Bacterial pneumonia: what is it, symptoms, treatment, prevention
The content of the article:
-
How does pneumonia develop
- Etiology
- Pathogenesis
- Classification
- Bacterial pneumonia symptoms
- Diagnostics
-
Treatment
- General principles
- Antibiotic therapy
- Additional therapies
- Evaluation of the effectiveness of treatment
- Complications
- Prevention
- Video
Bacterial pneumonia is one of the most common and dangerous diseases. It proceeds with a pronounced inflammatory reaction and, if inadequate treatment, can be fatal.
The development of the disease is associated with the penetration of bacteria into the lung tissue
This infectious pathology is based on an acute inflammatory process in the lung tissue caused by a microbial agent. The disease occurs in all age groups of the population.
How does pneumonia develop
Etiology
Pneumonia is caused by bacteria of different types, therefore, the clinical manifestations and severity of the course of the disease are quite diverse. The following bacteria can cause pneumonia:
- pneumococci;
- haemophilus influenzae;
- Staphylococcus aureus;
- pyogenic streptococcus;
- enterococci;
- legionella.
A large number of cases of severe pneumonia caused by a bacterial or mixed viral-bacterial infection are recorded annually.
One of the possible causative agents of the disease is legionella
To a large extent, this is due to the uncontrolled intake of antibacterial drugs, which are freely available in pharmacies, which leads to an increase in the antibiotic resistance of pathogens.
Also, the disease became widespread due to the increase in the population with weakened immunity against the background of concomitant severe chronic diseases.
The lungs are most often affected in patients with alcoholism, diabetes mellitus, HIV infection, hepatitis, bronchiectasis, cancer, cardiovascular insufficiency. This group of patients accounts for about 20% of the total number of pneumonia.
Pathogenesis
The pathogenic microorganism penetrates from the environment into the lower respiratory tract through the bronchi together with the inhaled air or secretions of the oral cavity and nasopharynx contaminated with bacteria.
Bacteria from inflammatory foci can spread through the blood or lymph
Also, the infection can spread from acute or chronic foci of inflammation through the lymph or blood. Hematogenous dissemination of the causative agent of pneumonia occurs from an extrapulmonary focus (retropharyngeal abscess, infective endocarditis) or from traumatized and postoperative areas.
A certain role is played by the virulence of the pathogen, the state of local and general immunity.
Classification
The following types of pneumonia are distinguished:
- community-acquired: acquired outside a medical institution;
- nosocomial, or nosocomial: acquired in a medical institution;
- aspiration pneumonia;
- pneumonia in persons with severe immunosuppression: congenital immunodeficiency, HIV infection, iatrogenic immunosuppression.
Bacterial pneumonia symptoms
Most people with bacterial pneumonia have the following symptoms:
| Symptoms | Features of manifestation |
| Cough | At first, the cough is unproductive, then with a lot of sputum |
| Excretion of sputum | May be rusty |
| Fever, chills | The body temperature rises to 38 ° C and higher, resulting in chills. It is also possible to lower blood pressure, the occurrence of tachycardia |
| Central nervous system disorders | Manifested as lethargy, confusion, fainting, sleep disturbance, severe night sweats |
| Dyspnea | It manifests itself as increased frequency and difficulty in breathing |
| Chest pain | Usually worse with inspiration, but can also occur at rest |
| Intoxication symptoms |
Manifest as general weakness, dizziness |
Signs of decompensation of underlying diseases may appear. Patients with cardiovascular pathology may develop arrhythmias, pain in the heart.
In SARS caused by intracellular bacteria, symptoms may include fever, nonproductive cough, runny nose, systemic manifestations of myalgia, headache, chills, and shortness of breath. Symptoms of general intoxication are possible: nausea, vomiting, diarrhea.
Diagnostics
If pneumonia is suspected, the doctor conducts an objective examination of the patient and prescribes laboratory and instrumental research methods: a clinical blood test, a chest X-ray.
A chest x-ray is taken to confirm the diagnosis.
On examination, attention is drawn to the pallor of the skin, increased respiratory movements. With bacterial pneumonia, the patient listens to:
- bronchial breathing;
- increased bronchophonia;
- crepitus;
- local moist rales.
X-ray examination confirms the presence of damage to the lung tissue in the form of focal infiltration of any segment or lobe of the lung. Pleural effusion is common. In severe cases, there is a need for pleural puncture.
Clinical and biochemical blood tests are of great diagnostic importance.
In laboratory studies, the following violations are determined:
- leukocytosis;
- neutrophilia;
- accelerated ESR (erythrocyte sedimentation rate);
- high levels of C-reactive protein.
