Symptoms of pneumonia of different etiology

The classical clinical picture of two clinico-morphological variants of pneumonia was described above in detail. In this case it was a question of a typical course of lobar and focal pneumonia, the causative agent of which is pneumococcus the most common etiologic factor of both community-acquired and hospital pneumonia. It should be remembered, however, that the biological properties of other pathogens, their virulence and the nature of the reaction of the macroorganism to the introduction of infection, often imposes a significant imprint on all clinical manifestations of the disease and its prognosis.

Pneumonia caused by a hemophilic rod

Gram-negative haemophilus influenzae (Haemophilus influenzae, or Pfeiffer's wand) is one of the frequent pathogens of community-acquired pneumonia. It is part of the normal microflora of the oropharynx, but has a tendency to penetrate into the lower respiratory tract, being a frequent causative agent of acute and chronic bronchitis. In adults, Haemophilus influenzae causes predominantly focal bronchopneumonia.

The clinical picture in most cases corresponds to the manifestations of focal pneumonia described above. A particular feature is the frequent combination with pronounced tracheobronchitis. Therefore, in the auscultation of the lungs, along with the characteristic auscultative signs of focal inflammation of the lungs (weakened breathing and wet finely bubbling sonorous rales) may be accompanied by a mass of dry, dry wheezing scattered over the entire surface, heard against the background of hard breathing.

Pneumonia caused by a hemophilic rod rarely gets severe. Nevertheless, in some cases it can be complicated by exudate pleurisy, pericarditis, meningitis, arthritis, and the like.

"Atypical pneumonia"

The term "atypical pneumonia" currently refers to lung inflammation caused by intracellular ("atypical") pathogens that can not be detected in the blood by conventional microbiological control methods. In addition, the pathogens are resistant to the traditional treatment of pneumonia with penicillins and cephalosporins.

Among the most common "atypical" pathogens of pneumonia are:

• mycoplasma;
• chlamydia;
• rickettsia;
• viruses.

In recent years, mycoplasma and chlamydia are increasingly the cause of community-acquired pneumonia.

Mycoplasmal pneumonia

Mycoplasma pneumonia is caused by mycoplasma pneumoniae - a special kind of intracellular pathogen, devoid of the cell membrane and in size approaching the viruses. The incidence of mycoplasma pneumonia varies at large limits (4% to 30%). Being a highly contagious pathogen, transmitted from person to person by airborne droplets, mycoplasma periodically causes outbreaks of pneumonia, especially in organized collectives. During such upsurge in incidence the incidence of mycoplasmal pneumonia reaches 30% and decreases during periods of epidemiological well-being to 4-6%.

The most common mycoplasmal pneumonia occurs in children and young people (younger than 30 years).

Mycoplasma pneumoniae usually causes focal or segmental inflammation of the lung tissue. Pneumonia often precedes the disease of the upper respiratory tract (pharyngitis, tracheobronchitis, rhinitis). In most cases, the course of pneumonia is not severe, but many symptoms of the disease acquire a long, protracted character.

The onset of pneumonia is more often gradual. The body temperature rises to a low-grade figure, a cough with a small discharge of viscous mucous sputum appears. Cough soon acquires a stubborn, torturous nature. Often the temperature remains normal, although cough with sputum and pronounced intoxication persist for a long time. Pleural pain, shortness of breath and chills are absent.

The physical data generally correspond to those characteristic of bronchopneumonia, but not so rarely are they completely absent. Often there are numerous extrapulmonary manifestations of mycoplasmal pneumonia - myalgia, arthralgia, profuse sweating, weakness, hemolytic anemia, etc. The dissociation of the clinical and radiological picture of pneumonia with excruciating cough, tormenting sweats, symptoms of intoxication and absence of leukocytosis and neutrophil shift is also characteristic. Radiologically, in half of the patients, only the intensification of the pulmonary pattern and interstitial changes are revealed. Non-homogeneous pockets of pulmonary tissue infiltration with fuzzy diffuse contours are determined only in 1/3 of patients with mycoplasmal pneumonia. In some cases, they can be two-sided.

