finely chopped agave leaves, linden honey (a glass) and pour a bottle of Cahors wine. Let it sit for a few days. Take a tablespoon three times a day.
Cut off the largest lower leaf of aloe from the bush and, after wiping off dust, chop finely. Add a glass of linden or may honey, and no more than half a glass of water. Let it simmer on the fire for no more than twenty minutes. When it cools down, you can use a tablespoon at least three times a day.
A good medicine for adults will be obtained if 1 liter. boil two tablespoons of lungwort in beer. The volume should be reduced by half. Before use, add a tablespoon of honey to the prepared mixture. The recommended dose is a tablespoon three times a day.
A fairly effective remedy used by people to cure pneumonia is badger fat. It is eaten a tablespoon before meals. To force yourself to swallow pure fat, you can dilute it with honey or drink warm milk with a teaspoon per glass of liquid. Pure fat is rubbed over the chest area for warmth. Then the patient must be wrapped up. Perform the procedure at night.
Drink plenty of fluids constantly. Rosehip compote is especially suitable at this time. Linden tea, chamomile, mint.

Inhalations

Over grated horseradish. Wash the horseradish root thoroughly, grind it in a meat grinder and place the pulp on several layers of gauze. Bring it to your nose and inhale until watery eyes appear.
Over potatoes. Boil a few potato tubers, strain the water and breathe in the hot steam for a few minutes.

Compresses

Spread honey on the chest or back in the area of the lower lobes of the lungs, then soak a gauze cloth in vodka at room temperature and place it in the indicated place. Cover the top with polyethylene, cotton wool and secure this compress with a long scarf or handkerchief,
Alcohol compress. Dilute pure alcohol by half with water and wet a gauze cloth. Squeeze and place the lungs on your back. Then proceed in layers and so that each layer is a little larger than the previous one: polyethylene, cotton wool, bandage. Or fabric that needs to be secured with adhesive tape.

Apply compresses only if the patient has a low temperature.

Prevention

In order to prevent the occurrence of pneumonia, including community-acquired forms, you need to:

Do not visit crowded places during periods of exacerbation of colds and viral diseases.
Constantly take care of the state of your immunity.
Avoid hypothermia and drafts.
Do not carry colds and infectious diseases on your feet.
Develop your lungs with simple exercises. For example, every morning, doing a mandatory fifteen-minute exercise, inflate a balloon.
Eliminate pockets of infection in the mouth. For example, simply treat carious teeth.
Walk in the fresh air more often, using every free minute for this.

conclusions

Now there is an international classification of diseases. According to the gradation, pneumonia is in the tenth class along with all diseases of the respiratory system. It can be caused by different pathogens and occur in different forms. And it can be treated both in a hospital and on an outpatient basis. The doctor decides everything by analyzing the patient’s vital signs, test results and identifying the pathogen. He also prescribes a treatment regimen with certain drugs. Proven folk remedies can also be used as complementary, but not alternative, remedies in the treatment of this particular disease.

Note. To use this category, please refer to the WHO Global Influenza Program (GIP, www.who.int/influenza/) guidelines.

Influenza caused by strains of influenza virus of particular epidemiological significance, with transmission by animals and humans

If necessary, use an additional code to identify pneumonia or other manifestations.

Excluded:

Haemophilus influenzae:
- infection NOS (A49.2)
- meningitis (G00.0)
- pneumonia (J14)
influenza, with identified seasonal influenza virus (J10.-)

Includes: influenza caused by an identified influenza B or C virus

Excluded:

caused by Haemophilus influenzae [Afanasyev-Pfeiffer bacillus]:
- infection NOS (A49.2)
- meningitis (G00.0)
- pneumonia (J14)
influenza caused by an identified zoonotic or pandemic influenza virus (J09)

Included:

influenza, no mention of virus identification
viral influenza, no mention of virus identification

Excluded: caused by Haemophilus influenzae [Afanasyev-Pfeiffer bacillus]:

infection NOS (A49.2)
meningitis (G00.0)
pneumonia (J14)

