Polysegmental Pneumonia: Right-sided And Left-sided, Treatment

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Polysegmental pneumonia: right-sided and left-sided, causes of development, treatment

The content of the article:

What is polysegmental pneumonia
Causes of development and predisposing factors
Symptoms of polysegmental pneumonia in adults and children
Diagnostics
Treatment
1. Features of the treatment of community-acquired pneumonia
  1. Patients under 60 years of age without concomitant pathologies
  2. Elderly patients and patients with concomitant diseases
2. Hospital pneumonia therapy
3. Treatment of patients with severe immunodeficiency
4. How the effectiveness of treatment is assessed
Possible complications
Video

Polysegmental pneumonia is one of the extended forms of the disease, in which more than one segment of the lung is involved in the pathological process.

If symptoms of pneumonia appear, you need to see a doctor to make a correct diagnosis.

The main danger is the high risk of an expansive spread of inflammation with the likelihood of developing extensive damage to the lung structures, therefore, its timely recognition and adequate treatment are an urgent task of pulmonology and pediatrics.

Pneumonia is an acute infectious disease of the pulmonary parenchyma, which is diagnosed by physical findings and / or a syndrome of respiratory disorders, as well as on the basis of infiltrative changes on the radiograph. The incidence in adults and children in the Russian Federation averages 400–500 and 700–800 cases in 100,000 population, respectively.

What is polysegmental pneumonia

The polysegmental form of pneumonia is a delimited inflammation and covers the lung tissue within the boundaries of several anatomical segments of one or two lungs (unilateral and bilateral pneumonia). Most often, the disease affects preschool children (from 3 to 7 years old), but the pathology also occurs in older children and adults.

How is the polysegmental form different from other forms of pneumonia?

Form of pneumonia	Distinctive features
Focal	The process involves one or more foci of infiltration up to 2 cm in size
Focal drainage	It is characterized by heterogeneous massive infiltration, consisting of several foci
Segmental	Process limited to one anatomical segment of lung tissue
Lobar	Inflammation develops in the lobe of the lung
Interstitial	The disease is characterized by pronounced changes in the interstitium of the lungs (usually in patients with immunodeficiency)

Polysegmental pneumonia can be:

unilateral (right-sided or left-sided): inflammation can occur in separate segments of different lobes of the same lung, occurs in 95% of cases of this type of pathology;
bilateral: segments in different lobes of both lungs are affected.

The following types of pneumonia are also distinguished:

primary: arises as an independent disease;
secondary: develops against the background of an acute respiratory viral infection.

Causes of development and predisposing factors

In primary pneumonia, the causative agents in most cases are pneumococci, Haemophilus influenzae, pyogenic streptococcus, staphylococcus. It is also possible to be affected by several bacterial agents at once. Of the atypical pathogens, mycoplasma, chlamydia, legionella can lead to the development of polysegmental pneumonia.

In most cases, pneumococci lead to the development of pneumonia.

Pathogens most often penetrate through the bronchogenic route: by inhaling microbes, moving them from the upper respiratory system against the background of infectious diseases, or during medical procedures (for example, with artificial ventilation, bronchoscopy, inhalation).

After the introduction of the pathogen, it is fixed and multiplied in the epithelium of the respiratory bronchioles. Pneumonia develops when microorganisms spread outside the respiratory bronchioles.

Due to the anatomical features of the structure of the lungs, the most affected are:

right lung: II, VI, X segments;
left lung: VI, VIII, IX, X segments.

The predisposing factors for the development of the disease include:

viral upper respiratory tract infections;
obstruction of the bronchial tree;
congestive heart failure;
industrial air pollution;
chest trauma;
postoperative period;
state after stress;
smoking;
exhausting, long-term diseases;
old age.

The disease usually occurs in children with manifestations of exudative-catarrhal diathesis and with a tendency to hyperergic reactions.

Symptoms of polysegmental pneumonia in adults and children

Symptoms of the disease appear acutely: body temperature rises sharply to 39 ° C, a pronounced intoxication syndrome appears (in the form of weakness, sweating, adynamia, body aches, headache), tachycardia, tachypnea.

The polysegmental form of pneumonia is characterized by a sharp increase in body temperature

Children may develop confusion and seizures. After a few days, other signs of pneumonia appear: an abrupt rare cough, pain in the epigastric region and chest. Respiratory failure develops rapidly.

As a rule, the affected pulmonary segments are in a state of atelectasis, pneumonia can be delayed for 2-3 months and acquire a torpid course. Unresolved acute segmental pneumonia can lead to the development of a polysegmental and chronic form of the disease.