With mycoplasmal pneumonia, sputum cultures or blood cultures are not informative. To identify the pathogen, serological diagnostic methods are used.

The course of mycoplasmal pneumonia is characterized by several important features:

1. The predominance of symptoms of inflammatory defeat of the upper respiratory tract (pharyngitis, laryngitis, rhinitis, tracheobronchitis) with excruciating cough, runny nose, lacrimation and hyperemia of throat.
2. Absence in some cases of any physical changes on the part of the respiratory tract, characteristic for bronchopneumonia.
3. In half of patients - dissociation of clinical manifestations of the disease (signs of severe intoxication, prolonged subfebrile condition, pouring sweat, etc.), radiologic picture (in some patients only pulmonary depiction is revealed) and laboratory data (absence of leukocytosis and neutrophil shift).
4. Frequent involvement in the pathological process of other organs and systems (arthralgia, myalgia, myocarditis, pericarditis).

Chlamydial pneumonia

In recent years, there has been an increase in the incidence of chlamydia pneumonia in Ukraine and abroad. The incidence rate is 5-15% and more. Especially often chlamydia cause pneumonia in young people (up to 20-25 years).

The defeat of the lungs Chlamydia pneumoniae is more often focal. The clinical picture often resembles the course of mycoplasmal pneumonia. The disease is often preceded by inflammation of the upper respiratory tract (tracheobronchitis, pharyngitis).

Pneumonia begins with a dry cough, sore throat, chills and fever to subfebrile digits. Gradually, the cough becomes productive, with the separation of mucopurulent sputum. There are moderately expressed signs of intoxication: headache, weakness, malaise, myalgia. In physical research, only scattered dry wheezing is often determined, and it is less common to detect wet wheezing characteristic for bronchopneumonia. Characterized by leukopenia and increased ESR. As with mycoplasmal pneumonia, interstitial changes are detected radiographically as augmentation of the pulmonary pattern. Infiltrative changes are not always found, often they are peribronchial

The more severe and protracted course of the disease is typical for pneumonia, the causative agent of which is Chlamydia psittaci (causative agent of ornithosis, or psittacosis).

Infection occurs when a person contacts infected birds. In the clinical picture of this pneumonia symptoms of severe intoxication predominate: headaches, nausea, vomiting, myalgia, fever to febrile digits. At the same time, fiscal data can be very scarce. Radiographically, interstitial changes are more often detected in the form of strengthening the pulmonary pattern, less often - focal infiltrative shadows. In blood tests, leukopenia and an increase in ESR are determined. Most patients have a slight increase in the liver and spleen, which reflects systemic damage to internal organs during ornithosis.

In general, chlamydial pneumonia is characterized by the following features:

1. In the overwhelming majority of cases, chlamydial pneumonia is detected in children, adolescents and young adults under 25-30 years of age.
2. In the clinical picture of the disease, signs of tracheobronchitis, pharyngitis, and sinusitis predominate, while in patients with ornithosis symptoms of severe intoxication predominate.
3. In physical examination, there are often no characteristic auscultative signs of focal pneumonia and more often absent-minded dry rales.
4. In blood tests, leukopenia is most often detected and there is no neutrophil shift.
5. X-ray is dominated by interstitial changes in the lungs as augmentation of the pulmonary pattern, and infiltration is not always revealed.

Pneumonia caused by legionella (legionnaires' disease)

The gram-negative bacillus Legionella pneumophila, which causes the development of pneumonia in humans, was first isolated in 1977 after an epidemic of the disease that broke out among the participants of the Congress "American Legion" in Philadelphia. All types of legionella are among the exogenous pathogens of pneumonia, which are not part of the normal human flora and live in the aquatic environment - in rivers, lakes, ponds, air conditioning systems, ventilation, water and sewerage lines, etc.

