Interstitial lung disease. What are idiopathic interstitial pneumonias, how are they treated, and why are they life-threatening? Factors contributing to the development of pneumonia

Among diffuse parenchymal lung diseases (DPLD), a number of pathological processes are distinguished that are not associated with infectious factors and, in a number of ways, may resemble the picture of ARDS, i.e. they are characterized by:

Acute onset;

P a O 2 /FiO 2 ≥200 mmHg (≤300 mmHg);

Bilateral pulmonary infiltrates on a frontal x-ray;

Pulmonary artery wedge pressure 18 mm Hg. or less or no clinical signs of left atrial hypertension.

Despite such similarity of these diseases with ARDS (some experts use the term "simulants" of ARDS), they fundamentally have a different morphological picture, and, most importantly, these diseases require additional anti-inflammatory and immunosuppressive therapy, which has a huge impact on the prognosis. The true frequency of these diseases among ICU patients is not known. Most of the DPLD-"imitators" of ARDS are quite rare in clinical practice, but together they significantly affect the number of causes of ARF. Diagnosis of DPLD is very difficult, often requiring differentiation from pneumonia. Despite the general similarity of the clinical picture, diseases from the DPLD group also have certain features that help to make the correct diagnosis. Of great importance in the diagnosis are CT of the lungs, bronchoalveolar lavage (BAL) with a cytological examination of the washings, as well as the determination of some biological markers. The tactics of respiratory support for DPZL practically do not differ from those used for ARDS. Timely immunosuppressive therapy in DPLD often saves the life of patients, so the most important condition for the success of this therapy is its early administration.

ACUTE INTERSTITIAL PNEUMONIA

SYNONYM

Hamman-Rich Syndrome.

ICD-10 CODE

J84.8. Other specified interstitial lung diseases.

DEFINITION AND CLASSIFICATION

Acute interstitial pneumonia (AIP) is included in the group of idiopathic interstitial pneumonias - clinical and pathological forms of diffuse parenchymal lung diseases, characterized by many similar features (unknown nature, close clinical and radiological signs), which do not allow considering each of the forms of interstitial pneumonia as a separate nosological unit. Interstitial pneumonia, however, has a sufficient number of differences: first of all, morphology, as well as different approaches to therapy and prognosis (Tables 4-17).

Table 4-17. Histological and clinical classification of idiopathic interstitial pneumonias (ATS/ERS, 2002)

The morphological basis of AIP is diffuse alveolar damage: in the early phase - interstitial and intraalveolar edema, hemorrhages, fibrin accumulations in the alveoli, the formation of hyaline membranes and interstitial inflammation; in the late - the collapse of the alveoli, the proliferation of type II alveolocytes, fibrosis of the parenchyma.

ETIOLOGY

The etiology is unknown. Potential causative factors for disease include exposure to infectious agents or toxins, genetic predisposition, or a combination of these factors.

Editor

IIP (idiopathic interstitial pneumonia) is a separate group of inflammatory lung pathologies that differ from each other in the type of pathological process of a non-infectious nature, course and prognosis. The etiology of the disease has not been fully established.

The international classifier implies the ICD-10 code - J 18.9. The course of the disease, as a rule, is long and severe, consequences are possible due to sclerosis of the lung tissue in the form of pulmonary heart failure.

In almost all cases, the patient's quality of life is significantly reduced, disability, disability, and death are possible.

Classification

In 2001, pulmonologists adopted the ATS / ERS international agreement, which is regularly reviewed, according to which pathology is classified as follows:

