Why is pneumonia dangerous?

Pneumonia is an acute infectious inflammation of the lungs that can be observed in patients of different ages and is a combination of pathological processes developing in the lung tissue.

Short information about pneumonia

Classification

Currently, there is a wide variety of different classifications of pneumonia, based on etiology, clinical and pathomorphological signs, course of the disease, clinical picture, and the like.

Depending on the location of the pathological process, foci are considered, polysegmental, partial, lower part, right-sided or left-sided pneumonia. The damage of the lung tissue can be unilateral and bilateral. Bacterial, viral, lobar pneumonia indicate the cause of the development of the pathological process.

Today, there are such forms of pneumonia distinguished:

- Community acquired (outside the hospital);
- Hospital-acquired;
- Developed against the background of immunodeficiency states;
- Typical and atypical pneumonia.

It is possible to divide diseases into primary (acquired by the patient before going to the doctor) and secondary (developed as complications against the background of complex surgical treatment, stay on artificial lung ventilation, or underwent aggressive therapy).

Of great importance is the division of pneumonia according to the complexity of the course of the process, which makes it possible to single out patients who need intensive treatment.

Etiology and pathogenesis

The development of pneumonia is very often preceded by the ingestion of gram-negative and opportunistic microflora, pneumocystosis, cytomegalovirus, nocardia, and fungi (in particular, aspergillus). In the occurrence of community-acquired pneumonia, the leading role is played by pneumococci, streptococci, staphylococci, Haemophilus influenzae. Atypical pathogens are mycoplasmas, legionella, chlamydia.

An important role in the pathogenesis of pneumonia is played by a decrease in the immunity of the primary and secondary type. This category includes patients with various types of neoplasms, autoimmune pathologies, patients receiving radiation and/or chemotherapy, immunosuppressive therapy.

Risk factors play an important role in the development of pneumonia:

- Chronic obstructive pulmonary disease;
- Diseases of the heart and circulatory system;
- Dysfunction of the digestive tract;
- Abuse of sleeping pills;
- Epilepsy;
- Brain injury;
- Alcohol intoxication;
- Smoking;
- Excess of the permissible dose of anesthesia, narcotic drugs.

In all of these cases, aspiration of the contents of the oropharynx and the digestive tract, which contains a large amount of various microflora, can occur.

The likelihood of developing the disease is increased by a sharp cold snap in warm weather, cold seasons, old age, and the postoperative period. Often, pneumonia develops in patients who are on mechanical ventilation for more than 24 hours.
Viral infections play a significant role in the development of pneumonia. Pneumonia develops against the background of lack of proper treatment for infection with parainfluenza, influenza A, B, C, adenoviruses, coronaviruses, etc. The causes of pneumonia may be due to close contact with birds and rodents.

Currently, there are 4 pathological mechanisms that cause the development of pneumonia:

- Absorption of nasopharyngeal secretions (one of the main factors in the appearance of pneumonia);
- Inhalation of air containing the pathogen (for example, when being with a sick person in the same room);
- Spread by blood transport of pathogenic microorganisms from the extrapulmonary focus of infection;
- The passage of the pathogen from infected neighboring organs, as well as infection from the outside through penetrating wounds of the chest.

Clinical manifestations

The symptoms of pneumonia largely depend on the nature of the pathogen and the state of the patient's body at the time of infection. Pneumonia is characterized by a varying combination of bronchopulmonary and extrapulmonary symptoms.

Pneumonia symptoms:

- Cough;
- Difficulty breathing and shortness of breath;
- Chest pain;
- Low pressure;
- Tachycardia;
- General weakness;
- Muscle pain;
- Fever;
- Confusion of consciousness;
- Symptoms of meningitis;
- Discharge of sputum (mucous, mucopurulent, rarely - blood consistency).

On physical examination, dullness of percussion sound, weakening of vesicular and bronchial breathing, crepitus, pleural friction noise are determined.

The severity of the disease can be judged by the following symptoms of pneumonia as: the degree of respiratory failure, the severity of the phenomena of intoxication, decompensation of concomitant diseases and the presence of complications.