Infection occurs by airborne droplets during human contact with fine aerosols containing legionella. People who suffer from chronic alcoholism, COPD, diabetes mellitus, immunodeficiency conditions, as well as patients taking corticosteroids and cytostatics are more likely to get sick. The frequency of legionella pneumonia ("Legionnaires' disease") reaches 5-15% of the total number of pneumonias. Epidemic outbreaks are observed in the autumn.

Legionella can cause both community-acquired and hospital-acquired pneumonia. The incubation period is from 2 to 10 days (an average of 7 days). The disease begins with signs of intoxication - general weakness, malaise, headache, drowsiness, myalgia and arthralgia. On the second day, the body temperature rises to 39-40 ° C and higher, and then there is a cough, at first dry, and then with the separation of purulent sputum with an admixture of blood. In 1/3 of patients, pleural pains occur due to fibrinous (dry) parapneumonic pleurisy, in half of these patients exudative pleurisy develops.

When examining, percussion and auscultation of the lungs, the signs characteristic of predominantly focal or focal-drain pneumonia are revealed. In the pathological process is often involved pleura. The course of legionella pneumonia is often complicated by the development of severe respiratory failure, infectious-toxic shock, pulmonary edema.

In legionellosis pneumonia, other organs and systems are often affected, which is explained by legionella bacteremia:

• CNS (snotty, headache, paresthesia, impaired consciousness, right up to coma);
• gastrointestinal tract: abdominal discomfort, vomiting, diarrhea, etc .;
• liver: liver enlargement, cytolysis, hyperbilirubinemia;
• kidneys: proteinuria, microhematuria, pyelonephritis, acute renal failure.

When radiographing in the early stages of legionella pneumonia, typical focal infiltrates are revealed, which later in the majority of patients (70%) consolidate and occupy almost the entire lobe of the lung.

In the general blood test, leukocytosis (10-15 x 10 ⁹ / L), neutrophil shift to the left, lymphopenia, a significant increase in ESR (up to 50-60 mm / h) are detected . In the biochemical analysis of blood, hyponatremia is detected; it is possible to increase the activity of transferases, hyperbilirubinemia and hypoalbuminemia.

It has already been pointed out that legionellosis pneumonia occupies the second place (after pneumococcal) in the frequency of fatal outcomes. Mortality reaches 8-39%.

To confirm legionellaeon pneumonia, the following characteristics should be considered:

1. Anamnestic instructions for the use of air conditioners, showers, ionic lately, especially in new places of residence (hotels, hotels, boarding houses).
2. Fever to 39.0 ° C for 4-5 days in combination with severe intoxication.
3. The presence of cough, diarrhea, impaired consciousness or a combination of these signs,
4. Lymphocytopenia (less than 10 x 10 ⁹ / l) in combination with leukocytosis (more than 15 x 10 ⁹ / L)
5. Hyponatremia, hypoalbuminemia.

Thus, "atypical" pneumonia caused by mycoplasma, chlamydia, legionella and some viruses, are characterized by some common features associated with the features of unimpeded penetration of pathogens through intact epithelial barriers and the possibility of their long intracellular functioning and reproduction.

Clinical manifestations of "atypical" pneumonia are characterized by some characteristic features.

1. The onset of pneumonia is often preceded by clinical manifestations of inflammation of the upper respiratory tract - pharyngitis, laryngitis, tracheobronchitis.
2. In the physical examination of patients with "atypical" pneumonia, there are often no characteristic clinical signs of focal inflammation of the lungs.
3. Radiologically, in many cases of "atypical" pneumonia, interstitial changes predominate, whereas focal infiltration of pulmonary tissue is detected in not more than half of cases and often has the character of peribronchial infiltration.

Pneumonia caused by Klebsiella

Klebsiella pneumoniae, which belongs to the Gram-negative bacteria of the Enterobakteriaceae family, is the causative agent of the so-called Friedlander pneumonia, which is characterized by the severity of the course, the frequency of complications, and the high lethality rate of up to 8%. Friedlander's pneumonia often develops in weakened patients suffering from severe chronic diseases (diabetes mellitus, CHF, COPD), as well as in patients over 60 years old and in people who abuse alcohol. Klebsiella can cause both out-of-hospital and in-hospital (hospital) pneumonia.

