Prolonged pneumonia: causes, symptoms, diagnosis, treatment

Prolonged pneumonia is an inflammatory process in the lungs that begins acutely, but is resolved over a period of more than 4 weeks. Unlike chronic pneumonia, prolonged pneumonia necessarily ends in recovery.

Pathogenesis of lingering pneumonia. The leading role belongs to violations in the system of local bronchopulmonary protection and the reactivity of the organism: a decrease in the function of T and B lymphocytes, a decrease in the synthesis of IgA in the bronchopulmonary system, suppression of the complement system, inhibition of phagocytosis, dysfunction of alveolar macrophages, which reduces the anti-infection protection of the macroorganism and promotes prolonged flow . A certain role is played by the violation of the glucocorticoid function of the adrenal glands.

Diagnostic criteria for prolonged pneumonia:

1. pneumonia, lasting more than 4 weeks;
2. radiological focal and peribronchial infiltration of segmental localization, which does not disappear within 4 weeks;
3. local segmental bronchitis, which is determined by bronchoscopy;
4. preservation of laboratory signs of the inflammatory process: leukocytosis, increased ESR, increased blood levels of sialic acids, fibrin, seromucoid;
5. immunological disorders - increase in IgA blood levels and decrease in IgM, C4, C3 and C9 components and total hemolytic activity of complement, an increase in activity of suppressor T-lymphocytes, a decrease in T-lymphocyte helper and killer;
6. in contrast to chronic pneumonia - mandatory recovery (clinical, radiologic and laboratory), the timing is individual (up to 3 months according to Heglin, according to other sources - up to a year or longer).

Treatment of lingering pneumonia

Prolonged pneumonia is pneumonia, in which the resolution of the acute inflammatory process in the lung occurs not in the usual time, but occurs slowly, for 4 weeks or more, but usually ends in recovery. Acute pneumonia takes a prolonged course in approximately 30% of cases.

When starting treatment of a patient with acute pneumonia, we must remember that the development of protracted pneumonia is facilitated by the following factors:

• untimely and incorrect treatment of acute pneumonia;
• premature termination of treatment and discharge of the patient with acute pneumonia;
• insufficient volume of rehabilitation measures;
• smoking and alcohol abuse;
• severe chronic obstructive bronchitis;
• violation of nasal breathing and frequent recurrences of nasopharyngeal infection;
• associated diseases, weakening the reactivity of the body (diabetes mellitus, etc.);
• superinfection;
• old age of the patient.

The curative program for prolonged pneumonia is generally similar to the program outlined in "Treatment of acute pneumonia." However, it is necessary to take into account some features of therapy for prolonged pneumonia:

• it is necessary to identify the above factors contributing to the development of a protracted course of pneumonia in a timely manner and to eliminate them (this is first of all a thorough sanitation of the oral cavity, nasopharynx, elimination of other foci of infection, cessation of smoking, alcohol intake);
• it is necessary to carefully analyze the methods and results of previous antibiotic therapy and to decide whether it is necessary to continue it in case of persistent infiltration of pulmonary tissue and symptoms of intoxication, but antibacterial therapy is appointed taking into account the results of mandatory bacteriological examination of sputum;
• pay special attention to the restoration of the drainage function of the bronchi and organize the rational use of expectorants, positional drainage, bronchodilators, massage of a difficult cell; in some cases, it may be necessary to perform fibrobronchoscopy and fibrobronchoscopic sanitation in the presence of symptoms of persistent chronic purulent bronchitis;
• widely use physical therapy, exercise therapy, respiratory gymnastics, massage, acupuncture;
• should carefully investigate the system of immunity, evaluate the factors of nonspecific protection and, taking into account the results obtained, to perform immunocorrection.

VP Silvestrov (1986) offers the following program for studying systemic and local immunity in prolonged pneumonia:

1. T-system
   1. The total content of T-lymphocytes (E-ROC).
   2. Evaluation of the regulatory link of the T-system:
      • suppressor activity: T-cells, theophylline sensitive ROC, concanavalin A-induced suppressors, short-lived suppressors;
      • helper activity: Tμ-cells, proliferative response to phytohemagglutinin, interleukin-2.
   3. Evaluation of the effective link of the T-system:
      • natural cytotoxicity;
      • antibody-dependent cytotoxicity.
2. B-system
   1. The total content of B-lymphocytes (EAC-ROC).
   2. Functional activity of B-lymphocytes (proliferative response to the mitogen of the lakonos and lipopolysaccharide).
   3. The content of immunoglobulins IgA, IgG, IgM, IgE.
3. Local defense factors (studied in bronchial secretion)
   1. Local immunity system:
      • determination of the total content of T- and B-lymphocytes;
      • determination of natural and antibody-dependent cytotoxicity;
      • determination of secretory immunoglobulins;
      • determination of enzymes of xenobiotic metabolism (cytochrome-450, glutathione-8-transferase and epoxyhydratase) of lymphocytes.
   2. Alveolar macrophages
      • the determination of the functional capacity of alveolar macrophages;
      • determination of enzymes of xenobiotic metabolism and lysosomal enzymes of alveolar macrophages.

Of course, a complete immunological examination according to the presented program is probably not in every medical institution, but patients with prolonged pneumonia should be examined in the immunological plan as fully as possible, because almost all of them have secondary immunodeficiency and it needs to be corrected taking into account the results of immunological research.

In the treatment of patients with protracted pneumonia:

• more widely use such methods of immunocorrective action as laser and ultraviolet irradiation of blood;
• use methods of stimulation of the adrenal glands (DKV on the adrenal gland, treatment with etazol, glycyrram);
• in the plan of complex therapy, it is necessary to provide sanatorium treatment, in the absence of such an opportunity, the rehabilitation program should be fully used in the rehabilitation departments of polyclinics, hospitals or sanatoriums at the place of residence;
• term dispensary observation for patients with prolonged pneumonia to increase to 1 year, sometimes longer (that is, until complete recovery).

• Pneumonia - Treatment regimen and nutrition
• Antibacterial drugs for the treatment of pneumonia
• Pathogenetic treatment of pneumonia
• Symptomatic treatment of pneumonia
• Fighting complications of acute pneumonia
• Physiotherapy, exercise therapy, respiratory gymnastics with pneumonia
• Sanatorium treatment and rehabilitation for pneumonia

[1], [2], [3], [4], [5], [6], [7]