Among out-of-hospital outpatient forms pneumonia is dominated by pneumococcal pneumonia, often caused by Gr+ streptococcus pneumoniae (pneumococcus), which can be found in the upper respiratory tract, especially in the spring.
Within this species there are 84 subtypes with varying pathogenicity. Most severe course caused by types I, II, III.
Pneumococcal pneumonia Depending on the reactivity of the macroorganism, it can occur in the form of:
Lobar (or with damage to two segments), with a typical spread of the process to the pleura (pleuropneumonia), severe acute respiratory failure and severe intoxication. Previously it was inaccurately designated as lobar pneumonia. This pneumonia requires hospitalization of the patient.
Mortality with it is 20-40%, and complications occur in 20-25% of patients;
Focal pneumonia (bronchopneumonia).
It must be remembered that lobar pneumonia can also be caused by Klebsiella and, less commonly, by Mycoplasma, Staphylococcus and Legionella.
Pneumococcal pneumonia (accounts for 25% of all pneumonias) most often occurs in men aged 20-60 years against the background of predisposing factors: previous viral infection(more than half of patients), hypothermia, chronic alcoholism, related chronic diseases(for example, coronary artery disease, hypertension).
Currently, pneumococcal (lobar) pneumonia has “changed” somewhat: it has become segmental rather than lobar (if treatment is started in the first 1-2 days), the duration of fever and the period of severe clinical manifestations, hemoptysis and collapse are rarely observed, but a protracted course is more common.
Lobar pneumococcal pneumonia:
Lobar pneumonia is characterized by suddenness (occurrence in the midst of full health) with a short shaking chill, but not more than 1-3 hours (in 80% of patients); presence of headache. Later, in 85% of cases, fever (38-39 ° C) of a constant type appears (but in old people and exhausted patients the body temperature is often normal); pleural pain in the chest, on the affected side, associated with the development of parapneumonic pleurisy on the first day of illness (on 80%)); the cough is initially dry, then productive with viscous sputum, mucopurulent (more often) or “rusty” (in 35%); shortness of breath, and in case of volumetric lesions of the lungs or the presence of cardiac pathology - and at rest (in 60%); herpetic rashes on the lips, near the nose on the 2-4th day of Bo-II (in 25%); cyanosis and symptoms of intoxication of varying severity - headache, general severe weakness (in 60%).
Elderly and weakened persons, alcoholics are often taken to the hospital with impaired consciousness ( acute disorder brain activity), and alcoholics can even develop psychosis of somatogenic origin. All this makes it difficult to diagnose pneumonia.
The presence of “rusty” sputum and herpes labialis is recorded quite rarely and cannot be considered as a pathognomonic sign of lobar pneumococcal pneumonia. If in clinical picture This pneumonia is dominated by damage not to the lungs, but to other organs, it is necessary to look for other pathology or complications. At severe forms This pneumonia may cause icteric discoloration of the skin, sclera of the eyes and mucous membranes due to increased blood levels total bilirubin(up to 25-30 mg/l). In patients with chronic diseases lungs or heart, this pneumonia can be complicated by acute respiratory failure, heart failure, or manifest as a severe septicemic disease.
An objective examination of a patient with lobar pneumococcal pneumonia reveals tachycardia and tachypnea; infiltration phenomena - intensification voice tremors and bronchophonia (in 60-90%), which can precede the appearance of percussion dullness by several hours (in 70-100% of cases). Dullness of pulmonary sound may not be detected if the focus of compaction is located deeper than 4 cm.
On the 2-3rd day, crepitus (which occurs in the alveoli and is heard at maximum inspiration, does not disappear and does not change its character when coughing) and pleural friction noise (in 30-60%) begin to be heard (in 65-90% of patients). . The latter occurs in both phases of breathing, and crepitus only at the end of inspiration. When simulating breathing (chest movements), crepitus is not audible. Hears out even later bronchial breathing(in 30-40% of cases) over the entire affected area. Bronchial breathing is due to the filling of the alveoli with exudate (air does not penetrate into them), better conductivity of the denser tissue of the air through the bronchi. Sometimes breathing can be harsh (in a third of patients) or weakened vesicular (in 30-60% of patients). Above the affected area, breathing is usually weakened, moist, often dull (less often sonorous) fine bubbling rales are heard.