The accumulation of viral and bacterial toxins in tissues and blood has a damaging effect mainly on the cardiovascular and central nervous system, causing toxic consequences: cardiovascular syndrome, arterial hypotension, acute heart failure, collapse.

Diagnostics

Determination of the pathogen plays an important role in determining the type of pneumonia. In practice, the doctor almost always prescribes antibiotic therapy to the patient, not being able to verify the infection in the first illness. Therefore, the diagnosis is made on the basis of clinical and epidemiological data, taking into account the etiological structure of modern pneumonia.

When making a diagnosis, it is usually carried out:

general blood analysis;
chest x-ray in two projections;
determination of sensitivity to antibiotics;
bacteriological examination of sputum (culture on media);
identification of pathogens by a quantitative method in diagnostically significant titers (from 10 ⁶ microbial cells in 1 ml of sputum).

In many cases, it is not possible to establish the etiology of the pathogen. This is due to various reasons:

improper collection of material;
lack of microbial testing;
carrying out antibiotic therapy before taking the material;
use of an inadequate treatment method.

The complexity of timely diagnosis is often associated with late visits by patients to a doctor. There is also the problem of differential diagnosis between influenza and pneumonia.

Often the disease cannot be diagnosed on time due to late visits to the doctor

During an epidemic, flu, an acute respiratory infection, is mistakenly diagnosed. In most cases, this is noted at the polyclinic stage. In the hospital, pneumonia is often not diagnosed that occurs against the background of various severe concomitant diseases: chronic obstructive pulmonary disease, cerebrovascular, cardiovascular, oncological diseases, as well as in elderly and debilitated patients.

Treatment

Features of the treatment of community-acquired pneumonia

Outpatients requiring treatment for community-acquired pneumonia can be conditionally divided into two groups.

Patients under 60 years of age without concomitant pathologies

The first group includes patients under 60 years of age who do not have concomitant pathologies. In most cases, an adequate response to antibiotic therapy can be obtained with the use of oral agents.

Antibiotics are prescribed to treat pneumonia

The drugs of choice are macrolide antibiotics or amoxicillin. The macrolide group is usually given preference against the background of β-lactam intolerance or if there is a suspicion of an atypical etiology of the disease (chlamydia, mycoplasma). Fluoroquinolones are prescribed as alternatives.

Elderly patients and patients with concomitant diseases

The second group includes elderly patients and / or patients with concomitant diseases that affect the etiology of the disease and are risk factors for a poor prognosis. These include:

chronic obstructive pulmonary disease;
cirrhosis of the liver;
diabetes;
chronic renal failure;
congestive heart failure;
alcoholism, drug addiction;
underweight.

An adequate clinical effect in patients of this group can also be obtained with the use of oral antibiotics. The probability of the etiological role of gram-negative bacteria in patients with comorbidities is higher, therefore, amoxicillin / clavulanate is recommended as the drug of choice.

In connection with a possible chlamydial etiology, such patients may be prescribed combination therapy with macrolides and β-lactams; an alternative may be the use of respiratory fluoroquinolones (levofloxacin, moxifloxacin).

Hospital pneumonia therapy

Patients diagnosed with hospital-acquired pneumonia, with severe pathology, are shown parenteral administration of broad-spectrum antibiotics that maximally overlap the gram-positive and gram-negative putative flora: fluoroquinolones, cephalosporins of III-IV generations, carbapenems.

In hospital pneumonia, parenteral antibiotics are indicated

Treatment of patients with severe immunodeficiency

With severe immunodeficiency, decompensation of concomitant diseases, combined antimicrobial therapy may also be required - a combination of aminoglycosides and cephalosporins (synergistic effect against Pseudomonas aeruginosa) or macrolides (in the presence of suspicion of legionella pneumonia).

How the effectiveness of treatment is assessed

The main criteria for the adequacy of the treatment:

decrease in body temperature to <37.5 ° C;
absence of intoxication of the body, purulent sputum, respiratory failure (with a respiratory rate of up to 20 / min), negative dynamics on the roentgenogram;
normalization of blood counts: leukocyte count <10x10 ⁹ / l, neutrophils <80%, young forms <6%.

During the recovery period, drug treatment can be supplemented with physiotherapeutic methods: ultra-high-frequency therapy (UHF), inductothermia, drug electrophoresis, ultraviolet radiation (UFO) on the chest. In order to improve the drainage of the bronchial tree, breathing exercises, vibration massage, chest massage are prescribed.