1. Idiopathic fibrosing alveolitis- the most common type of IIP. Previously, this form as a whole was referred to as ordinary interstitial pneumonia. It is most common among men under 50, as it is associated with professional employment. Connective tissue fibers grow pathologically in the subpleural region along the periphery, as well as in the basal regions.
2. Nonspecific interstitial pneumonia- this type of pathology affects patients under 50 years of age, while smokers are not at risk. Women with a burdened family history are more susceptible to the disease. The lower parts of the lungs are affected in the form of loose. It is registered in such clinical situations as professional injuries, immunodeficiency, drug-induced and chronic hypersensitivity pneumonitis, infections.
3. In other words, bronchiolitis obliterans with pneumonia. The disease is associated with autoimmune processes, toxic effects of drugs, infectious agents, tumors, organ transplants, and radiation therapy. The alveoli and bronchioles become inflamed, as a result, the lumen of the latter becomes narrow. Women and men are ill with the same frequency, most often at the age of 55 years.
4. Respiratory bronchiolitis with interstitial lung disease- the lesion touches the walls of the small bronchi in combination with interstitial pneumonia. It is diagnosed mainly in smokers. The bronchial walls become thickened, the lumen is clogged with a viscous secret.
5. Acute interstitial pneumonia- diffuse inflammation of the alveoli. It occurs in such clinical situations as asbestosis, familial idiopathic fibrosis, hypersensitivity pneumonitis. Pathology is similar to respiratory distress syndrome.
6. Desquamative interstitial pneumonia- observed mainly in middle-aged men,. This is a rather rare pathology, accompanied by infiltration of the walls of the alveoli by macrophages. Similar to respiratory bronchiolitis.
7. Lymphoid interstitial pneumonia- Diagnosed among women over 40 years old. The lower lobes are affected, and the alveoli and interstitium become inflamed. Described in chronic active hepatitis, lymphoma, liver cirrhosis, connective tissue diseases, after organ transplantation.

Causes

The term "idiopathic" means that the exact cause of the pathology could not be established. There are groups of provoking factors that can contribute to the development of IIP:

• immunodeficiency state;
• inhalation of poisonous, toxic aerosols and toxic substances;
• smoking;
• taking certain medications (cytostatics, antiarrhythmics, antirheumatic, some antimicrobials, antidepressants, diuretics);
• systemic hereditary pathologies of connective tissue;
• chronic liver diseases.

The pathological process can be accelerated by microorganisms. If we talk about whether it is possible to become infected with interstitial pneumonia initiated by bacteria and viruses, pathogenic flora penetrates the lungs in the following ways:

• airborne (inhaled air);
• bronchogenic (aspiration of the contents of the oropharynx into the bronchi);
• hematogenous (spread of infection from other organs);
• contagious (with infections of nearby organs).

New types of SMPS:

• "nylon" lung;
• popcorn makers' disease;
• radiation pneumonitis.

Symptoms

Each type of disease has distinctive features:

1. Acute IP is developing rapidly. It is preceded by muscle pain, chills, high fever, then severe shortness of breath increases, cyanosis progresses. Described by a high mortality rate. In surviving patients, the structure of the bronchi and vascular bundles is disturbed, bronchiectasis develops. Wheezing like "cellophane cod" is heard. Diffuse shading and spots on x-ray. There is resistance to hormone treatment and ineffectiveness of mechanical ventilation.
2. non-specific IP. This type of pathology is characterized by a slow course (1.5-3 years before the diagnosis). Cough and shortness of breath are moderate. Fingernails take the form of drumsticks. The patient is losing weight. With timely treatment, the prognosis is favorable. On CT scan in the lower lobes under the pleura, areas called “ground glass” are determined due to uniform tissue infiltration.
3. lymphoid IP. This is a rare type of pathology that develops over several years. Cough and shortness of breath gradually increase, joints hurt, the patient loses weight, anemia is formed. On x-ray - "honeycomb lung".
4. Cryptogenic IP. The disease is similar to influenza and SARS. There is malaise, weakness, fever, headache and muscle pain, cough. Sputum is clear, mucous. Often, antibiotics are mistakenly prescribed, which does not bring results. X-rays show lateral darkening, sometimes nodular.
5. Desquamative IP. Most often observed in patients with a long history of smoking. The clinical picture is poor: shortness of breath with slight exertion, dry cough. Symptoms develop over several weeks. On the X-ray in the lower lobes, the sign of "frosted glass" is visualized.
6. Idiopathic fibrosing alveolitis. It is characterized by a slow progression of dry cough and shortness of breath. Cough attacks are described. Fingertips take on the appearance of drumsticks. In the later stages, edema is characteristic. With the addition of infection, the course of alveolitis is aggravated. In the process of auscultation, a characteristic “crack of cellophane” is heard, on x-ray - “honeycomb lung”, on CT - signs of “frosted glass”.
7. Respiratory bronchiolitis with interstitial lung disease. It is a typical disease of smokers. Development occurs gradually - a cough appears, the intensity of which is constantly increasing, the patient is worried about shortness of breath. “Cracking” rales, disturbances in pulmonary ventilation with an increase in the residual volume of the lungs are determined.