In most cases, Friedlander's pneumonia is of a focal and draining nature, when multiple foci of inflammation merge with each other, capturing large areas of the lung. Often affected is a whole lot, which creates the appearance of the development of croupous pneumonia (pseudoblury character of pneumonia). The upper lobe of the lung is often affected.

Characteristic is the tendency to rapid (within a few days) the development of destruction of lung tissue - the emergence of multiple sites of decay of lung tissue and the formation of abscesses. Airways are usually filled with fibrinous-purulent exudate with an admixture of blood.

The disease begins acutely with a high fever, rapidly increasing dyspnea, severe intoxication, until the confusion appears. Extremely characteristic for Friedlander pneumonia, the destruction of lung tissue and the formation of multiple abscesses occurs extremely quickly (already 2-4 days after the onset of the disease). Characterized by the appearance of a viscous bloody sputum of the color of currant jelly, which has a specific smell, reminiscent of the smell of rancid meat.

The results of the physical examination as a whole correspond to those characteristic of focal-drain pneumonia. The weakened breathing and wet fine and medium bubbling sonorous rales are more often determined, especially when multiple abscesses occur. In addition to frequent destruction and abscessing of pulmonary tissue, expressed symptoms of intoxication and progressive respiratory failure, the course of Friedlander's pneumonia is often complicated by exudative pleurisy, meningitis, and arthritis.

Pneumonia caused by E. Coli

Gram-negative Escherichia coli also belongs to the enterobacteria group, being an obligate inhabitant of the gastrointestinal tract. It infects the lung tissue and causes the development of focal pneumonia, usually in persons who underwent operations on the intestines, organs of the urinary system, as well as in weakened patients, long-suffering chronic diseases of internal organs, leading to violations in the immune system of the body.

The clinical picture basically corresponds to the manifestations of focal pneumonia, but sometimes it is distinguished by the special severity of the flow. Often in these cases, there is arterial hypotension and collapse, severe cough, chest pain. Sometimes abscess formation develops.

Staphylococcal pneumonia

Staphylococcus aureus (Staphylococcus aureus) is more often the cause of intra-hospital (nosocomial) pneumonia developing in patients whose resistance to the causative agent is impaired by severe concomitant diseases, recent surgery, decreased immunity, ARVI, and the like.

Staphylococcal pneumonia often develops against a background of sepsis and severe bacteremia. Especially often it occurs in elderly and senile patients and infants. Long stay in the hospital increases the risk of nosocomial staphylococcal pneumonia. Predisposed to the development of this pneumonia are patients suffering from cystic fibrosis, as well as injecting drug users. Often, staphylococcal pneumonia complicates respiratory viral infection.

Staphylococcal pneumonia usually proceeds according to the type of multifocus focal-discharge bronchopneumonia, less often a lesion of the whole lobe of the lung is observed. For staphylococcal pneumonia, the most characteristic is abscess formation, which is observed in 15-50% of cases, especially in children. Empyema of the pleura is observed in 20% of cases in adults and in 75% of cases in children.

The course of pneumonia is characterized by a sharp onset, high fever accompanied by repeated chills, severe intoxication, pleural pain, dyspnoea and cough with separation of purulent sputum yellowish or brown, often with an admixture of blood.

The physical data may vary depending on the morphological changes in the lung and the clinical variant of staphylococcal pneumonia. Usually there is a significant local blunting of percussion sound, bronchial or weakened breathing, moist sonorous rattles and a noise of friction of the pleura.

When forming an abscess of large dimensions (more than 5 cm in diameter), local dulling with a tympanic tinge, amphoric respiration and a mass of large-calibrated moist sonorous rales are determined. The formation of pleural empyema is characterized by the appearance of severe pain in the chest, the appearance of absolutely dull (femoral) sound in the lower parts of the lung and a sharply weakened breathing.

