What are the symptoms of pneumonia

Pneumonia, or lung inflammation characteristic of the disease

The main division of the pneumonia is determined by the location of disease and severity of its course. Approach to diagnosis and treatment for pneumonia varies depending on, it is taking place in outpatient or inpatient. To assess the severity of illness and risk of mortality serve as a so-called evaluation criteria. A dominant position in treatment for pneumonia is a penicillin antibiotic.

Epidemiology

Pneumonia is one of serious inflammatory diseases of the respiratory system, both in our country and around the world. Even in the era of antibiotics the disease annually in the world takes 3-5 million lives, and this figure is typical of a rising trend. We get sick every year around 100,000 people. Mortality from pneumonia ranks second among the diseases of the respiratory system with the number 28/100000 residents. The disease affects people of all ages. The risk category is mainly represented by children under 5 years and persons over 65 years of age, who, usually, are associated with chronic diseases. We are talking about cardiovascular diseases, diabetes, immunodeficiency States after treatment of malignant tumors, the risk group also includes chronic smokers.

What is pneumonia – definition

Pneumonia is the acute inflammation of the respiratory bronchioles, alveoli and interstitial tissue. Diagnostic criteria is a fresh infiltrative finding on the chest x-ray, which is a diagnostic criterion of the gold standard, as well as the presence of at least two typical symptoms are respiratory in nature. The first signs of pneumonia include cough, fever, chest pain, shortness of breath and abnormal results in pulmonary listening.

Pathogenesis

Most often, the infection droplets. Another way can develop the disease, is microaspiration secretions from the nasopharynx into the lungs. The inflammation begins when damaged lung's natural protective barrier. Less common is due to which can develop the ailment, is aspiration of gastric contents, inhalation of foreign bodies. Non-infectious pneumonia may begin after the inhalation of harmful gases, the result of radiation therapy.

Distribution and symptoms of pneumonia lungs

Community-acquired pneumonia – how to start

Community-acquired pneumonia is the most common group of pneumonia. Infection and disease development occurs in everyday life and affects people of all ages. Infection occurs through the respiratory tract, the incidence is characterized by significant seasonal fluctuations. A number of epidemiological studies showed that the most common pathogen is Streptococcus pneumoniae. Another common reason is represented by Staphylococcus aureus, Haemophilus infection and so-called atypical pathogens – Mycoplasma pneumonia, chlamydia pneumonia, at least – the Legionella.

In children, as a rule, inflammation of the lungs in 40% of cases is caused by viruses. Polymicrobial etiology of the disease is also is not uncommon. The causative agent of community-acquired pneumonia could only be determined in 30-50% of cases. As the disease pneumonia is divided into mild, moderate and severe degree. In accordance with the risk factors that are considered in the study, the decision on whether the personbe treated as an outpatient or inpatient.

Hospital-acquired pneumonia – how is

For nosocomial pneumonia characterized by the fact that the incipient disease manifests within the first 48 hours after admission to the hospital. However, the first symptoms may occur a week after release. After urological infections this disease is the second most common nosocomial infection. Against the etiologic pathogens are dominated by gram-negative bacteria – Pseudomonas aerugi nosa, Kl ebsi el l a pneumoni ae, Escherichia coli, Proteus vulgaris, Acinetobacter spp., Enterobacter spp. Frequent is the involvement of anaerobic infections. The risk of nosocomial pneumonia in postoperative patients are exposed, especially in the abdomen, the chest, long bedridden, in disorders of consciousness. In patients receiving mechanical ventilation, this ventilation disease is called nosocomial pneumonia.

To develop disease either comes through microaspiration or transmission is occurring from the external environment of the hospital. A common source of infection is the medical staff, contaminated equipment and materials of other patients. In pneumonia hospital-acquired type we are talking about serious inflammatory complication, which is burdened with higher mortality. It requires specific treatment with antibiotics, usually a combination of several drugs. Extends the period of hospitalization, on average, from 1 to 2 weeks. This is related to much higher costs for health care.

Pneumonia in people with weakened immune systems

In connection with the increase in the number of people whose immune system is weakened for various reasons, increases the representation of this type of pneumonia. As a condition of immunosuppression indicates the damage of cellular or humoral immunity, which is associated with an increased risk of infectious lesions. We are talking about conventional Cytostatics, irradiation, patients after transplantation and immunosuppressive therapy, and HIV-positive people. These individuals are at risk, as exposure to common respiratory pathogens and opportunistic microorganisms. This cytomegalovirus, herpes virus, RS virus, environmental mycobacteria, fungi.

Aspiration pneumonia

Aspiration pneumonia is a particular subunit, both in terms of community-acquired and nosocomial pneumonia. This is a very serious disease that most often found in violation of the protective reactions of the respiratory tract. It is reported that up to 9% of cases of community-acquired pneumonia develops on the basis of aspiration. Conditions which contribute to increased risk of aspiration include myasthenia gravis, chronic alcohol abuse, epilepsy, vomiting, gastro-esophageal reflux, tracheal intubation, airway obstruction, bronhoektasia.

These factors lead to aspiration of gastric contents, secretions of the oropharynx or other materials in the external environment. Pneumonia develops after the inhalation of large amounts of material at low pH of the aspirate is a very serious pH is below 2.5 or bacterial content. Developing acute chemical pneumonia in response to insulinaemia material.