Important! Regardless of the form of the disease, interstitial pneumonia is a dangerous pathology that needs immediate treatment.

The symptoms of all types of IIP are either erased or not specific, so the diagnostic process is rather difficult.

Treatment in adults

1. The patient should completely stop smoking, especially when it comes to respiratory bronchiolitis and desquamative PI. The influence of occupational hazards is excluded.
2. The main treatment is represented by glucocorticoids in order to stop inflammation and proliferation of connective tissue. Hormone therapy lasts for several months.
3. Cytostatics - to suppress cell division.
4. - in order to facilitate the excretion of mucus (fluimucil).
5. IVL, oxygen therapy - are prescribed for respiratory failure.

In bronchiolitis, inhaled and non-inhaled bronchodilators are prescribed to eliminate obstruction.

Additionally, exercise therapy is prescribed - special exercises that help improve pulmonary ventilation, which are important in terms of preventing respiratory failure.

After six months of such therapy, its effectiveness is evaluated. If the results are positive, this treatment regimen is recommended to be followed for a year.

To protect the patient from secondary accession, antibiotics are prescribed for prophylactic purposes. In some cases, influenza and pneumococcal infections are vaccinated.

Non-traditional remedies (herbs) can be used at the stage of remission. Doctors do not recommend self-medication and folk remedies for IIP, as the reaction can become unpredictable. Good results are given by the following medicinal herbs that have an expectorant and anti-inflammatory effect:

• liquorice root;
• peppermint;
• thyme;
• coltsfoot;
• sage;
• St. John's wort.

With a strong dry cough, which is accompanied by a sore throat, warm milk with natural honey helps.

Forecast

The prognosis of the disease is entirely related to the type of pathology and the presence of complications:

1. On average, patients with IIP live 6 years.
2. In pulmonary fibrosis, pulmonary or heart failure, survival is 3 years.
3. The death rate in Hamman-Rich syndrome (total fibrosis) is 60%.
4. Improving the patient's condition after adequate therapy with a non-specific form of the disease is observed in 75% of cases, the survival rate is 10 years.
5. With desquamative pneumonia, improvement after treatment is noted in 80%, ten-year survival is also in 80% of patients.
6. With adequate treatment of lymphoid and cryptogenic PV, the prognosis is quite favorable.
7. After getting rid of the addiction to smoking, respiratory bronchiolitis goes away, however, repetitions of the disease are not ruled out.

Diffuse interstitial lung disease(DIBL) is a general term for a group of diseases characterized by diffuse inflammatory infiltration and fibrosis of the small bronchi and alveoli.

Code according to the international classification of diseases ICD-10:

Causes

Etiology and risk factors. Inhalation of various substances .. Mineral dust (silicates, asbestos) .. Organic dust .. Mercury vapor .. Aerosols. Taking drugs (bisulfan, bleomycin, cyclophosphamide, penicillamine, etc.). Radiation therapy. Recurrent bacterial or viral lung disease. Adult respiratory distress syndrome. Neoplasms.. Bronchoalveolar cancer.. Leukemias.. Lymphomas. Bronchoalveolar dysplasia (Wilson-Mikiti syndrome, interstitial mononuclear focal fibrosing pneumonia). Sarcoidosis. Diffuse connective tissue diseases.. Rheumatoid arthritis.. SLE.. Systemic scleroderma.. Sjögren's syndrome. Pulmonary vasculitis.. Wegener's granulomatosis.. Churg-Strauss syndrome.. Goodpasture's syndrome. Amyloidosis. Hemosiderosis of the lungs. Alveolar lung proteinosis. Histiocytosis. Hereditary diseases.. Neurofibromatosis.. Niemann-Pick disease.. Gaucher disease. HPN. Liver diseases.. Chronic active hepatitis.. Primary biliary cirrhosis. Bowel disease.. Ulcerative colitis.. Crohn's disease.. Whipple's disease. Graft-versus-host reaction. Left ventricular heart failure. Idiopathic interstitial fibrosis, or cryptogenic fibrosing alveolitis (50% of cases of pulmonary fibrosis), is a chronic progressive hereditary disease with diffuse inflammatory infiltration of the alveoli and an increased risk of developing lung cancer.

Genetic aspects. Hamman-Rich syndrome (178500, Â). Laboratory: an increase in the content of collagenase in the lower respiratory tract, an increase in the concentration of g - globulins, hyperproduction of platelet b - growth factor. Pulmonary fibrocystic dysplasia (*135000, Â) is clinically and laboratory identical to Hamman-Rich disease. Familial interstitial desquamative pneumonitis (pneumocyte proliferation disease type 2, 263000, r), early onset, death before three years. Cystic lung disease (219600, r) is characterized by recurrent infections of the respiratory tract and spontaneous neonatal pneumothorax.

Pathogenesis. acute stage. Damage to capillaries and cells of the alveolar epithelium with interstitial and intraalveolar edema and subsequent formation of hyaline membranes. Both complete regression and progression to acute interstitial pneumonia are possible. chronic stage. The process progresses to extensive lung damage and collagen deposition (common fibrosis). Hypertrophy of smooth muscles and deep ruptures of alveolar spaces lined with atypical (cubic) cells. Terminal stage. The lung tissue acquires a characteristic "honeycomb" appearance. Fibrous tissue completely replaces the alveolar and capillary network with the formation of dilated cavities.

Pathomorphology. Severe fibrosis of small bronchi and alveoli. The accumulation of fibroblasts, inflammatory cellular elements (mainly lymphocytes and plasma cells) and collagen fibers in the lumen of the small bronchi and alveoli. Germination of terminal and respiratory bronchioles, as well as alveoli by granulation tissue, leads to the development of pulmonary fibrosis.

Pathological classification. Simple interstitial fibrosis. Desquamative interstitial fibrosis. Lymphocytic interstitial fibrosis. Giant cell interstitial fibrosis. Obliterating bronchiolitis with pneumonia.

Symptoms (signs)

clinical picture. Fever. Shortness of breath and dry cough. Weight loss, fatigue, general malaise. Data of an objective study .. Tachypnea .. Deformation of the fingers in the form of "drumsticks" (with a long course of the disease) .. Inspiratory dry crackling rales (usually in the basal parts of the lungs) .. In severe forms - signs of right ventricular failure.

Diagnostics

Laboratory research. Leukocytosis. Moderate increase in ESR. Negative results of serological tests with Ag mycoplasmas, coxiella, legionella, rickettsiae, fungi. Negative results of virological tests.

Special studies. Lung biopsy (open or transthoracic) is the method of choice for differential diagnosis. Investigation of respiratory function - restrictive, obstructive or mixed type of disorders. Fibrobronchoscopy allows for differential diagnosis with neoplastic processes in the lungs. ECG - hypertrophy of the right heart with the development of pulmonary hypertension. X-ray of the chest organs (minimal changes against the background of severe clinical symptoms) .. Small-focal infiltration in the middle or lower lobes of the lungs .. In the later stages - a picture of a "honeycomb lung". Bronchoalveolar lavage - the predominance of neutrophils in the lavage fluid.