Currently, several clinical variants of staphylococcal pneumonia are distinguished:

1. Abscessing form of pneumonia with the formation of an abscess draining in the bronchus.
2. Staphylococcal infiltrate. With this form of pneumonia in the lung, a limited inflammatory focus of one or another magnitude is formed, which undergoes all stages of inflammation of the lung tissue. Dilation of the infiltrate is very slow and stretches to 4-8 pedl. With the usually favorable course of the disease, the site of the staphylococcal infiltrate forms a site with a pneumosclerosis. This variant of staphylococcal pneumonia proceeds quite heavily with high fever, chills, severe intoxication, increased respiratory failure. The course of the disease resembles the clinical picture of sepsis
3. Metastatic staphylococcal destruction of the lungs, in fact, is a form of lung damage with staphylococcal sepsis, when as a result of hematogenous dribbling of the pathogen from the primary focus in the lungs, multiple, relatively small secondary lesions of infiltration and abscess formation are formed. This clinical form of staphylococcal pulmonary disease is characterized by cranial hardness and high lethality.
4. Bullous form of staphylococcal destruction of the lungs. - the most frequent variant of a lesion of lungs at a staphylococcal infection. With this form in the lungs formed foci of non-homogeneous infiltration, in which as a result of the destruction of lung tissue for several days from the onset of the disease cavities (bullae) that do not contain exudate are formed. Against the background of adequate therapy, these cavities, which are not abscesses, undergo a slow (for 6-10 days) reverse development, some of them completely disappear, and some remain in the form of air residual cysts. The course of such a clinical form of staphylococcal infection is considered relatively favorable.

Hospital Staphylococcus aureus strains are usually antibiotic resistant.

Pneumonia caused by Pseudomonas aeruginosa

Pseudomonas aeruginosa (Pseudomonas aeruginosa) in most cases is the causative agent of hospital pneumonia, especially in the postoperative period, in patients undergoing treatment in the ICU, in patients receiving respiratory support and the form of ventilation, etc. Community-acquired pneumonia caused by Pseudomonas aeruginosa develop in patients with bronchiectasis, cystic fibrosis, as well as in people receiving corticosteroid therapy. The disease begins sharply with a high fever with chills quickly increases into intoxication, respiratory failure, arterial hypotension develops. There is a cough with separation of purulent sputum, hemoptysis.

In a physical examination, signs of focal lung injury are revealed. Characteristically, a very rapid appearance in the lungs of new inflammatory foci, as well as a tendency to pleural complications (pleurisy, empyema of the pleura, pneumothorax) and to abscessing of pneumonia.

The disease is characterized by a particularly severe course and high mortality, reaching 50-70% in elderly, weakened patients.

Pneumonia caused by anaerobic bacteria

As noted above, gram-negative and gram-positive anaerobic bacteria (Fusobacteiium nucleatum, Bacteroides fragilis, Bacteroides melaninogenicus, Peptostreptococcus spp., Eubactenum, Bifidobacterium, Actinomyces, etc.) are part of the normal microflora of the oropharynx, being in symbiosis with aerobic bacteria.

The cause of pneumonia caused by anaerobes is the development of immunodeficiency states or oppression of the aerobic microflora of the oropharynx with broad-spectrum antibiotics. Colonization of the respiratory sections of the lungs by anaerobes occurs, as a rule, as a result of aspiration of the contents of the oropharynx, which is most characteristic for neurological patients, patients with impaired consciousness, swallowing act, and also for people suffering from alcoholism and drug addiction.

The clinical picture of pneumonia caused by anaerobes may be different, but in general it resembles the clinical manifestations of focal pneumonia. It should be remembered that anaerobes are not sensitive to many antibiotics, which in many ways complicates the treatment of patients.

Pneumonia with respiratory viral infections

Various acute etiology of acute respiratory viral infections (ARI) are grouped together on the basis of 1) a single mechanism of transmission of infection (airborne), 2) localization of the main pathological process mainly in the airways and 3) a similar clinical picture of the disease.

Currently, more than 200 viruses are known to cause ARVI in humans. The most important of them are influenza A and B viruses, parainfluenza, respiratory syncytial virus (PC virus), adenoviruses.