Complications

Adverse consequences of pneumonia are observed not only in the damage to the respiratory system and damage to the lung tissue, but also in the damage to other organs and systems.

Such complications often develop as:

- Scars on the lungs;
- Parapneumonic pleurisy;
- Purulent pleurisy;
- Lung abscess;
- Purulent decay of the lung parenchyma;
- Acute respiratory failure;
- Pulmonary edema;
- Septic shock;
- Multiple organ failure;
- Atelectasis (lung collapse);
- Meningitis;
- Brain and liver abscesses;
- Heart pathology;
- Kidney inflammation;
- Acute pulmonary edema with diffuse infiltration, etc.

Pneumonia is a very dangerous disease. In case of untimely treatment, the consequences of pneumonia can lead to serious complications and even death.

Diagnostics

An obligatory step in the diagnosis of pneumonia is to establish the etiology of the development of inflammation according to clinical and epidemiological data.

Diagnosis of pneumonia requires a number of laboratory tests:

- Biochemical analysis;
- Studies of the level of C-reactive protein;
- Coagulogram;
- Gram staining of sputum;
- Bacterioscopy;
- Sputum culture;
- Blood culture;
- PCR diagnostics;
- Qualitative and quantitative determination of blood composition;
- Determination of antibodies to antigens of various pathogens in blood serum;
- Microbiological examination of pleural fluid;
- Blood gas;
- Rapid tests to detect pneumococcal and legionella antigenuria.

An important role in the diagnosis is played by instrumental diagnostics: X-ray of the lungs, fibrobronchoscopy, computed tomography, pulse oximetry, transthoracic ultrasound of the chest cavity, ECG.

When making a diagnosis, a pulmonologist must exclude the likelihood of similar symptoms of diseases: pulmonary embolism, chronic nonspecific lung diseases, viral infections, tuberculosis, cancer, interstitial lung diseases, heart attack and bruises of the lungs, heart and vascular diseases and other pathologies.

Treatment

Treatment of pneumonia involves monitoring the patient in a hospital setting. Such therapy is especially important for patients with a severe course of the disease, with suspicion of complications, if signs of pneumonia indicate bilateral damage, with serious concomitant diseases. Children and elderly patients are subject to compulsory hospitalization.

Treatment of pneumonia should be started as soon as the patient is admitted. The basis of therapeutic measures is a course of antibacterial drugs (for instance, Cefaclor), taking into account the sensitivity of the pathogen. Upon receipt of bacteriological data, the diagnosis of treatment is corrected taking into account etiotropic data and in case of insufficient effectiveness of the therapy.

When choosing antibacterial drugs, the type of pathogen, the severity of the disease, possible contraindications, and allergic history are taken into account.

Treatments may include:

- Antiviral therapy;
- Antibacterial therapy;
- Respiratory support;
- Extracorporeal membrane oxygenation;
- The appointment of immunoglobulins, immunostimulants, corticosteroids, mucoactive agents.
- Healing control.

As a rule, recovery occurs within 4 weeks. The clinical criterion for recovery is considered to be the normalization of the patient's physical condition, the disappearance of foci of inflammation during X-ray and external examination, and the return to normal blood composition indicators.

However, sometimes the dynamics of the clinical manifestations of recovery does not correspond to the X-ray picture. Complete regeneration of the lung parenchyma may take up to 6 months. During this period, the patient should be under the supervision of a physician and regularly visit a pulmonologist.

Prevention and vaccination

The most effective prevention of pneumonia is pneumococcal and influenza vaccination. Pediatricians recommend vaccinating children against pneumococcal infection, starting at six weeks of age. Modern drugs are designed for the vaccination of adult patients. Belgian, French and American pneumococcal vaccines are easily tolerated and do not cause complications.

Important preventive measures are:

- Strengthening immunity;
- Leading an active, healthy lifestyle;
- Physical activity;
- Rational and nutritious food;
- Adequate treatment of viral diseases and bacterial infections;
- Keeping your home clean.

Post by: John Johansson, M.D., Amsterdam, Netherlands