Included: bronchopneumonia caused by viruses other than influenza virus

Excluded:

congenital rubella pneumonitis (P35.0)
pneumonia:
- aspiration:
  - NOS (J69.0)
  - during anesthesia:
    - during pregnancy (O29.0)
  - newborn (P24.9)
- for influenza (J09, J10.0, J11.0)
- interstitial NOS (J84.9)
- fat (J69.1)
- viral congenital (P23.0)
severe acute respiratory syndrome (U04.9)

Bronchopneumonia caused by S. pneumoniae

Excluded:

congenital pneumonia caused by S. pneumoniae (P23.6)
pneumonia caused by other streptococci (J15.3-J15.4)

Bronchopneumonia caused by H. influenzae

Excludes: congenital pneumonia caused by H. influenzae (P23.6)

Includes: bronchopneumonia caused by bacteria other than S. pneumoniae and H. influenzae

Excluded:

chlamydia pneumonia (J16.0)
congenital pneumonia (P23.-)
Legionnaires' disease (A48.1)

Excluded:

lung abscess with pneumonia (J85.1)
drug-induced interstitial lung diseases (J70.2-J70.4)
pneumonia:
- aspiration:
  - NOS (J69.0)
  - during anesthesia:
    - during labor and delivery (O74.0)
    - during pregnancy (O29.0)
    - in the postpartum period (O89.0)
- newborn (P24.9)
- inhalation of solids and liquids (J69.-)
- congenital (P23.9)
- interstitial NOS (J84.9)
- fat (J69.1)
- ordinary interstitial (J84.1)
pneumonitis caused by external agents (J67-J70)

In Russia International Classification of Diseases 10th revision ( ICD-10) was adopted as a single normative document for recording morbidity, reasons for the population’s visits to medical institutions of all departments, and causes of death.

ICD-10 introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

Pneumonia, unspecified

Definition and general information [edit]

Atypical pneumonia is a term used to designate an infectious disease caused by a coronavirus and occurring with epidemiological and clinical and laboratory signs of a respiratory viral infection, the development in some cases of acute respiratory failure, with high (for the group of respiratory viral infections) mortality.

The source of infection is a sick person, and the greatest danger is posed by patients in the initial (acute) period of the disease. At the same time, the possibility of prolonged isolation of the virus during the period of late convalescence cannot be ruled out.

Assumptions about the transmission of the virus from animals to humans are not yet considered proven (although coronavirus diseases in domestic animals are known, and, according to some experts, it is the strains of coronavirus of animal origin that underlie the emergence of a particularly virulent strain of the human virus) and the latent carriage of coronaviruses.

Airborne transmission of infection has been proven. The possibility of transmission of the virus through water and household contact with the fecal-oral mechanism of infection is assumed. As of May 2003, 8,046 cases of the disease had been diagnosed, and 682 people had died. Moreover, the majority of registered patients with “atypical pneumonia” are people aged 25-70 years. Several cases of the disease have been reported in children under 15 years of age.

“SARS” has been registered in 28 countries. All cases are currently associated with Southeast Asia, including countries such as China, Vietnam, Hong Kong, and Singapore. Patients with “SARS” have now been identified in many countries: Australia, England, Ireland, Romania, Slovenia, Germany, Israel, Brunei, Thailand, Taiwan and Japan. Passengers arriving from Southeast Asia are falling ill.

The question of the duration of virus shedding and the possibility of relapse or reinfection has not been reliably studied.

Of course, the fact of prolonged isolation of the virus after an illness, as well as the possibility of asymptomatic virus carriage, can significantly complicate the implementation and ultimate effectiveness of anti-epidemiological

The virus remains viable in the external environment for at least 24 hours (at room temperature).

Coronaviruses are known to be sensitive to fat solvents. Exposure to ether℘ and chloroform significantly reduces the infectivity of these viruses. At a temperature of 56 °C these viruses die within 10-15 minutes, at 37 °C their infectivity remains for several days, and at 4 °C for several months. It was revealed that in the presence of ether and trypsin, coronaviruses lose their ability to cause hemagglutination.