Treatment

TREATMENT. GC. Prednisolone 60 mg/day for 1-3 months, then a gradual dose reduction to 20 mg/day for several weeks (later the drug at the same dose can be given as maintenance therapy) to avoid acute adrenal insufficiency. The duration of treatment is at least 1 year. Cytostatics (cyclophosphamide, chlorambucil) - only if steroid therapy is ineffective. Bronchodilators (adrenergic agonists inhaled or orally, aminophylline) are appropriate only at the stage of reversible bronchial obstruction. Replacement oxygen therapy is indicated when p a O 2 is less than 50-55 mm Hg. Treatment of the underlying disease.

Complications. Bronchiectasis. Pneumosclerosis. Arrhythmias. Acute cerebrovascular accident. THEM.

Age features. Children - development of interstitial mononuclear focal fibrosing pneumonia due to underdevelopment of the elastic elements of the lung .. Prolonged course, persistent cough, stridor .. Frequent formation of bronchiectasis. Elderly - people over 70 years of age rarely get sick.

Reduction. DIBL - diffuse interstitial lung disease

ICD-10. J84 Other interstitial lung diseases

APPS

Hemosiderosis of the lungs- a rare disease characterized by episodic hemoptysis, pulmonary infiltration and secondary IDA; younger children are more commonly affected. Genetic Aspects: inherited pulmonary hemosiderosis (178550, Â); hemosiderosis due to deficiency of g - A globulin (235500, r). Forecast: outcome in pulmonary fibrosis with the development of respiratory failure; cause of death was massive pulmonary hemorrhage. Diagnostics: a study of respiratory function - violations of the restrictive type, but the diffusion capacity of the lungs may falsely increase due to the interaction of carbon dioxide with hemosiderin deposits in the lung tissue; chest x-ray - transient pulmonary infiltrates; lung biopsy - detection of macrophages loaded with hemosiderin. Treatment: GK, iron replacement therapy for secondary IDA. Synonyms: pneumohemorrhagic hypochromic remitting anemia, brown idiopathic lung induration, Celen syndrome, Celen-Gellerstedt syndrome. ICD-10. E83 Disorders of mineral metabolism.

Histiocytosis of the lungs- a group of diseases characterized by the proliferation of mononuclear phagocytes in the lungs (Letterer-Siwe disease; Hand-Schuller-Christian disease; eosinophilic granuloma [benign reticuloma, Taratynov's disease] - a disease characterized by the development of a tumor-like infiltrate in the bones or skin, consisting of large histiocytes and eosinophils ). The predominant gender is male. The risk factor is smoking. Pathomorphology: progressive proliferation of mononuclear cells and eosinophil infiltration of the lung with subsequent development of fibrosis and "honeycomb lung". Clinical picture: unproductive cough, shortness of breath, chest pain, spontaneous pneumothorax. Diagnostics: moderate hypoxemia; in alveolar washings - the predominance of mononuclear phagocytes, the presence of Langerhans cells, identified by monoclonal AT OCT - 6, is possible; chest x-ray- pulmonary dissemination with the formation of small cysts, localized mainly in the middle and upper sections of the lungs; FVD study- restrictive - obstructive ventilation disorders. Treatment: smoking cessation, GC (effect intermittent). Forecast: both spontaneous recovery and uncontrolled progression and death from respiratory or heart failure are possible. Note. Langerhans cells - Ag - representing and processing Ag dendritic cells of the epidermis and mucous membranes, contain specific granules; carry surface cell receptors for Ig (Fc) and complement (C3), participate in DTH reactions, migrate to regional lymph nodes.

Idiopathic interstitial pneumonia is an interstitial lung disease of unknown etiology that shares similar clinical features. They are classified into 6 histological subtypes and are characterized by varying degrees of inflammatory response and fibrosis and are accompanied by dyspnea and typical radiographic changes. Diagnosis is based on history, physical examination, radiological findings, lung function tests, and lung biopsy.