In general, physical findings are consistent with the spread of pulmonary infiltrate and involvement of the pleura. With the early prescription of antibiotics, the appearance of clinical and radiological symptoms in the flushing stage is ephemeral; a thorough physical search is necessary. In cases of fatal pneumonia, severe acute respiratory failure and circulatory collapse occur. When listening to the heart, tachycardia (more than 120 per minute), dullness of heart sounds (20-40%) are noted, there may be an accent of the 2nd tone over the pulmonary artery.
Depending on the characteristics of the clinical picture, we can distinguish:
- 1. central shape this pneumonia, in which the process is localized deep in the pulmonary parenchyma. With this pneumonia, pulmonary symptoms are mild: they change little percussion sound, crepitus and wheezing may not be heard, but general symptoms are clearly expressed;
- 2. upper lobe pneumonia, which is characterized by severe course, high fever, severe shortness of breath, disorders of the central nervous system and hemodynamics. At the same time, physical data are scanty, often only in axillary area bronchial breathing and crepitus are heard;
- 3. lower lobe pneumonia, in which the diaphragmatic pleura is often affected, followed by a pseudopicture “ acute abdomen" The appearance of chills, fever, and the presence of “rusty” sputum help in diagnosing pneumonia.
The results of the X-ray examination depend on the time of examination. At the beginning of the disease, they are minimal: increased pulmonary pattern in the affected area, lack of structure of the root on the affected side. Then (on the 4-6th day) in 3/4 of patients homogeneous segmental foci of infiltration are detected on the periphery of the pulmonary fields. In severe pneumonia there may be a rapid increase in compaction lung tissue despite antibiotic treatment. More often affected upper lobe the right lung (in 16-32% of cases) and the lower lobe of the left lung (12-24%). In 1/3 of patients, parapneumonic pleurisy is detected, although with a targeted search it is found in half of the cases. With adequate and early treatment in 1/3 of adult patients, resorption of infiltration occurs on the 7-8th day, and with delayed treatment with antibiotics, against the background of chronic obstructive diseases, it slows down (up to 30-40 days). The usual time frame for radiological normalization of the pulmonary pattern is 20-30 days. Prolonged resolution of lobar pneumonia occurs in 30-50% of patients.
IN peripheral blood leukocytosis of 15-25 x10 9 /l in 95% of cases is noted) with a shift of the formula to the left, toxic granularity of neutrophils, hyperfibrinogenemia, increased ESR. In very severe cases of pneumonia, leukocytosis may not be present, but leukopenia is detected (less than 3H10 9 /l).
Lobar pneumococcal pneumonia can be complicated by abscess formation, minor parapneumonic pleurisy, less commonly - meningitis, endocarditis with lesions aortic valve. Elderly, weakened patients may develop shock, cardiac and respiratory failure, and delirium.
The prognosis of this pneumonia, without complications, is good in young, treated individuals. But there is high risk mortality (15-20%) in a number of elderly patients with big defeat lung tissue, severe concomitant diseases (chronic obstructive pulmonary diseases, cardiac pathology, liver cirrhosis, oncological diseases) against the background of low or high leukocytosis (less than 4 × 10 9 /l and more than 20 × 10 9 /l leukocytes, respectively) and the appearance of a bacteremic form of this pneumonia with the development of extrapulmonary lesions (meningitis, endocarditis).
The high sensitivity of pneumococcus to penicillins and cephalosporins allows the use of these antibiotics as a diagnostic tool. Their administration in 2/3 of cases of pneumococcal pneumonia leads to normalization of body temperature within 3 days, sharp decline intoxication and leukocytosis in peripheral blood. In 1/3 of patients, such treatment is ineffective; body temperature normalizes only after 6-7 necks. This is usually observed when more than one lobe of the lung is affected or in persons suffering from alcoholism or concomitant diseases (coronary heart disease, chronic obstructive pulmonary disease, hepatitis).
Quite often (up to 50% of cases) lobar pneumonia is not recognized during life or patients are hospitalized late (up to 60%). In general, lobar pneumococcal pneumonia is characterized by:
- · development against the background of various pathologies (chronic obstructive pulmonary diseases, ischemic heart disease, diabetes, tuberculosis, chronic alcoholism, oncological diseases) and a decrease in the general reactivity of the macroorganism;
- · high fever (88 %);
- · drug crisis (good, “terminating” effect) with rapid normalization of temperature within two days from the start of treatment with penicillin, cephalosporins (in 75% of cases);
- · symptoms of lung compaction (60%);
- · crepitation (65%);
- · pleural friction noise (30-60%).
IN modern conditions the clinical picture of this pneumonia may still be varied, blurred and not fit into the above classic description. This is determined not only by the pathogen, but also by the reactivity of the patient.