Etiology and pathogenesis[edit]

On April 16, 2003, WHO announced that the etiological agent of “SARS” was a new virus classified as a member of the coronavirus family, but not identical to any of the known strains of this virus. This was preceded by a detailed study of the viral spectrum in patients at different stages of infection: in the acute period, in the period of early and late convalescence, as well as in cases of death. Coronaviruses were detected in more than 50% of patients. A significant portion of the isolates were cultured and isolated in pure culture. In patients with “atypical pneumonia” and identified coronaviruses, an increase in the content of specific antibodies was found. Infection of monkeys with the isolated pathogen caused a clinical picture characteristic of “atypical pneumonia.”

The genus coronaviruses are large, enveloped, single-stranded RNA viruses that cause widespread disease in humans and animals.

Coronaviruses have the largest genome of all RNA viruses, and recombination has often been detected in them. Currently, the complete genome sequences of some coronaviruses have been deciphered; their RNA size ranges from 27,000 to 32,000 nucleotide pairs.

In China, data have been obtained from the study of several isolates of the SARS virus. Comparison of the sequences of these isolates with data presented by American and Canadian scientists suggests that the virus may be rapidly mutating.

According to researchers, the SARS virus differs in nucleotide sequences by 50-60% from the three known groups of coronaviruses, but, undoubtedly, this is a typical variation among existing groups II and III coronaviruses.

Comparison of complete genomes of coronaviruses does not allow us to identify the genome closest to the SARS virus, although the largest number of matching lineages is observed between this virus and bovine coronavirus type II.

Coronaviruses that cause animal diseases are also susceptible to mutations. Thus, it is known that avian intestinal coronavirus, which is similar in structure to the SARS virus, can cause severe pneumonia in livestock. And in the 1980s. Coronavirus of intestinal infection of pigs unexpectedly mutated and caused a disease in animals with damage to the respiratory tract.

It is known that the so-called bovine viruses, as a rule, also turn out to be viruses of small rodents and cats living with or near cows, so the hypothesis about the feline nature of the causative agent of “SARS” is not without foundation.

Many issues regarding the development of coronavirus infection have not yet been studied. At the same time, some pathogenetic mechanisms for the development of disease symptoms are common to the group of ARVI pathogens. Thus, it has been proven that the pathogen selectively infects epithelial cells of the upper respiratory tract, where it multiplies. At the same time, universal signs of inflammation of the mucous membranes of the respiratory tract are noted. The active replication phase of the virus is accompanied by the death of epithelial cells. This pathogenetic feature underlies the catarrhal syndrome, as well as intoxication, which is characteristic of the course of ARVI.

Another feature of a coronavirus infection that occurs with severe acute respiratory syndrome is the body’s hyperimmune reaction that occurs in the second week of the disease: humoral and cellular factors of the immune response destroy the alveoli, followed by the release of cytokines and tumor necrosis factors. Severe damage to the lung tissue, such as bronchiolitis, causes the development of pulmonary edema, which can be fatal for some patients. It should be noted that in the development of the disease and its outcomes, an important role is played by viral-bacterial associations, which are certainly present during the development of severe course and complications of most acute respiratory viral infections.

Clinical manifestations[edit]

The incubation period is usually 2-7 days, but in some cases it can reach 10 days. The onset of the disease is most often acute and is characterized by high fever (over 38 °C), accompanied by chills, muscle pain, body aches, headaches and dry cough. Patients are concerned about weakness, malaise, nasal congestion, and difficulty breathing. There is usually no rash, neurological or gastrointestinal symptoms, but in some cases diarrhea is noted early in the disease.

Thus, the onset of coronavirus infection, i.e. “SARS” is clinically no different from the onset of many respiratory viral infections, which undoubtedly complicates the early diagnosis of this disease.

The further course of the infection in the vast majority of cases is favorable - on the 6-7th day from the onset of the disease, an improvement in the condition of patients is observed: the severity of symptoms of intoxication and catarrhal phenomena decreases.

However, in 10-20% of cases, in the second week of the disease (sometimes after 3 days), a more severe form of “atypical pneumonia” develops. Patients develop acute respiratory distress syndrome, acute respiratory distress - bronchiolitis, pneumonia and pulmonary edema with signs of increasing respiratory failure: tachypnea, cyanosis, tachycardia and other symptoms, which requires immediate transfer of patients to mechanical ventilation.