Six histological subtypes of idiopathic interstitial pneumonia (IIP) have been identified, listed in descending order of frequency: common interstitial pneumonia (UIP), known clinically as idiopathic pulmonary fibrosis; nonspecific interstitial pneumonia; bronchiolitis obliterans with organizing pneumonia; respiratory bronchiolitis associated with interstitial lung disease RBANZL; desquamative interstitial pneumonia and acute interstitial pneumonia. Lymphoid interstitial pneumonia, although still sometimes considered a subtype of idiopathic interstitial pneumonia, is now considered to be part of the lymphoproliferative diseases and not the primary IBLARB. These subtypes of idiopathic interstitial pneumonia are characterized by varying degrees of interstitial inflammation and fibrosis, and all result in dyspnea; diffuse changes on chest x-ray, usually in the form of increased pulmonary pattern, and are characterized by inflammation and / or fibrosis on histological examination. This classification is due to the different clinical features of individual subtypes of idiopathic interstitial pneumonia and their different response to treatment.

ICD-10 code

J84 Other interstitial lung diseases

Diagnosis of idiopathic interstitial pneumonia

Known causes of ILD must be ruled out. In all cases, a chest X-ray, lung function tests, and high-resolution CT (HRCT) are performed. The latter allows differentiation of hollow space lesions from those of interstitial tissues, provides a more accurate assessment of the extent and location of the lesion, and is more likely to detect an underlying or concomitant disease (eg, occult mediastinal lymphadenopathy, malignant tumors, and emphysema). HRCT is best performed with the patient in the prone position to reduce lower lung atelectasis.

A lung biopsy is usually required to confirm the diagnosis, unless the diagnosis is established by HRCT. A bronchoscopic transbronchial biopsy can rule out IBLARB by establishing a diagnosis of another disease, but does not provide enough tissue to diagnose IBLARB. As a result, a biopsy of a large number of sites may be required to make a diagnosis when performing open or video-assisted thoracoscopic surgery.

Bronchoalveolar lavage helps narrow the differential diagnosis in some patients and provide information about disease progression and response to treatment. However, the benefit of this procedure in the initial clinical examination and follow-up in most cases of this disease has not been established.

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 the children and adults in our country. All these facts make it necessary to understand the issues associated with this disease.

Definition of pneumonia

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

Classification of community-acquired pneumonia

Due to the cause of pneumonia is divided:

• Bacterial (pneumococcal, staphylococcal);
• Viral (exposure to influenza viruses, parainfluenza, adenoviruses, cytomegalovirus)
• allergic
• ornithoses
• Gribkovs
• Mycoplasma
• Rickettsial
• mixed
• With an unknown cause

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

• pneumococcal pneumonia of a non-severe course;
• atypical pneumonia of a non-severe course;
• pneumonia, probably of pneumococcal etiology of severe course;
• pneumonia caused by an unknown pathogen;
• aspiration pneumonia.

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

• J12 Viral pneumonia, not elsewhere classified;
• J13 Pneumonia due to Streptococcus pneumoniae;
• J14 Pneumonia due to Haemophilus influenzae;
• J15 Bacterial pneumonia, not elsewhere classified;
• J16 Pneumonia caused by other infectious agents;
• J17 Pneumonia in diseases classified elsewhere;
• J18 Pneumonia without specification of the causative agent.

Since it is rarely possible to identify the pathogen in pneumonia, the code J18 (Pneumonia without specifying the pathogen) is most often assigned.

The international classification of pneumonia distinguishes the following types of pneumonia:

• out-of-hospital;
• hospital;
• Aspiration;
• Pneumonia associated with severe diseases;
• Pneumonia in immunocompromised individuals;

community-acquired pneumonia- This 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 are pathogenic and cause the development of pneumonia.

Factors contributing to the development of pneumonia:

• hypothermia;
• Lack of vitamins;
• Being close to air conditioners and humidifiers;
• The 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, adenovirus infection.