Pneumococcal pneumonia is an inflammation of the lungs caused by pneumococcus (70% of all cases). One type or another of this bacterium is found in every body. It lives in the upper respiratory tract. The disease begins if the microorganism falls below when the immune system is weakened. As a rule, one segment of the lung becomes inflamed (more rarely, several). The disease is dangerous due to the possibility of disability or death if treatment is started late. However, in most cases the prognosis is favorable.
Pneumococcal pneumonia occurs in several cases:
- most often as a complication of ARVI and bronchitis;
- infection by airborne droplets (when sneezing, coughing, talking) both from patients and from carriers of the bacteria. Outbreaks often occur in kindergartens or families;
- transmission of infection from a pregnant woman to the fetus occurs.
The bacterium penetrates into the lower Airways and causes inflammation. Then part of the alveoli of the lung (small bubbles that exchange oxygen and carbon dioxide With blood vessels) fill with liquid and cease to function. The most susceptible to this process are:
- children aged six months to two years, prone to frequent acute respiratory infections. From birth, the baby’s body contains antibodies from the mother, the number of which decreases significantly after six months of age, and its own immunity is not yet able to overcome the causative agent of the disease;
- people with various chronic diseases that reduce protective functions body (respiratory diseases, of cardio-vascular system, diabetes mellitus, HIV infection, oncology and others);
- elderly people over 65 years of age whose immunity is weakened due to age;
- exposed to prolonged stress (hypothermia, mental stress, malnutrition);
- people with bad habits (dependence on tobacco and alcohol).
Symptoms
The disease develops quickly: the incubation period is from one to three days. The intensity of the symptoms depends on the area of the lung lesion. Lobar pneumonia begins abruptly and progresses severely, affecting a third of the lung. Focal, widespread in a small area, is easier to tolerate, but it lasts longer. Most often it occurs against the background of ARVI. The symptoms of the disease are:
- high temperature (up to 40 degrees);
- severe weakness, headache, loss of appetite, insomnia;
- shortness of breath, rapid heartbeat, chills and sweating;
- dry cough, gradually turning into a wet cough with pus;
- chest pain on the affected side.
Diagnostics
After examining and interviewing the patient, the doctor makes a preliminary diagnosis. Pneumonia is finally determined based on laboratory and X-ray studies. The doctor prescribes the following tests:
- Bacteriological culture of sputum to determine the presence of pneumococcal bacteria.
- Microscopic tests of blood and urine to detect signs of inflammation.
- Radiography chest area, and CT scan to exclude other diseases with similar symptoms (cancer, tuberculosis).
Treatment
Treatment for pneumococcal pneumonia should be started immediately. It is often carried out before research results are available. IN severe cases the patient is hospitalized.
The main method of getting rid of the disease is antibacterial therapy. However, not all antibiotics can cope with the bacterium: pneumococcus has developed resistance to some (especially to the penicillin, tetracycline and chloramphenicol groups).
To alleviate the condition, symptomatic treatment is prescribed:
- mucolytics (thin sputum) and bronchodilators (relieve bronchospasm);
- anti-inflammatory drugs and analgesics to relieve pain in the affected lungs;
- antipyretics;
- immunomodulators to increase the body's defenses;
- inhalations and therapy with humidified oxygen (using a special device).
A person suffering from pneumonia must follow bed rest. His contact with healthy people. Carry out disinfectant cleaning, because pneumococci are not resistant to external environment and will quickly die from special means. The exception here is dried sputum. There the bacteria remain viable for up to two months.
Do not self-medicate under any circumstances. At the first sign of pneumococcal pneumonia, go to the doctor immediately. The course of the disease is rapid - a couple of days. If treatment is delayed, there is a high risk of death.
Complications
This type of pneumonia can lead to heart and respiratory failure, as well as inflammation of the cerebral cortex (meningitis) and the lining of the heart (pericarditis). With sepsis (blood poisoning by pneumococci), death occurs in half of the cases.
Prevention
Besides general rules compliance healthy image life and timely treatment ARVI, it is necessary to get vaccinated against pneumococcal pneumonia. This procedure is carried out once in a lifetime. Repeatedly after 5 - 10 years, people who have increased risks get sick.
Get vaccinated against pneumococcal pneumonia. It protects against two thirds of pneumococcal infections (meningitis, otitis, pleurisy and others). Very rarely side effects in the form of fever, pain at the injection site, allergic reactions.
Pneumococcal pneumonia - dangerous disease, which without proper treatment can result in death. Young children, the elderly and people suffering from various chronic diseases are most susceptible to its influence. When the first symptoms of bacterial lung damage appear, consult a doctor.