Mortality in such cases is high and may be associated with the presence of other diseases in patients, in addition to “atypical pneumonia”.

Characteristic X-ray changes in the lungs can be noted within 3-4 days after the first symptoms of the disease appear, but in some cases, X-ray changes may be absent during the first week or even the entire disease. With the development of severe “atypical pneumonia”, most patients experience bilateral changes in the form of interstitial infiltrates. These infiltrates give on radiographs a specific picture of the lungs, speckled with spots. In the future, the infiltrates can merge.

It has been suggested that mutated forms of the virus can cause a more severe course of the disease. Patients more often had diarrhea in the early stages of the disease, 2 times more patients needed intensive care and were less susceptible to complex treatment with antiviral drugs. At the same time, the higher frequency of diarrhea in patients in this group suggested that this virus can affect not only the upper respiratory tract, but also the gastrointestinal tract.

The age of patients older than 40 years is considered prognostically unfavorable, when there is a high probability of developing a severe form of the disease.

In a clinical blood test, moderate lymphopenia and thrombocytopenia can be noted. In biochemical studies - a moderate increase in the activity of liver enzymes.

Pneumonia, unspecified: Diagnosis[edit]

In the initial period, the clinical picture of the disease does not have any pathognomonic symptoms, which makes differential diagnosis with other respiratory viral diseases difficult.

Taking into account the complexity of differentiated diagnosis of “atypical pneumonia” at the onset of the disease, clinical and epidemiological criteria were developed to identify cases suspicious for this disease and with a probable presumptive diagnosis of this disease. “Suspicious cases” should include respiratory diseases of unknown etiology and meeting the following criteria:

An increase in body temperature above 38 ° C and the presence of one or more clinical signs of a respiratory disease (cough, rapid or difficult breathing, hypoxia);

Traveling within 10 days before the onset of the disease to areas with a massive incidence of “SARS” or communicating with patients suspected of having this disease;

When identifying a “presumptive” diagnosis, criteria such as:

X-ray confirmation of pneumonia or presence of respiratory distress syndrome;

Autopsy findings consistent with respiratory distress syndrome with no identifiable cause.

Laboratory diagnosis of coronavirus pneumonia primarily relies on the detection of the genetic material of the virus or antibodies to it.

PCR can detect the genetic material (RNA) of coronavirus (SARS-CORONAVIRUS, SARS-COV) in various samples (blood, sputum, feces or tissue biopsies) in the very early period of the disease. However, existing PCR systems lack sensitivity. The modern test system is a set of reagents for carrying out PCR to detect the RNA of the coronavirus that causes SARS. Any biological material can be used as an object for diagnosis - blood, sputum, feces, urine, swabs from the nasopharyngeal mucosa. The study time is no more than 4 hours, and positive results can be obtained not 2 weeks after infection, as in the case of antibody testing, but almost immediately after the virus enters the respiratory tract tissue. A method for determining antibodies to the SARS-COV virus has been developed. Various types of antibodies (IgM and IgG) appear and change quantitatively during the infectious process and may not be detected in the early period of the disease. IgG is usually recorded during the period of convalescence (3 weeks from the onset of the disease). The ELISA method (ELISA) of enzyme-labeled antibodies - detection of a mixture of IgM and IgG in the serum of patients gives reliable positive results by the 21st day after the onset of the disease. The immunofluorescence method detects IgM in the serum of patients by the 10th day of the disease.

In all methods for determining specific antibodies to the SARS virus, the results are considered reliable with a fourfold increase in their titer, which is observed after 21 days from the onset of the disease and later, i.e. studies of the dynamics of antibody content are rather retrospective in nature, which undoubtedly reduces the relevance of the research for practitioners.

Virological studies make it possible to grow the virus in cell cultures, and are therefore quite labor-intensive and expensive. Blood, feces, and sputum are used as material for virological studies. At the same time, a negative result of growing the virus in a single test does not exclude the presence of “atypical pneumonia” in the patient. It should be noted that in patients with “atypical pneumonia,” along with coronaviruses, other viruses that can cause ARVI can be detected.

