Features of symptoms of pneumonias of different etiologies

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

Haemophilus influenzae pneumonia

Gram-negative Haemophilus influenzae (or Pfeiffer's bacillus) is one of the common causative agents 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 mainly focal bronchopneumonia.

The clinical picture in most cases corresponds to the above-described manifestations of focal pneumonia. A feature is the frequent combination with pronounced tracheobronchitis. Therefore, during auscultation of the lungs, along with the characteristic auscultatory signs of focal pneumonia (weakened breathing and moist fine-bubble sonorous wheezing), it may be accompanied by a mass of dry wheezing scattered over the entire surface of the lungs, heard against the background of harsh breathing.

Pneumonia caused by Haemophilus influenzae rarely becomes severe. However, in some cases it can be complicated by exudative pleurisy, pericarditis, meningitis, arthritis, etc.

"Atypical pneumonia"

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

The most common "atypical" pathogens that cause pneumonia include:

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

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

Mycoplasma pneumonia

Mycoplasma pneumonia is caused by Mycoplasma pneumoniae, a special type of intracellular pathogen that lacks a cell membrane and is similar in size to viruses. The incidence of mycoplasma pneumonia varies widely (from 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 groups. During such increases in incidence, the incidence of mycoplasma pneumonia reaches 30%, decreasing during periods of epidemiological well-being to 4-6%.

Mycoplasma pneumonia most often occurs in children and young people (under 30 years of age).

Mycoplasma pneumoniae usually causes focal or segmental inflammation of the lung tissue. Pneumonia is often preceded by diseases of the upper respiratory tract (pharyngitis, tracheobronchitis, rhinitis). In most cases, the course of pneumonia is not severe, but many symptoms of the disease become long-term and protracted.

The onset of pneumonia is often gradual. The body temperature rises to subfebrile levels, a cough appears with a small amount of viscous mucous sputum. The cough soon becomes persistent and painful. The temperature often remains normal, although the cough with sputum and severe intoxication persist for a long time. Pleural pain, shortness of breath, and chills are absent.

Physical data generally correspond to those characteristic of bronchopneumonia, but they are often completely absent. Numerous extrapulmonary manifestations of mycoplasma pneumonia are often detected - myalgia, arthralgia, profuse sweating, weakness, hemolytic anemia, etc. Dissociation of the clinical and radiological picture of pneumonia with a painful cough, profuse sweating, symptoms of intoxication and the absence of leukocytosis and neutrophilic shift is also very typical. Radiologically, half of the patients only show an increase in the pulmonary pattern and interstitial changes. Non-homogeneous foci of pulmonary tissue infiltration with unclear diffuse contours are determined only in 1/3 of patients with mycoplasma pneumonia. In some cases, they can be bilateral.

In mycoplasma pneumonia, sputum or blood cultures are uninformative. Serological diagnostic methods are used to identify the pathogen.

The course of mycoplasma pneumonia is distinguished by some important features:

1. Predominance of symptoms of inflammatory lesions of the upper respiratory tract (pharyngitis, laryngitis, rhinitis, tracheobronchitis) with a painful cough, runny nose, lacrimation and hyperemia of the pharynx.
2. The absence in some cases of any physical changes in the respiratory tract characteristic of bronchopneumonia.
3. In half of the patients, there is a dissociation of clinical manifestations of the disease (signs of severe intoxication, prolonged subfebrile temperature, profuse sweating, etc.), radiological picture (in some patients only an increase in the pulmonary pattern is detected) and laboratory data (absence of leukocytosis and neutrophilic shift).
4. Frequent involvement of other organs and systems in the pathological process (arthralgia, myalgia, myocarditis, pericarditis).

Chlamydial pneumonia

In recent years, there has been an increase in the incidence of chlamydial pneumonia in Ukraine and abroad. The incidence rate reaches 5-15% and more. Chlamydia especially often causes pneumonia in young people (up to 20-25 years).

Chlamydia pneumoniae lung damage is often focal. The clinical picture often resembles the course of mycoplasma 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 an increase in body temperature to subfebrile numbers. Gradually, the cough becomes productive, with the separation of mucopurulent sputum. Moderate signs of intoxication appear: headache, weakness, malaise, myalgia. During a physical examination, only scattered dry wheezing is often determined, less often it is possible to detect wet wheezing characteristic of bronchopneumonia. Leukopenia and an increase in ESR are characteristic. Just as with mycoplasma pneumonia, interstitial changes in the form of an increase in the pulmonary pattern are detected radiologically. Infiltrative changes are not always detected, they are often peribronchial in nature.