Pneumonia (pneumonia) – acute infection bacterial, fungal or viral etiology. It is characterized by damage to the pulmonary parenchyma and inflammation of the respiratory tract.
Complications
Complications develop in severe forms of pneumonia. In the absence of treatment or inadequate therapy, consequences can also occur with ordinary focal pneumonia.
Possible complications:
- abscess formation;
- obstruction;
- pneumothorax;
- pneumosclerosis - replacement of the alveolar cavity with connective tissue;
- pulmonary edema;
- myocarditis, endocarditis, pericarditis;
- infectious toxic shock (ITSH);
- sepsis.
Hospitalization or home treatment
After production accurate diagnosis“pneumonia” the doctor will determine the type and severity of the disease, based on this he recommends outpatient or hospital treatment pneumonia.
When choosing drugs and place of treatment, the doctor takes into account the following unfavorable factors (risk factors for complications):
- children's or elderly age(patients under three years of age and elderly people over 65 years of age are at risk);
- the presence of chronic diseases (COPD, diabetes mellitus, heart failure and others) and immunodeficiency;
- smoking;
- alcoholism;
- low social status;
- pregnancy and breastfeeding;
- the presence of hospitalizations in the current year.
The type of pathogen also influences the course of the disease: for example, the most severe course of pneumonia is provoked by Pseudomonas aeruginosa, Staphylococcus aureus and Klebsiella. Inflammation of the lungs caused by pneumococcus, mycoplasma, legionella and chlamydia respond better to antimicrobial therapy.
If the patient is at risk, in most such cases the disease will be severe and recovery is unlikely to occur quickly. However, young, physically strong people without bad habits with no history of concomitant diseases. The American Thoracic Society has formulated the main signs of severe pneumonia:
- respiratory failure (shortness of breath);
- vascular insufficiency (low blood pressure);
- high body temperature (above 38 degrees);
- weakness, drowsiness, spatial disorientation, stupor;
- leukopenia or leukocytosis (less than 4 thousand/µl or more than 30 thousand/µl);
- hematocrit less than 30%;
- renal failure;
- damage to several lobes of the lungs at once, the formation of abscesses.
In the absence of the above symptoms, risk factors for complications and social indications (and the disease meets the criteria for non-severe), you can prescribe ambulatory treatment with mandatory medical supervision. If the pneumonia is not severe, treatment is carried out by a general doctor (pediatrician, family doctor, therapist). Patients in in serious condition must be hospitalized in a hospital.
The treatment period for mild pneumonia is about 7-10 days. For severe pneumonia, the course is 14-21 days. If complications develop (for example, in the form of abscess formation, encysted pleurisy), the treatment period can be increased to 1.5 months. In this case, it is necessary to distinguish between the duration of treatment and the period of complete recovery. Full recovery absence is considered clinical symptoms and radiological signs of pneumonia, which at the end of the course of treatment may still be present in the form of residual effects or a stage of resolution.
If you do not seek help in a timely manner in the presence of concomitant diseases, there is a risk of developing severe pneumonia. This diagnosis can be made if one of the following signs is present (absolute EPO criteria for admission to the ICU):
- necessity artificial ventilation lungs, tracheal intubation;
- septic shock, multiple organ failure;
- coma.
In fact, patients with this course of the disease require resuscitation measures. To avoid the possibility of death, treatment of such patients can be very long, often with non-standard antibiotic regimens (lasting more than a month). Recovery time ranges from 30 days to several months.
The speed of recovery, in addition to favorable or unfavorable factors in the patient’s medical history, is influenced by more early start administration of antibiotics and adequate therapy.
Antibiotics
Antimicrobial therapy using antibiotics will help cure pneumonia. As a rule, antibiotic therapy for pneumonia is empirical, since the patient does not have time to wait for sensitivity culture results. Among the diversity antibacterial drugs allocate drugs of choice, reserve and alternative means. In every individual case the doctor recommends any drug from these groups. You can read more about antibiotics for pneumonia.
Pathogenic microorganisms resistant to exposure antimicrobials, determine a more severe and prolonged course of pneumonia. Resistance of microorganisms to many antibiotics is typical in nosocomial pneumonia, in people with immunodeficiency and in people who are often ill. The effectiveness of the drug is assessed by the doctor two to three days after the start of its use based on a decrease in temperature and improvement in well-being.