Differential diagnosis[edit]

Pneumonia, unspecified: Treatment[edit]

Currently, there are no effective drugs to combat “SARS” (coronavirus infection) at all stages of the infectious process.

Despite the fact that there are conflicting opinions in assessing the effectiveness of antiviral drugs and there are no official recommendations for the treatment of “atypical pneumonia,” doctors in the outbreaks of the disease most often use ribavirin as the main antiviral drug.

The blood plasma of patients who successfully survived the infection was used as a drug against the SARS virus.

Antiviral treatment Coronavirus infection is treated with interferon drugs and nucleoside analogues; it is not fundamentally different from the treatment of other respiratory viral infections. Apparently, the use of interferon and other drugs of this group, especially in the first 3 days of the disease, should reduce the severity of the disease. Nucleoside analogues - drugs of the ribavirin group - enhance the effect of antiviral treatment.

Detoxification treatment includes intravenous administration of glucose, crystalloids, polyvinylpyrollidone derivatives (hemodez-N) in combination with potassium preparations and vitamins, the volume of administration can vary from 800 to 1200 ml/day with adequate diuresis. Desensitizing treatment primarily involves the administration of glucocorticoids, which not only have a powerful anti-inflammatory effect, but also can reduce the level of hyperimmune reactions. The drugs are prescribed parenterally, as part of crystalloid solutions, including glucose, prednisolone in doses of 180-300 mg/day.

WHO recommends the inclusion of several antibacterial drugs in treatment regimens from the first days of the disease to prevent the threat of developing a bacterial infection. Preference is given to broad-spectrum antibiotics: cephalosporins, fluoroquinolones and tetracyclines.

If symptoms of developing pulmonary edema appear, patients must be transferred to the intensive care unit, where intensive therapy with the use of mechanical ventilation is carried out.

Symptomatic treatment includes drugs aimed at reducing fever, reducing cough, relieving headaches, etc.

Prevention[edit]

Along with the usual hygienic measures, such as washing hands, as well as frequent ventilation of the room and wearing masks, when working with those affected by “SARS”, it is mandatory to wear glasses, two pairs of gloves and two gowns or special anti-plague suits, as when working in an outbreak of highly contagious (especially dangerous) infections. When caring for a patient, it is necessary to observe protective measures against possible infection and treat hands with disinfectants.

If a case of “atypical pneumonia” occurs or is suspected, a set of anti-epidemic, disinfection and sanitary measures is carried out, including the measures listed below.

Patients and persons suspected of having “atypical pneumonia” of any age are subject to mandatory hospitalization in an infectious diseases hospital in boxes. Evacuation of sick (suspicious) patients is carried out using special medical transport, which is subject to mandatory disinfection.

Immediate introduction of quarantine for 10 days for contact persons. Carrying out current and final disinfection. Medical staff must work in respirators or four-layer gauze masks. It is necessary to regularly ventilate the premises, disinfect the air with ultraviolet radiation and chemical agents (during final disinfection) that help reduce the amount of the pathogen in the air. After each contact with a patient, personnel are required to wash their hands twice with warm water and soap, and if they become contaminated with sputum, saliva and other secretions, disinfect them with a skin antiseptic in accordance with the instructions for its use.

A vaccine against coronavirus infection has not been developed.

If any signs of illness occur in persons traveling or returning from Southeast Asian countries, they should immediately seek medical attention.

Other [edit]

Synonyms: nosocomial pneumonia, hospital-acquired pneumonia

Nosocomial pneumonia is pneumonia that develops in a patient no earlier than 48 hours after hospitalization, subject to the exclusion of infections that were in the incubation period at the time of admission to the hospital. A special type of nosocomial pneumonia is ventilator-associated pneumonia (VAP), which develops in patients on mechanical ventilation (ALV).

Etiology and pathogenesis

The spectrum of bacterial and fungal pathogens of hospital ventilator-associated pneumonia depends to a certain extent on the profile of the hospital where the patient is located.

In addition, respiratory viruses account for up to 20% of cases. Viruses cause the disease independently or more often in the form of a viral-bacterial association, in 7% of cases - in the form of an association of fungi of the genus Candida with viruses or viruses and bacteria. Among the viruses, influenza A and B viruses dominate.