The main ways that microorganisms that cause pneumonia enter the lung tissue is the ingestion of microorganisms with air or the 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 drainage system of the lungs. If 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.

Very rarely, a route of infection is possible with chest wounds and infective endocarditis, liver abscesses.

Symptoms of Community Acquired Pneumonia

The disease always begins suddenly and manifests itself in various ways.

Pneumonia is characterized by the following clinical symptoms:

• The rise in body temperature to 38-40 C. The main clinical symptom of the disease in people over 60 years old, the temperature increase can remain in the range of 37-37.5 C, which indicates a low immune response to the introduction of the pathogen.
• Persistent cough characterized by rust-colored sputum
• Chills
• General malaise
• Weakness
• Decreased performance
• sweating
• Pain during 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 malaise. Pathology covers both lungs and is characterized by the development of acute respiratory failure and general intoxication of the body.

With segmental injury lung is characterized by the development of an inflammatory process in the whole segment of the lung. The course of the disease is mostly favorable, without a rise in temperature and cough, and the diagnosis can be made by chance during an X-ray examination.

With croupous pneumonia clinical symptoms are bright, high body temperature worsens the condition up to the development of delirium, and if 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, often sick children under 15 years of age. Allocate acute and subacute course. The outcome of this type of pneumonia is pneumosclerosis.

• For a sharp current the phenomena of severe intoxication, the development of neurotoxicosis are characteristic. The course is severe with a high rise in temperature and persistent residual effects. Often sick children aged 2-6 years.
• Subacute course characterized by cough, increased lethargy and fatigue. Large distribution among children 7-10 years of age who have had ARVI.

There are features of the course of community-acquired pneumonia in persons 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 possible development of disorders of the blood supply to the brain, accompanied by psychoses and neuroses.

Types of nosocomial pneumonia

Hospital-acquired (hospital) 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 therapeutic measures, increases the number of complications and deaths.

Divided by time of occurrence:

• Early- occurs in the first 5 days after hospitalization. Cause microorganisms already present in the body of the infected (Staphylococcus aureus, Haemophilus influenzae and others);
• Late- develops 6-12 days after admission to the hospital. Pathogens are hospital strains of microorganisms. The most difficult to treat is due to the emergence of resistance of microorganisms to the effects of disinfectants and antibiotics.

Due to the occurrence, several types of infection are distinguished:

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

• Violation of the drainage function of the lungs;
• A small amount of swallowed contents of the oropharynx containing the causative agent of pneumonia;
• Microorganism-infected oxygen-air mixture;
• Infection from carriers of strains of hospital infection among medical personnel.

Postoperative pneumonia is an infectious and inflammatory lung disease that occurs 48 hours after surgery.

Causes of postoperative pneumonia:

• Stagnation of a small circle of blood circulation;
• Low ventilation of the lungs;
• Therapeutic manipulations on the lungs and bronchi.

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

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

Diagnosis of community-acquired pneumonia

To date, there is a complete list of clinical and paraclinical methods.

The diagnosis of pneumonia is made after the following studies:

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

Treatment of Community Acquired Pneumonia

The treatment of 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
• The presence of chronic diseases (bronchial asthma, COPD, diabetes mellitus, immunodeficiencies);
• The impossibility of care.

The main drugs aimed at the treatment of pneumonia are antibacterial drugs:

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

In the absence of the onset of the effect of taking the drug for several days, a change in the antibacterial drug is necessary. To improve sputum discharge, mucolytics are used (Ambrocol, Bromhexine, ACC).

During the recovery period, it is possible to carry out physiotherapy procedures (laser therapy, infrared radiation and chest massage)

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

Pneumonia prognosis

In 80% of cases, the disease is successfully treated and does not lead to serious adverse consequences. After 21 days, the patient's state of health improves, partial resorption of infiltrative shadows begins on the x-ray.

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 a person, especially if it goes unnoticed and has few symptoms. Therefore, you need to be attentive to your own health, get vaccinated, consult a doctor at the first sign of the disease and remember what serious complications pneumonia can threaten.