The minimum course of antibiotics is 7-10 days. Even if the patient’s condition improves, you cannot stop antimicrobial therapy earlier: untreated pneumonia can lead to serious complications; the disease must be cured completely.
To alleviate the patient's condition, it is also necessary symptomatic therapy. The patient is prescribed mucolytic and expectorant drugs to thin the mucus and facilitate expectoration. If the body temperature rises above 39 degrees, antipyretics are prescribed.
In order to recover as quickly as possible, the patient must observe bed rest, extended bed rest (in a hospital - ward) and free rest, depending on the severity of the disease.
Outpatients are allowed lungs physical exercise(if your health allows and the temperature remains within normal limits), you can perform exercises such as easy walking for 15 minutes, walking along the steps of the stairs, various exercises for all muscle groups in dosed volumes: arm raises while sitting and standing, leg raises and extensions while lying in bed, grasshopper push-ups, squats.
Inpatients with bed rest are recommended to limit physical activity, however, such patients can change their position in bed more often, get up periodically, and they are also shown light static exercises that affect small muscle groups, and special massage.
Inpatients with extended bed rest and free rest are recommended to carry out more vigorous exercise for a speedy recovery. They can be recommended to walk in place and walk around the ward, while the patient should gradually increase the load, including general tonic exercises for all muscle groups in his complex.
To maintain strength, patients with pneumonia are advised to eat easily digestible, but sufficiently high-calorie foods. It is necessary to exclude fatty, fried and spicy foods; the diet should contain enough protein and complex carbohydrates: You can have steamed meat dishes, cereals, vegetables, soups with meat, fruits.
The amount of fluid consumed should be at least two liters per day; it is recommended to drink frequently in a volume of approximately 200 ml.
It is imperative to unquestioningly comply with all the doctor’s instructions: take all prescribed medications by the hour, adhere to the recommended motor mode, diets, quit smoking and alcohol, do not refuse prescribed procedures. When treating pneumonia, high compliance is very important, that is, adherence to all the instructions of the attending physician; the outcome of treatment, especially the severe course of the disease, depends on this.
For patients with pneumonia, special physiotherapy is indicated: inhalation using a nebulizer or ultrasonic inhalers, electrophoresis, UHF therapy, magnetic therapy, UV irradiation of the chest, vibration and percussion massage of the chest can be used.
Breathing exercises
Special breathing exercises, which can be performed even in the acute course of the disease, will also help you recover quickly. A few simple exercises:
- The patient, relaxed as much as possible, lies on his back. Inhale slowly through the nose, hold the air in the lungs for three seconds and exhale slowly through tightly pursed lips for five seconds. Repeat 20 times.
- Lying on your back, stretch your arms along your body. Slowly raise your arms up - inhale. We lower our hands - exhale, do it four to six times.
- When inhaling, the patient rises from a lying position left leg, exhale - lowers. Repeat with right foot. The pace of the exercise is average.
Excellent breathing exercises is inflating a balloon, blowing air through a juice straw into a glass of water (bubbles are formed that children love to blow). Special techniques include breathing according to Buteyko and Strelnikova.
Primary control is carried out two to three days from the start of treatment. The main criteria at this moment will be a decrease in temperature and a decrease in the patient’s shortness of breath, a general improvement in well-being and a decrease in intoxication.
Seven days from the start of treatment is required general analysis blood to assess the effectiveness of therapy. X-ray control is performed on the fifth to seventh day (with normal effectiveness of the antibiotic and therapy in general), then on 10-14, and then depending on the dynamics of the disease.
How quickly a patient with pneumonia recovers depends on the joint efforts of both the doctor and the patient. When treating at home, the doctor also necessarily monitors the effectiveness of the prescribed therapy. At the end of the course, when symptoms are eliminated and good analyzes A gentle regime of work is recommended for the recovered: for several more weeks the body will be weakened and susceptible to infections.
Editor
Pulmonologist
Pneumococcal pneumonia is a typical variant (70-90% of all cases), which is caused by the bacterium Streptococcus pneumoniae (Streptococcus pneumoniae). This bacterium is a representative normal microflora humans and lives in the upper respiratory tract, where it is contained by the forces of local immunity.
When weakening immune defense In the body, the pathogen freely descends into the lower respiratory tract and causes disease. The favorite habitats of streptococcus are the pharynx, nose and throat.
ICD-10 code: J13 Pneumonia caused by Streptococcus pneumoniae (Streptococcus pneumoniae).