Among ventilator-associated hospital pneumonia, early and late pneumonia are distinguished. Their etiology is different. Pneumonia that develops in the first 72 hours after intubation usually has the same etiology as community-acquired pneumonia in patients of the same age. This is due to the fact that microaspiration of the contents of the oropharynx is of primary importance in their pathogenesis. In late VAP, the etiology is dominated by pathogens such as Ps. aeruginosa, S. marcescens, Acinetobacter spp, as well as S. aureus, K. pneumoniae, E. coli, Candida, etc., since late VAP is caused by hospital microflora that colonizes the respiratory apparatus.

In case of humoral immunodeficiencies, pneumonia is most often caused by S. pneumoniae, as well as staphylococci and enterobacteria; in case of neutropenia, it is caused by gram-negative enterobacteria and fungi.

Classic clinical manifestations of pneumonia are shortness of breath, cough, increased body temperature, symptoms of intoxication (weakness, impairment of the child’s general condition, etc.). With pneumonia caused by atypical pathogens (for example, C. trachomatis), there is usually no fever; body temperature is either subfebrile or normal. In addition, bronchial obstruction is observed, which is not at all characteristic of pneumonia. Thus, the diagnosis of pneumonia should be assumed if the child develops a cough and/or shortness of breath (with the number of respiratory movements more than 60 per minute for children under 3 months, more than 50 per minute for children under one year, more than 40 per minute for children under 5 years ), especially in combination with retraction of the compliant areas of the chest and with fever above 38 ° C for 3 days or more or without fever.

Corresponding percussion and auscultation changes in the lungs, namely: shortening of the percussion sound, weakening or, conversely, the appearance of bronchial breathing, crepitus or fine wheezing, are determined only in 50-70% of cases. During a physical examination, attention is paid to identifying the following signs:

Shortening (dullness) of percussion sound over the affected area/areas of the lung;

Local bronchial breathing, sonorous fine rales or inspiratory crepitus during auscultation;

In older children and adolescents - increased bronchophony and vocal tremors.

Clinical manifestations of hospital-acquired pneumonia are the same as for community-acquired pneumonia. Thus, the diagnosis of hospital-acquired pneumonia should be assumed if a child in a hospital has a cough and/or shortness of breath (with the number of respiratory movements more than 60 per minute for children under 3 months, more than 50 per minute for children under 1 year, more than 40 per minute for children under 5 years of age), especially in combination with retraction of the compliant areas of the chest and with a fever of more than 38 ° C for 3 days or more or without fever.

With VAP (ventilator-associated pneumonia), it is necessary to take into account that the child is on mechanical ventilation, so neither shortness of breath, nor cough, nor physical changes are typical. Pneumonia is accompanied by a pronounced disturbance in the general condition of the patient: the child becomes restless or, conversely, “busy”, appetite is reduced, children in the first months of life experience regurgitation, sometimes vomiting, flatulence, bowel dysfunction, symptoms of cardiovascular failure, central nervous system disorders and excretory function of the kidneys, sometimes intractable hyperthermia or, conversely, progressive hypothermia is observed.

Hospital-acquired pneumonia in unfavorable cases is characterized by a lightning-fast course, when pneumonia within 3-5 days leads to death due to respiratory, cardiovascular and multiple organ failure, as well as due to the development of infectious-toxic shock. DIC syndrome is often associated, accompanied by bleeding, including from the lungs.

a) Laboratory diagnostics

A peripheral blood test should be performed in all patients with suspected pneumonia. Leukocytosis more than 1012x10 9 /l and band shift more than 10% indicate a high probability of bacterial pneumonia. When pneumonia is diagnosed, leukopenia less than 3x10 9 /l or leukocytosis more than 25x10 9 /l are considered unfavorable prognostic signs.

A biochemical blood test and a study of the acid-base state of the blood are standard methods for examining children and adolescents with severe pneumonia who require hospitalization. The activity of liver enzymes, the level of creatinine and urea, and electrolytes are determined. The etiological diagnosis is established mainly for severe pneumonia. Blood cultures are performed, which are positive in 10-40% of cases. Microbiological examination of sputum in pediatrics is not widely used due to technical difficulties in collecting sputum in the first 7-10 years of life. But in cases of bronchoscopy, microbiological testing is used. The material for it is aspirates from the nasopharynx, tracheostomy and endotracheal tube. In addition, to identify the pathogen, puncture of the pleural cavity and culture of punctate pleural contents are performed.