It is believed that in the development of pneumonia complicating the course of acute respiratory viral infection in adults, viral-bacterial associations play a decisive role. Probably, the viral infection serves only as a premorbid background for bacterial superinfection occurring on the 3rd-6th day of the acute respiratory viral infection with lesions of the respiratory parts of the lungs. In young children (1-3 years) is not excluded purely viral heies of pneumonia.

In children under the age of three years, viral pneumonia accounts for about half of all cases of community-acquired pneumonia. In adults, viral-bacterial pneumonia is observed in 5-15% of cases.

Risk factors for the development of viral and viral-bacterial pneumonia include staying in closed organized groups (kindergartens, schools, nursing homes, hostels, etc.). In adults, the risk of viral pneumonia is also increased in the presence of concomitant bronchopulmonary and cardiovascular diseases and in immunodeficient diseases. In recent cases, the risk of developing pneumonia caused by cytomegalovirus and herpes simplex virus increases. Naturally, in all cases, the risk of viral pneumonia increases during the winter epidemics.

Typically, respiratory viruses are introduced and replicated in the epithelial cells of the mucous membrane of the trachea, large and medium bronchi, causing a picture of acute hemorrhagic tracheobronchitis. The defeat of small bronchi and respiratory parts of the lungs with influenza, adenovirus infection is less common. For PC-viral infection, on the contrary, the epithelial lesion of small bronchi and bronchioles is characteristic, only then the inflammation passes to the larger bronchi.

On day 3-6 of the disease, a bacterial infection joins. It is easy to overcome already defective protective barriers of the lungs, bacterial pathogens cause inflammation in the respiratory parts of the lungs.

It should be noted that the physical and radiological signs of viral, viral-bacterial and bacterial pneumonia differ little from each other, and the diagnosis of viral pneumonia is most often based on an assessment of the epidemiological conditions of the onset of the disease and the risk factors described above.

The nature of changes in the general analysis of blood is largely determined by the prevalence of a viral or bacterial infection. In severe viral infection complicated by pneumonia, leukocytosis is often absent, and in some cases there is a tendency to develop leukopenia.

The diagnosis of viral or viral-bacterial pneumonia can be verified using modern virological methods. To this end, biological samples (flushes from the nasal passages, swabs from the nasopharynx and pharynx, sputum, aspiration washings) are placed in a special chilled medium and delivered to the virological laboratory.

To detect and identify viruses, the following methods are most commonly used:

1. Isolation of the culture of the virus - "seeding" the obtained sample into various tissue cell cultures and detecting the cytopathogenetic activity of viruses.
2. Determination of viral antigen by immunofluorescence and solid-phase enzyme-linked immunosorbent assay.
3. Serologic methods - determination of the titer of specific antiviral antibodies in blood serum.
4. The method of polymerase chain reaction (PCR).

Pneumonia with influenza respiratory infection

In adults, S. Pneumoniae (in 30-60% of cases) and N. Influencae, combined with respiratory viruses, most often appear as pathogens of viral-bacterial pneumonia, especially during the winter epidemics. Influenza infection, even at early stages of development, is characterized by a predominance of vascular disorders with the development of pronounced edema of tissues and hemorrhages.

The disease begins acutely with a high body temperature (39 ° C and above), chills, symptoms of severe intoxication (severe weakness, headache, pain in the eyeballs, muscles and joints, etc.). In severe cases, nausea, vomiting, and mental disturbance occur. Within a day, these symptoms are usually associated with mild signs of rhinitis (runny nose, lachrymation, nasal congestion) and tracheobronchitis (dry painful cough, unpleasant sensations behind the sternum).

The flu is complicated by the development of pneumonia usually in the first three days from the onset of the disease, although this period may be more. There is a new "wave" of body temperature increase (up to 40 ° C and higher), intoxication is increasing, nonsense, adynamia, headache. Cough is accompanied by separation of mucous and mucopurulent sputum, sometimes with blood veins, dyspnea, cyanosis, chest pain.