Mechanism of infection
As mentioned earlier, this bacterium is a representative of the normal microflora of most people. As a rule, almost 100% carriage of pneumococcus is observed in organized groups of children and adults. The source of infection is a sick person or a simple bacteria carrier. There are several ways of spreading infection:
- (most common during sneezing, coughing, talking);
- (if the contents of the nasopharynx enter the lower respiratory tract);
- hematogenous(spreads with the bloodstream from another source of infection).
If the patient took anti-inflammatory pills during the beginning of the incubation period for a completely different reason, for example, dental treatment, the symptoms of pneumococcal pneumonia will most likely appear later.
Stages of development
There are four pathological stages of development of pneumococcal pneumonia:
- Tide stage(12-72 hours) – at this stage, the bacteria actively multiply in the alveoli with the formation large quantity serous exudate and its spread through the pores in the alveolar sacs (Cohn's pores) throughout the lung tissue. In this case, there is a flow of blood to the lungs (lung plethora).
- Red liver stage(1-3 days) – the affected alveoli are completely filled with exudate, which contains a large amount of fibrin and red blood cells. At the same time, the affected area of the lung becomes dense and acquires a brown color (similar to the liver).
- Gray hepatization stage(2-6 days) - during this period, hemolysis (disintegration) of red blood cells and the release of a large number of leukocytes into the alveoli is observed, as a result of which the color of the affected area of the lung changes to gray.
- Resolution stage(can last for a very long time) – the alveoli are cleared of exudate and restore their structure and function.
Consecutive changes in pathological stages are not observed in all patients.
Symptoms of pneumococcal pneumonia
Pneumococcal pneumonia is characterized by sudden and acute onset. Most often it occurs in the form of lobar. It is characterized by four main syndromes: 
- intoxicating(sharp rise in temperature to 38-40 o C, headache, chills, muscle pain, weakness, loss of appetite);
- general inflammatory(fever, leukocytosis, increased ESR, changes in biochemical blood test);
- bronchopulmonary(cough, first dry, then with a large amount of sputum, shortness of breath, pneumococcus is detected in the sputum);
- pleural(local pain in the affected area, worsens with deep breath and cough).
Up to 10 to 5 CFU/ml of streptococci can be found on human mucous membranes and not cause an inflammatory process.
Diagnostics
Diagnosis starts with general examination and taking anamnesis. The patient complains of symptoms that bother him, and the doctor objectively assesses his condition. On auscultation it is heard hard breathing with fine bubbling rales or crepitus, you can also hear pleural friction noise (with dry pleurisy).
If in pleural cavity exudate has accumulated (exudate pleurisy, develops after dry pleurisy), then breath sounds will be attenuated or inaudible. During percussion, there is a dullness of sound over the affected area. One more characteristic feature there is a blush on the cheek (on the affected side).
After examination, the doctor prescribes additional research to clarify the diagnosis:
- X-ray examination (determine the source of inflammation) - pictures are taken in frontal and lateral projections;
- fluoroscopy;
- CT scan;
- Ultrasound of the pleura;
- general and biochemical tests blood (leukocytosis with a shift of the formula to the left, increased ESR, C-reactive protein, and so on.);
- sputum analysis for the presence of the pathogen and its sensitivity to antibiotics (Streptococcus pneumoniae is detected in sputum).
After all the research, the doctor made the final diagnosis. Treatment may be started before a full diagnosis is made.
Treatment
Streptococcal pneumonia, like other types of pneumonia, requires immediate treatment. Etiotropic (affecting the cause of the disease) therapy is, since only they kill the bacterium and lead to the cessation of its effect on the body.
Important! Antibiotic therapy should be started immediately after diagnosis.
Before determining sensitivity pathogenic microorganism to antibiotics ( empirical therapy) antibiotics are prescribed wide range actions:
- penicillins;
- cephalosporins 2-3 generations;
- macrolides;
- fluoroquinolones;
- aminoglycosides;
- carbapenems.
If there is no positive dynamics within 48 hours, the drug is replaced. After determining the sensitivity of the bacterium, treatment is adjusted based on the data obtained.
In addition, they are used in treatment, which are symptomatic or pathogenetic therapy and promote a speedy recovery:
- mucolytics and sputum expulsion agents(improves the drainage function of the bronchi and promotes their cleansing);
- nonsteroidal anti-inflammatory drugs(NSAIDs) - reduce temperature and reduce inflammation);
- immunomodulatory therapy ().
Also, in the treatment of pneumonia great importance has high quality and patient, which contributes to the restoration of the body.
After the patient’s condition improves, you can begin physical therapy and exercise therapy:
- inhalation;
- vibration massage;
- UHF therapy;
- breathing exercises.