Serological research methods are also used to determine the etiology of the disease. An increase in titers of specific antibodies in paired sera taken during the acute and convalescent periods may indicate mycoplasma or chlamydial etiology of pneumonia. Reliable methods are also considered to be the detection of antigens using latex agglutination, counter immunoelectrophoresis, ELISA, PCR, etc.

b) Instrumental methods

The “gold standard” for diagnosing pneumonia is an X-ray examination of the chest organs, which is considered a highly informative and specific diagnostic method (the specificity of the method is 92%). When analyzing radiographs, the following indicators are assessed:

The size of lung infiltration and its prevalence;

Presence or absence of pleural effusion;

The presence or absence of destruction of the pulmonary parenchyma.

With clear positive dynamics in the clinical manifestations of community-acquired pneumonia, there is no need for control radiography. X-ray examination of dynamics during the acute period of the disease is carried out only if there is progression of symptoms of lung damage or if signs of destruction and/or involvement of the pleura in the inflammatory process appear. In cases of complicated pneumonia, mandatory x-ray monitoring is carried out before the patient is discharged from the hospital.

With hospital-acquired pneumonia, it must be remembered that if an X-ray examination is done 48 hours before death, then in 15-30% of cases there may be a negative result. The diagnosis is established only clinically on the basis of severe respiratory failure, weakened breathing; Often there may be a short-term rise in temperature.

A radiographic study of the dynamics of hospital-acquired pneumonia in the acute period of the disease is carried out when the symptoms of lung damage progress or when signs of destruction and/or involvement of the pleura in the inflammatory process appear. If there is a clear positive trend in the clinical manifestations of pneumonia, a control radiography is performed upon discharge from the hospital.

CT is used if necessary when carrying out differential diagnosis, since CT has 2 times higher sensitivity compared to plain radiography in identifying foci of infiltration in the lower and upper lobes of the lungs.

Fiberoptic bronchoscopy and other invasive techniques are used to obtain material for microbiological research in patients with severe immune disorders and for differential diagnosis.

The main method of treating pneumonia is immediate antibiotic therapy, which is prescribed empirically. The indication for replacing antibiotics is the lack of clinical effect within 36-72 hours, as well as the development of side effects from the prescribed drugs. Criteria for lack of effect: maintaining body temperature more than 38 ° C and/or deterioration of the child’s condition, and/or increasing changes in the lungs or pleural cavity; with chlamydial and Pneumocystis pneumonia - an increase in shortness of breath and hypoxemia.

Antibacterial therapy for hospital-acquired pneumonia

The choice of antibacterial therapy for hospital-acquired pneumonia is significantly influenced by the fact that this disease is characterized by a fulminant course with frequent death. Therefore, in severe hospital-acquired pneumonia and VAP, the de-escalation principle of drug selection is absolutely justified.

For mild and relatively severe hospital-acquired pneumonia, treatment begins with drugs that are most suitable for the spectrum of action: in the therapeutic department, amoxicillin + clavulanic acid can be prescribed orally, if the patient’s condition allows, or intravenously. For severe pneumonia, the use of III (cefotaxime, ceftriaxone) or IV generation (cefepime) cephalosporins, or ticarcillin + clavulanic acid is indicated. If there is a suspicion of mild staphylococcal hospital pneumonia, then it is possible to prescribe oxacillin as monotherapy or in combination with aminoglycosides. But if severe staphylococcal pneumonia, especially destructive pneumonia, is suspected, or such a diagnosis has already been established, then linezolid or vancomycin is prescribed as monotherapy or in combination with aminoglycosides.