According to the indications, a biochemical blood test is performed, which does not provide specific information, but may indicate damage to other organs, which affects the tactics of therapy and prognosis.
In the diagnosis of the severity of respiratory failure, pulse oximetry, determination of gases and the acid-base state of the blood are important.
The separated sputum is sent for bacteriological examination, which allows you to determine the type of pathogen and its sensitivity to antibiotics.
Treatment
General principles
Treatment of pneumonia can be carried out in a hospital or at home (with a mild form of the disease and following all the doctor's recommendations).
According to indications, the patient can be hospitalized in a hospital
Hospitalization of patients is carried out in case of moderate and severe forms, as well as in the presence of concomitant chronic diseases, ineffectiveness of outpatient treatment for three days. Patients over 70 years old and pregnant women are subject to hospitalization.
Treatment for pneumonia should be started as early as possible. Therapy should be comprehensive and include broad-spectrum antibiotics.
Antibiotic therapy
Bacterial pneumonia in a patient who has not been in the hospital for three or more months often has an out-of-hospital flora as a bacterial cause. For this category of patients, amoxicillin is prescribed in combination with clavulanic acid or sulbactam, cephalosporins without antipseudomonal activity, fluoroquinolones. Clarithromycin may be used.
The widespread availability and availability of antibacterial drugs has led to the development of resistance to many pathogens. The identification of such strains in the inoculation complicates the tactics of treating the patient and requires an integrated approach to therapy.
In order to prevent the development of many side effects from the wrong choice of medication and not to provoke the appearance of antibiotic resistance, it is very important to consult a doctor in a timely manner. The specialist will be able not only to choose the right drug, but also to determine its dosage, regimen, and timing of administration.
The resistance of many pathogens to antibiotics is associated with their uncontrolled use
Self-treatment with antibiotics is unacceptable. This can be dangerous to health, since inadequate therapy hides some of the symptoms of the disease without eliminating the cause, as a result of which infectious and somatic complications of pneumonia develop.
Additional therapies
Simultaneously with antibiotics, the doctor prescribes drugs for symptomatic and pathogenetic therapy, which lower body temperature, replenish the water-salt balance, relieve pain syndrome, and prevent possible side effects of antibiotics.
So, patients receiving antibiotic therapy are prescribed preparations of bifidobacteria and lactobacilli (Linex, Bifidumbacterin, Acipol) inside, which is the prevention of the development of intestinal dysbiosis.
With the development of respiratory failure, oxygen therapy is performed
In order to improve the discharge of viscous sputum, broncho- and mucolytic agents are prescribed. Omeprazole is recommended to prevent the development of stress damage to the stomach. With the development of respiratory failure, oxygen therapy is necessary.
Evaluation of the effectiveness of treatment
Three days after the start of the main treatment, the specialist evaluates its effectiveness. The criteria for the adequacy of antibacterial treatment are:
- a decrease in body temperature to subfebrile numbers (within 37.1-38.0 ° C);
- reduction of respiratory symptoms (cough, shortness of breath, sputum production) and intoxication (general weakness, dizziness, chills, muscle and joint pain, loss of appetite, poor sleep);
- decrease in leukocytosis;
- lack of negative dynamics in X-ray examination.
Persistent subfebrile condition, dry cough, weakness and persistence of residual changes on the x-ray may be present for a long time, but the clinical picture as a whole should change for the better already on the third day after the start of taking the antibacterial drug. Otherwise, the attending physician decides to change the antibiotic.
Complications
Bacterial damage to the lungs can lead to various complications:
- purulent pleurisy;
- lung abscess;
- gangrene of the lung;
- myocarditis;
- glomerulonephritis;
- meningitis;
- respiratory distress syndrome;
- infectious toxic shock;
- sepsis.
Prevention
Preventive measures to prevent the development of pneumonia include timely treatment of inflammatory and non-inflammatory diseases of the respiratory system.
In order to exclude the contact route of transmission of infection, it is important to observe the rules of personal hygiene.
The infection often enters the body through household contact, therefore, adherence to the rules of personal hygiene plays an important role in preventing the onset of the disease.
Other activities:
- quitting bad habits, in particular smoking;
- doing regular exercise;
- annual flu vaccination;
- adherence to the principles of healthy eating;
- maintaining remission of somatic diseases that reduce the overall resistance of the body;
- exclusion of self-medication in the event of influenza and timely referral to a specialist for qualified medical care.
Video
We offer for viewing a video on the topic of the article.
Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
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