All these procedures and exercises help improve mucociliary clearance (sputum discharge) and restore lung function.
Rehabilitation
Rehabilitation begins during treatment and includes:
- physiotherapy;
- therapeutic and breathing exercises;
- taking pro- and prebiotics (restoration of intestinal microflora after taking antibiotics);
- restorative therapy (vitamins);
- diet (proper and nutritious nutrition);
- Spa treatment.
Rehabilitation measures are necessary for speedy recovery respiratory function affected areas of the lung.
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Conclusion
Pneumococcal pneumonia is usually community-acquired, which means it responds well to treatment. Therefore, it is very important to consult a doctor in a timely manner for qualified help and not self-medicate, so as not to aggravate the situation. Treatment is most often carried out on an outpatient basis and after 7-10 days the patient will be completely healthy.
Pneumococcal pneumonia is an etiological type of bacterial pneumonia caused by pneumococci. The clinical picture of the disease is dominated by febrile intoxication and bronchopulmonary syndrome. Damage to the body pneumococcal infection can provoke meningitis and inflammation in the ENT organs. Severe pneumonia most likely leads to the development of dangerous diseases.
Pneumococcal inflammation is caused by gram-positive pneumococcal bacteria. Their sources are carriers or infected people. Carriage is typical for a quarter of the adult population and half of children attending educational institutions.
In addition, a high percentage of carriage is observed among medical workers, large manufacturing enterprises, and people living in camps or barracks. Most often, pathology caused by pneumococci affects children under five years of age and elderly people. In older people, this disease can be fatal. At risk are patients with chronic diseases of the liver, heart, lungs, immunodeficiency and after undergoing transplant surgery.
Infection occurs through contact or by airborne droplets. In cold weather, the probability of the latter increases several times. Factors that worsen prognosis for a diagnosis of pneumococcal pneumonia include:
- extensive lung damage;
- smoking;
- alcoholism;
- work in hazardous production;
- cardiovascular pathologies with stagnation in the pulmonary circulation;
- chronic diseases of the respiratory system;
- chronic fatigue;
- weak immunity;
- children under 2 years of age.
Clinical course
Pneumococcal pneumonia progresses very quickly, with incubation lasting only 1 to 3 days. The severity of symptoms depends on the size of the lesion and the form of inflammation:
- affects a small area, is easily tolerated with timely organization of therapy;
- affects a third of the organ - begins abruptly and is characterized by a severe course;
- lobar pneumococcal pneumonia - affects a lobe or several lobes of the lung - the most dangerous form.
- high body temperature up to 39 – 40 degrees;
- weakness, headaches, sleep disturbances and lack of appetite;
- shortness of breath, rapid pulse, profuse sweating and chills;
- dry cough, which gradually turns into wet cough mixed with pus;
- chest pain on the affected side.
The clinical picture develops in 4 stages:
1. Initial – characterized by the formation of edema and accumulation of exudate.
2. Red seal.
3. Brown seal.
4. Permissions.
Important! The child is characterized by a severe infection with severe intoxication, when hospitalization cannot be avoided.
Initial stage of pneumonia
Pneumococcal pneumonia begins acutely, sharply, and is accompanied by:
- temperature rise immediately to 38 - 40 degrees;
- chest pain;
- unproductive cough;
- one-time chill.
The initial period of the disease is 12 – 72 hours.
Red seal stage
This stage lasts about the same: 12 – 72 hours. At the same time, many red blood cells enter the lumen of the alveoli filled with exudate. Because of this, the exudate becomes airless and dense. Symptoms of the previous stage are supplemented by the following:
- increased breathing;
- dyspnea;
- productive cough;
- discharge of mucopurulent sputum with blood streaks;
- progressive symptoms of intoxication - weakness, muscle pain, aches all over the body and lack of appetite.
In addition to the alveoli, the pathology affects the pleura, mediastinum, The lymph nodes, interstitial tissue.
Brown compaction stage
This stage is the longest - it takes 2 - 7 days. It is characterized by penetration of leukocytes into the exudate. Red blood cells disintegrate and the color of the sputum changes. The symptoms are the same as at the previous stage.
Permission
This stage lasts no longer than 3 days. Subsidence occurs pathological processes in the body, the exudate is gradually absorbed under the influence of macrophages, reducing painful sensations and relieves attacks of shortness of breath.
Diagnostics
Diagnosis of pneumococcal pneumonia against the background of bacterial proliferation is difficult and requires thorough examination. For this purpose, laboratory, instrumental and clinical methods are organized.