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

Infection occurs when humans come into contact with infected birds. The clinical picture of this pneumonia is dominated by symptoms of severe intoxication: headaches, nausea, vomiting, myalgia, and an increase in body temperature to febrile levels. At the same time, fiscal data can be very scanty. Radiologically, interstitial changes in the form of increased pulmonary pattern are most often detected, less often - focal infiltrative shadows. Blood tests reveal leukopenia and an increase in ESR. Most patients have a slight increase in the liver and spleen, which reflects the systemic damage to internal organs in ornithosis.

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

1. In the vast majority of cases, chlamydial pneumonia is detected in children, adolescents and young people under 25-30 years of age.
2. The clinical picture of the disease is dominated by signs of tracheobronchitis, pharyngitis, sinusitis, and in patients with ornithosis, symptoms of severe intoxication.
3. During physical examination, characteristic auscultatory signs of focal pneumonia are often absent and scattered dry wheezing is more often detected.
4. Blood tests most often reveal leukopenia and an absence of neutrophilic shift.
5. Radiologically, interstitial changes in the lungs predominate in the form of increased pulmonary pattern, and infiltration is not always detected.

Legionella pneumonia (Legionnaires' disease)

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

Infection occurs through airborne droplets when a person comes into contact with fine aerosols containing legionella. People suffering from chronic alcoholism, COPD, diabetes, immunodeficiency states, as well as patients taking corticosteroids and cytostatics are more likely to get sick. The incidence of legionella pneumonia ("Legionnaires' disease") reaches 5-15% of the total number of pneumonias. Epidemic outbreaks are observed in the fall.

Legionella can cause both community-acquired and hospital-acquired pneumonia. The incubation period is from 2 to 10 days (on average 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 above, and then a cough appears, initially dry, and then with the separation of purulent sputum with an admixture of blood. In 1/3 of patients, pleural pain occurs, caused by fibrinous (dry) parapneumonic pleurisy, in half of these patients, exudative pleurisy subsequently develops.

During examination, percussion and auscultation of the lungs, signs characteristic mainly of focal or focal-confluent pneumonia are revealed. The pleura is often involved in the pathological process. The course of legionella pneumonia is often complicated by the development of severe respiratory failure, infectious-toxic shock, and pulmonary edema.

With Legionella pneumonia, other organs and systems are often affected, which is explained by Legionella bacteremia:

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

In the early stages of legionella pneumonia, radiography reveals typical focal infiltrates, which later consolidate in most patients (70%) and occupy almost the entire lobe of the lung.

A general blood test reveals leukocytosis (10-15 x 10 ⁹ /l), a neutrophilic shift to the left, lymphopenia, and a significant increase in ESR (up to 50-60 mm/h). A biochemical blood test reveals hyponatremia; increased transferase activity, hyperbilirubinemia, and hypoalbuminemia are possible.

It has already been stated above that legionella pneumonia ranks second (after pneumococcal) in terms of fatality rate. Mortality reaches 8-39%.

To confirm Legionella pneumonia, the following characteristic signs should be taken into account:

1. Anamnestic indications of recent use of air conditioners, showers, ionic ones, especially in new places of residence (hotels, hostels, boarding houses).
2. Fever up 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 symptoms,
4. Lymphocytopenia (less than 10 x 10 ⁹ /l) combined with leukocytosis (more than 15 x 10 ⁹ /l)
5. Hyponatremia, hypoalbuminemia.

Thus, “atypical” pneumonias caused by mycoplasma, chlamydia, legionella and some viruses are characterized by some common features associated with the features of unhindered penetration of pathogens through intact epithelial barriers and the possibility of their long-term 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. During physical examination of patients with "atypical" pneumonia, characteristic clinical signs of focal lung inflammation are often absent.
3. Radiologically, in many cases of “atypical” pneumonia, interstitial changes predominate, while focal infiltration of the lung tissue is detected in no more than half of the cases and often has the character of peribronchial infiltration.

