Bacterial pneumonia - Respiratory microbial infection of the lungs, which flows to the development intraalveolar exudation and inflammatory infiltration of the lung parenchyma. Bacterial pneumonia is accompanied by fever, malaise, headache, cough with mucopurulent or rusty sputum, shortness of breath, chest pain, myalgia and arthralgia, pulmonary insufficiency. The diagnosis of bacterial pneumonia is based on physical examination, X-ray light, general and biochemical blood tests, sputum microscopy and culture. The basis of the treatment of bacterial pneumonia is causal antibiotic therapy.
Pneumonia - an acute infectious inflammation of the lung tissue caused by a pathogenic microbial flora and characterized by frenetic development, intoxication syndrome and respiratory failure. Among other etiological forms of pneumonia (viral, parasitic, fungal, and so forth.), Bacterial pneumonia confidently hold the first place. Annually bacterial pneumonia sick about 1000 people per 100 thousand. Population. The most vulnerable population - children under 5 years of age and older people after 75 years. In pulmonology problem of bacterial pneumonia focuses on attention due to the steady increase in the incidence of morbidity and mortality levels.
alopecia (bronchopneumonia) and severally (lobar, lobar) bacterial pneumonia. In the form of focal inflammatory changes affect some parts of the lung tissue and adjacent bronchi; at equity - an entire lobe of the lung parenchyma. Most often affects the lower parts of the lungs.
There may be a one-sided and two-sided bacterial pneumonia, pleural lesions, while developing pleuropneumonia.
The classification of nosological forms of disease based on the types of infectious agents, according to which the distinction pneumococcal, staphylococcal, streptococcal, meningococcal pneumonia and pneumonia caused by Haemophilus influenzae, Klebsiella, E. coli, Pseudomonas aeruginosa, Legionella and others.
According to clinical and pathogenetic criteria for bacterial pneumonia may have the character of outpatient (ambulatory) or nosocomial (hospital, nosocomial) infections with symptoms developing after 48-72 hours after the patient's room in the hospital. Bacterial pneumonia can be mild, moderate, severe and protracted course.
anthrax, gonorrhea, salmonellosis, tularemia, typhoid fever, whooping cough) causes pneumonia might be representatives of specific microorganisms. When immunodeficient states bacterial agents often act pneumococcus, Legionella and Haemophilus influenzae.
Pathogenic microorganisms can penetrate the lung tissue by direct, airborne and hematogenous route. Patients with neurological symptoms and disturbance of consciousness is often observed aspiration of secretions of the mouth and throat, contaminated with bacteria. Hematogenous dissemination of bacterial pneumonia pathogen occurs through the blood of extrapulmonary focus (in infective endocarditis, retropharyngeal abscess). The infection can enter the lungs when the chest wounds, intubation of the trachea from the surrounding tissues in the breakout postdiafragmalnogo abscess and so on. D.
The pathogenesis of bacterial pneumonia is not only determining the virulence of the pathogen and the mechanism of penetration but also the level of local and general immunity. By the development of bacterial pneumonia predispose SARS, smoking, alcohol consumption, frequent stress, fatigue, vitamin deficiencies, older age, air pollution. Reduced immune protection occurs when comorbidity: congestive heart failure, congenital bronchopulmonary system, COPD, chronic upper respiratory infections, immunodeficiency, severe and prolonged diseases occurring; due to surgery and prolonged immobilization.
Bacterial pneumonias tend to damage the airways with inflammatory infiltration of lung parenchyma; syndrome of irritation of the pleura, and pleural effusion. Perhaps the formation of foci of necrosis of lung tissue from the cavity formation is complicated by necrotizing pneumonia and lung abscess.
arthralgia, and loss of appetite. Often revealed sinus tachycardia, arrhythmia, hypotension. May develop signs of respiratory, cardiac and renal failure.
For staphylococcal pneumonia is characterized by a rapid start, jump in temperature to 40 ° C with recurrent fever, general grave condition associated with the destruction of the lungs, the emergence of foci of necrosis, cavities, abscess of the lung tissue. Fridlenderovskaya resembles pneumonia lobar pneumonia, has a protracted course and is accompanied by fever (39-40 ° C), persistent cough, the release of a viscous brown phlegm with an unpleasant odor, general intoxication, the rapid development of extensive necrosis of lung tissue, single abscesses, pleurisy, pulmonary infarction, septic complications. Heavily flowing pneumonia caused by Pseudomonas aeruginosa, is characterized by a high level of mortality. In pneumococcal pneumonia, necrosis and abscess formation is rare.
Atypical forms of bacterial pneumonia occur when infected lung anaerobic oral Legionella. Their feature is the gradual development of symptoms, the dominance of extrapulmonary manifestations. For example, Legionella pneumonia is accompanied by neurological symptoms, liver dysfunction, diarrhea. Older persons bacterial pneumonia characterized by a prolonged course with long-term low-grade fever, marked malaise, dyspnea, exacerbation of concomitant diseases, central nervous system dysfunction.
Complications of bacterial pneumonia can be purulent processes in the lungs (abscesses, gangrene of the lung), pleural empyema, purulent pleural effusion, respiratory distress syndrome, myocarditis, glomerulonephritis, meningitis, toxic shock, sepsis.
Radiography of the lungs in direct and lateral projections determines the presence, location and extent of inflammation sites and destruction of lung tissue, the presence of pleural effusion. Install a potential causative agent of bacterial pneumonia helps microscopy and culture sputum and bronchial tubes wash water.
If shortness of breath and chronic obstructive pulmonary disease studied FMR, with severe complications during bacterial pneumonia investigated arterial blood gas to assess the level of hypoxemia and hypercapnia, oxygen saturation of Hb. Additionally performed blood cultures for sterility analysis of pleural effusion, ELISA.
Spiral CT and MRI can be easily applied in the differential diagnosis. When diagnosing bacterial pneumonia want to exclude infiltrative tuberculosis, lung cancer, pulmonary infarction, eosinophilic infiltration, congestive heart failure, pulmonary atelectasis.
aspiration and nosocomial bacterial pneumonia are additionally used fluoroquinolones, carbapenems, combined with aminoglycosides, lincosamides and metronidazole.
In complicated cases, a detoxification and immunotherapy, correction of microcirculatory disorders and dysproteinemia, oxygen. Can be administered antipyretics, analgesics, glucocorticoids, cardiac medications. Patients with broncho-obstructive pathology shows aerosol with broncho and mucolytics. When abscess formation is conducted remedial bronchoscopy with antiseptic solutions, antibiotics, mucolytics. Recommended breathing exercises, massage, physiotherapy. Displaying therapist observation and pulmonologist, a spa treatment.
Forecast bacterial pneumonia caused by the weight of the process, the adequacy of antibiotic therapy. Mortality in bacterial pneumonia reaches 9% (with nosocomial form - 20% in elderly patients - 30%, in complicated cases - up to 50%).