Premature children who are in the second stage of nursing and have contracted hospital-acquired pneumonia, if Pneumocystis pneumonia is suspected (which is characterized by a subacute course, bilateral lung damage, small focal nature of infiltrative changes in the lungs, severe hypoxemia), are prescribed sulfamethoxazole/trimethoprim in parallel with antibiotics. If the diagnosis of Pneumocystis nosocomial pneumonia is accurately established, treatment is carried out with sulfamethoxazole/trimethoprim alone for at least 3 weeks.

Oncohematological patients (in cases where the disease begins acutely, with a rise in temperature and the appearance of shortness of breath and often coughing) are prescribed third-generation cephalosporins with an antipseudomonal effect. Alternative therapy is carbapenems (imipenem/cilastatin, meropenem) or ticarcillin + clavulanic acid. If staphylococcal hospital-acquired pneumonia is suspected, in particular in the absence of cough, in the presence of shortness of breath, threat of lung destruction with the formation of bullae and/or pleural empyema, linezolid or vancomycin is prescribed either in monotherapy or in combination with aminoglycosides, depending on the severity of the condition.

Fungal hospital-acquired pneumonia in hematological oncology patients is usually caused by Aspergillus spp. That is why in oncohematological patients with shortness of breath, in addition to chest X-ray, a CT scan of the lungs is indicated. When a diagnosis of hospital-acquired pneumonia caused by Aspergillus spp. is made, amphotericin B is prescribed in increasing doses. Course duration is at least 3 weeks. As a rule, therapy lasts longer.

In patients in surgical departments or burn departments, hospital-acquired pneumonia is more often caused by Ps. aeruginosa, in second place in frequency are K. pneumoniae and E. coli, Acenetobacter spp. and others. S. aureus et epidermidis are rarely detected, sometimes anaerobes are also found, which often form associations with Ps. aeruginosa, K. pneumoniae and E. coli. Therefore, the choice of antibiotics is approximately the same as in hematologic oncology patients with hospital-acquired pneumonia. III generation cephalosporins with antipseudomonal action (ceftazidime) and IV generation (cefepime) are prescribed in combination with aminoglycosides. Alternative therapy is therapy with carbapenems (imipenem/cilastatin, meropenem) or ticarcillin + clavulanic acid, either alone or in combination with aminoglycosides, depending on the severity of the process. If staphylococcal hospital-acquired pneumonia is suspected, linezolid or vancomycin is prescribed either in monotherapy or in combination with aminoglycosides, depending on the severity of the process. For anaerobic etiology of pneumonia, metronidazole is indicated.

Features of the development of hospital-acquired pneumonia in patients in the intensive care unit require the appointment of the same range of antibiotics as in surgical and burn patients. With late VAP, the etiology of hospital-acquired pneumonia is exactly the same. That is why antibacterial therapy should be the same as for patients in surgical and burn departments.

Pneumonia in nursing homes

Synonyms: pneumonia in nursing home residents

According to the conditions for the occurrence of pneumonia in nursing home residents, it should be considered as community-acquired, but the range of pathogens (and their antibiotic resistance profile) brings them closer to nosocomial pneumonia.

Pneumonia that develops in elderly people in nursing homes and boarding schools is most often caused by pneumococcus, Haemophilus influenzae, Moraxella and Legionella.

The most common etiological agent of aspiration pneumonia in the elderly is non-clostridial obligate oral anaerobes that enter the respiratory tract from the stomach during regurgitation. Most often they are combined with a variety of gram-negative microflora.

Sources (links) [edit]

Infectious diseases. Course of lectures [Electronic resource] / ed. IN AND. Luchsheva, S.N. Zharova - M.: GEOTAR-Media, 2014. - http://www.rosmedlib.ru/book/ISBN9785970429372.html

Pediatrics [Electronic resource]: National guidelines. Brief edition / ed. A. A. Baranova. - M.: GEOTAR-Media, 2015. - http://www.rosmedlib.ru/book/ISBN9785970434093.html

Antibacterial drugs in clinical practice [Electronic resource] / Ed. S.N. Kozlova, R.S. Kozlova - M.: GEOTAR-Media, 2010.

Guide to gerontology and geriatrics. In 4 volumes. Volume 2. Introduction to clinical geriatrics [Electronic resource] / Ed. V.N. Yarygina, A.S. Melentyeva - M.: GEOTAR-Media, 2010.