At objective research it is possible to find out physical signs of a pneumonia: local shortening of a percussion sound, easing of respiration, wet finely bubbly sonorous rattles.

Radiographic examination reveals an increase in pulmonary pattern due to the expansion of the roots of the lungs, as well as foci of pulmonary tissue infiltration, often bilateral.

Pneumonia with parainfluous respiratory infection

The clinical picture of an acute respiratory disease caused by parainfluenza virus is characterized by:

• a slight increase in body temperature to subfebrile digits;
• mildly expressed manifestations of intoxication;
• marked signs of acute laryngitis;
• moderate manifestations of rhinitis.

In contrast to influenza, parainfluenza begins gradually - with a little malaise, cognition, headache and fever to 37.5 ~ 38 C. Soon, nasal congestion, runny nose and lacrimation appear. The most characteristic clinical sign of parainfluenza is acute laryngitis. The patients have sore throat, coughing, sometimes "barking". The voice becomes rough, hoarse, aphonia appears.

If parainfluenza is complicated by pneumonia, the patient's condition worsens, intoxication develops, body temperature rises, dyspnea, cyanosis, cough with phlegm-purulent phlegm, sometimes with a trace of blood.

Objective and X-ray examination reveals signs characteristic of focal or focal-drain pneumonia.

Pneumonia with adenovirus respiratory infection

Acute adenovirus infection is characterized by a combined defeat of the mucosa of the respiratory tract and eyes with a pronounced exudative component and lymphoid tissue damage.

In the clinical picture of adenovirus infection the most pronounced swelling of the nasal and pharyngeal mucosa, abundant serous-mucous discharge from the nasal cavity, pain in the throat during swallowing, cough, signs of conjunctivitis are most characteristic. Upon examination, the posterior wall of the pharynx is hyperemic, "loose", tonsils are enlarged. Possible enlargement of submandibular and cervical lymph nodes. Often, adenoviruses cause inflammation in the mucosa and lymph nodes of the intestine, which manifests itself in abdominal pain, diarrhea.

The emergence of pneumonia against the background of adenovirus infection, as well as in other respiratory viral diseases, is accompanied by a new increase in body temperature, intoxication, increased cough, and sometimes the appearance of dyspnea. At the same time, the characteristic clinical manifestations of adenovirus infection (conjunctivitis, pharyngitis, lymphadenopathy) persist.

Radiographically determined foci of infiltration of lung tissue, increased vascular pattern and increased mediastinal lymph nodes.

Pneumonia with respiratory syncytial virus infection

Respiratory syncytial virus (PC virus), in contrast to influenza, parainfluenza and adenovirus infection, affects mainly small bronchi and bronchioles. Changes in the trachea and large bronchi are less pronounced. Therefore, the most typical clinical manifestations of PCV viral infection is the development of bronchiolitis and bronchitis.

The disease begins acutely with a moderate increase in body temperature, chills and symptoms of intoxication. Soon there is a cough, a slight hyperaemia of the posterior pharyngeal wall, arches, soft palate. A characteristic symptom of MS virus infection is increasing dyspnoea and difficulty exhalation (expiratory dyspnea), which is associated with an inflammatory narrowing of the small airways - bronchiolitis. Sometimes respiratory insufficiency rapidly increases due to the obstructive type. There is diffuse cyanosis (hypoxemia), sometimes a painful blush on the cheeks (hypercapnia). Dry and wet rales are heard in the lungs. Radiographically, you can identify small focal shadows and atelectasis, as well as bloating.

The emergence of pneumonia on the background of PC-viral infection is accompanied by increased intoxication, hyperthermia, signs of respiratory failure. Percutally determined by local compaction of lung tissue, and with auscultation, weakening of breathing, moist finely bubbly sonorous rales, sometimes - pleural friction noise.

X-ray reveals infiltrative shadows against the background of intensification of the pulmonary pattern. It should be remembered that pneumonia, which developed against the background of PC-viral infection, can be focal, focal-drain, segmental and fractional in nature.

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