Pneumococcal inflammation can only be detected by culture of sputum samples and subsequent accurate diagnosis of the pathogen.
Through auscultation, the doctor diagnoses wheezing, weakening and sometimes complete absence of pulmonary respiration at the site of maximum inflammation. Characteristic feature Crepitus is considered a pathology.
The x-ray shows darkening of the entire lobe in the lung. When diagnosing, computed spiral tomography visualizes atelectasis of varying volumes.
Treatment of pneumococcal pneumonia
After identifying the disease and its etiology, the doctor determines the need for hospitalization. Treatment in a hospital is carried out for children under 6 years of age and some other groups of patients with the following pathological conditions:
- concomitant chronic diseases;
- immunodeficiency;
- disturbances of consciousness;
- suspected aspiration of vomit or other liquid;
- severe tachycardia;
- state of shock;
- damage to 2 or more lobes of the lung;
- no result after antibiotic therapy for 3 days.
Therapy is organized comprehensively and necessarily includes the following methods:
- compliance with the treatment regimen;
- diet;
- taking antibiotics;
- pathogenetic treatment;
- relief of symptoms;
- treatment of concomitant pathologies and complications;
- phytotherapeutic procedures, exercise therapy and massages.
Regimen and nutrition for pneumococcal pneumonia
In case of fever, the patient must observe strict bed rest. The room must be ventilated, wet cleaning and quartzing are carried out as necessary.
Particular attention must be paid to the drinking regime - the patient needs to consume at least 3 liters of liquid per day. This will prevent dehydration caused by severe intoxication.
The diet should include fresh fruits, vegetables, proteins and easily digestible fats.
Antibiotic therapy for pneumococcal pneumonia
The method of administration of antibacterial drugs, the exact dose and duration of the course correspond to the severity of the lesion. Pneumococci are especially sensitive to the following drugs:
- from penicillins – Oxacillin, Ampicillin;
- from fluoroquinolones – Ciprofloxacin;
- from cephalosporins – Cefazolin, ;
- from carbapenems – Meropenem.
Pathogenetic therapy of pneumonia
Pathogenetic treatment corresponds to the severity of inflammation and the severity of symptoms. It includes the following groups of drugs:
- bronchodilators – Berodual, Atrovent;
- expectorants – Lazolvan;
- mucolytics – Mucaltin;
- antioxidants – vitamin E, multivitamin complexes, rutin, vitamin C;
- immunomodulators – Dekaris, Timalin;
- bronchodilators – Eufillin.
The main goal of pathogenetic treatment is to restore the functioning of the bronchi, because without removing the exudate, the recovery stage will not begin. If you have a non-productive cough, it must be converted into a wet cough.
Important! Antioxidant therapy no less important, since many free radicals that appear during inflammation damage the membrane of the alveoli and blood vessels.
Detoxification
Detoxification is the removal of various toxins from the body. It is carried out using an infusion of drugs - saline, hemodez, Ringer, lipoic acid, etc. At the same time, urinary control is realized. In case of severe intoxication, plasmapheresis and blood purification from toxins using sorbents are required.
Symptomatic treatment
Symptomatic therapy involves eliminating severe symptoms that provoke discomfort and pain. For this purpose the following are assigned:
- antitussive drugs for severe dry cough - Libexin, Codterpin;
- NSAIDs for chest pain, to reduce swelling of the interstitial tissue - Paracetamol, Aspirin;
- heart medications to normalize contractile functions cardiac muscle – Cordiamine, Camphor oil.
Non-drug treatment
Physiotherapy treatment methods are prescribed during the recovery stage. This helps speed up the resorption of exudate, restore microcirculation and activate immune functions. To the very effective procedures relate:
- aeroionotherapy;
- inhalation; with Bioparox;
- electrophoresis with magnesium sulfate or calcium chloride;
- UHF, microwave;
- inductothermy;
- mud, paraffin applications;
- acupuncture.
Exercise therapy is allowed 2–3 days after normalization temperature regime. Classes restore vital capacity lungs, normalize ventilation and drainage of the bronchi, restore microcirculation.
Massage is allowed at any stage of the disease, but its techniques will differ. For this reason, only a professional should carry out manipulations. Massage restores bronchial drainage and microcirculation in the lung tissue.
Pneumococcal pneumonia – dangerous disease, which without the necessary correct treatment can be fatal. Children and elderly people with various chronic disorders in the body are susceptible to the development of pathology. Already at the first symptoms you need to contact a specialist; delay provokes complications.
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