Aspiration is accompanied by varying degrees of hypoxemia that occurs due to bronchospasm, formation of atelectasis, alveolar injury and inadequate ventilation and perfusion. Most of these pneumonias are caused by several organisms, which are dominated by anaerobic pathogens. These include Bacteroides, Peptostreptococcus, Fusobacterium SPP. Initial treatment with antibiotics for aspiration pneumonia is often empirical and takes into account important characteristics of a person. It should cover the polymicrobial spectrum and, optionally, modified in accordance with the subsequent results of treatment.

Pneumonia symptoms and the main signs

The typical main symptoms of bacterial pneumonia include the sudden appearance of the problems associated with high fever, chills, weakness. Usually there is cough, dry or with sputum, shortness of breath, pleural pain in nature. These problems usually last for 2-5 days before diagnosis. People with chronic lung disease symptoms of inflammation are prone to deterioration. It is characterized by a change in the quantity and quality otharcivatmi sputum, reduction of tolerance to physical load and progressive shortness of breath as during physical activity and at rest. In some cases, the first signs of pneumonia is characterized by a slow onset and the presence of extrapulmonary symptoms.

Dominating the first signs of pneumonia are presented articular and muscle pain, fatigue, low-grade fever, headache, stomach upset and flu-like symptoms. This clinical picture is usually caused by the so-called atypical pathogens or viruses. The disease may be associated with tachycardia, tachypnea, hypotension.

What are the symptoms of pneumonia criteria that define the severity of the disease?

To assess the severity of pneumonia and mortality risk was developed by the so-called criteria of severity of the disease. They can help to decide whether the pneumonia to be treated on an outpatient basis, or the person must be hospitalized.

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The basis is to consider three important points. They are associated with other concomitant diseases, the assessment of the current clinical picture, severity and complexity of pneumonia. Patients are classified according to risk factors in groups of one to five and, thus, there is an increased risk of mortality in the course of the disease.

The British scheme CURB-65 is based on an assessment of the following factors: the confusion, the value of urea greater than 7 mmol/l, respiratory rate 30 breaths/min, blood pressure 90/60 mm Hg.article and patient age older than 65 years.

If the presence of any of the above mentioned symptoms, the condition is evaluated at one point. If there are already three of these factors, treatment should be in hospital, because, among other things, an increased risk of death. In the absence of these characters has a mortality rate of 0.7%, and 40% of the risk present in that case, if there are all these factors.

Complications of pneumonia

To frequent complications of pneumonia include:

1. Pleurisy.
2. Empyema.

Approximately 40% of cases of community-acquired pneumonia is accompanied by pleurisy. In some cases, inflammation of the lungs accompanied by the disintegration of tissue, a lung abscess or extensive bacterial infection. Development of atelectasis is patients with intrabronchial obstruction most often develops on the basis of tumor or mucous plug. Severe pneumonia can lead to sepsis and the emergence of septic shock, development of ARDS, multiple organ failure and required pulmonary ventilation.

Treatment

Therapeutic strategies

Recommendations for treatment of pneumonia are based on the definition of the type and severity of the disease. There are also differences between outpatient and hospital treatment. A common feature is to start antibiotic therapy as soon as possible after the examination of the person.

In outpatient care must submit an antibiotic within 8 hours. In the hospital is recommended to start treatment from 1 to 4 hours after the examination. The postponement of the introduction of antibiotics associated with deterioration of therapeutic response.

In both cases, initial treatment is empirical in nature, although this does not mean that it will be inappropriate. If people can not take antibiotics, for example, because of an Allergy or intolerance to recommended drug, it is recommended that an alternative method of treatment.

If after 3 days there is no improvement in the condition, the treatment should be changed in accordance with the results of the primary survey.

The duration of antibiotic treatment

There is no common approach and consensus on the duration of antibiotic therapy of pneumonia. Some studies consider a 5-day treatment as sufficient. Similarly, 8-day therapy for severe pneumonia is equally as effective as 15 days. In addition, a shorter introduction of antibiotics reduces the risk of resistance to antimicrobial drugs. In accordance with the British recommendations in uncomplicated pneumonia antibiotics are introduced, usually 7-10 days. If the disease is caused by atypical pathogen or is more serious, treatment is continued at least for 14 days. The treatment of pneumonia caused by Staphylococcus aureus or gram-negative bacteria, with collapse of the lung tissue or the creation of a lung abscess should be carried out within 14 to 21 days.

In the case legionellae pneumonia, which is not a common disease, the therapy duration is up to 21 days. People with a mild form of disease are recommended oral antibiotics. In the case of severe disease, impaired consciousness or gag reflex, enter the full parenteral treatment in which, however, there is no need for the entire duration of therapy. If, after the first days of antibiotic therapy there is an apparent clinical improvement with bringing the temperature to normal values and a decrease in inflammatory parameters, consistent way to replace injectable antibiotic in oral form, and to translate the person to outpatient treatment.

Conclusion

Currently, for the treatment of inflammation of the lungs is a large amount of drugs with a broad antibacterial spectrum. In addition to their undeniable contribution to the improvement, it is necessary to reckon with the side effects. They are mainly individual, as each person can have different symptoms.

In addition, you must keep in mind the constant risk of increase of antibiotic resistance of previously sensitive pathogens. Skillful use of antibiotics for the treatment of inflammation can prevent the development of resistance to these drugs.