Klebsiella pneumonia

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 high mortality, reaching 8%. Friedlander pneumonia often develops in weakened patients suffering from severe chronic diseases (diabetes mellitus, CHF, COPD), as well as in patients over 60 years of age and in people who abuse alcohol. Klebsiella can cause both community-acquired and hospital-acquired pneumonia.

In most cases, Friedlander's pneumonia is focal-confluent in nature, when multiple foci of inflammation merge with each other, capturing large areas of the lung. Often, an entire lobe is affected, which creates the appearance of lobar pneumonia (pseudobar pneumonia). The upper lobe of the lung is often affected.

A tendency to rapid (within a few days) development of lung tissue destruction is characteristic - the emergence of multiple areas of lung tissue decay and the formation of abscesses. The airways are usually filled with fibrinous-purulent exudate mixed with blood.

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

The results of physical examination generally correspond to the data characteristic of focal-confluent pneumonia. Weakened breathing and moist small- and medium-bubble sonorous wheezing are most often determined, especially when multiple abscesses occur. In addition to frequent destruction and abscess formation of lung tissue, pronounced symptoms of intoxication and progressive respiratory failure, the course of Friedlander's pneumonia is often complicated by exudative pleurisy, meningitis, arthritis.

E. coli pneumonia

Gram-negative Escherichia coli also belongs to the group of enterobacteria, being an obligate inhabitant of the gastrointestinal tract. It infects lung tissue and causes the development of focal pneumonia, as a rule, in people who have undergone operations on the intestines, urinary system organs, as well as in weakened patients who have long suffered from chronic diseases of internal organs, leading to disturbances in the body's immune defense system.

The clinical picture generally corresponds to the manifestations of focal pneumonia, but sometimes it is distinguished by a particularly severe course. Often in these cases, arterial hypotension and collapse, severe cough, chest pain are observed. Sometimes abscess formation develops.

Staphylococcal pneumonia

Staphylococcus aureus is most often the cause of hospital-acquired (nosocomial) pneumonia, which develops in patients whose resistance to the pathogen is impaired by severe concomitant diseases, recent operations, decreased immunity, acute respiratory viral infections, etc.

Staphylococcal pneumonia often develops against the background of sepsis and severe bacteremia. It occurs especially often in elderly and senile people and infants. A long stay in hospital increases the risk of developing nosocomial staphylococcal pneumonia. Patients with cystic fibrosis and injection drug addicts are predisposed to developing this pneumonia. Staphylococcal pneumonia often complicates a respiratory viral infection.

Staphylococcal pneumonia usually occurs as a multifocal focal-confluent bronchopneumonia, less often an entire lobe of the lung is affected. For staphylococcal pneumonia, abscess formation is most typical, 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 an acute onset, high fever, accompanied by repeated chills, severe intoxication, pleural pain, shortness of breath and cough with the separation of purulent sputum of a yellowish or brown color, often mixed with blood.

Physical findings may vary depending on the specific morphological changes in the lung and the clinical variant of staphylococcal pneumonia. Typically, significant local dullness of percussion sound, bronchial or weakened breathing, moist sonorous rales and pleural friction noise are detected.

When a large abscess (more than 5 cm in diameter) is formed, local dullness with a tympanic tint, amphoric breathing and a mass of large-caliber wet sonorous wheezing are determined. The formation of pleural empyema is characterized by the occurrence of severe pain in the chest, the appearance of an absolutely dull (femoral) sound in the lower parts of the lung and sharply weakened breathing.

Currently, there are several clinical variants of staphylococcal pneumonia:

1. An abscessing form of pneumonia with the formation of an abscess draining into the bronchus.
2. Staphylococcal infiltrate. With this form of pneumonia, a limited focus of inflammation of one size or another is formed in the lung, which undergoes all stages of inflammation of the lung tissue. Resorption of the infiltrate occurs very slowly and extends over 4-8 weeks. With a usually favorable course of the disease, a pneumoscleroma area is formed at the site of the staphylococcal infiltrate. This variant of staphylococcal pneumonia is quite severe with high fever, chills, severe intoxication, and increasing respiratory failure. The course of the disease resembles the clinical picture of sepsis.
3. Metastatic staphylococcal destruction of the lungs is essentially a form of lung damage in staphylococcal sepsis, when as a result of hematogenous introduction of the pathogen from the primary focus in the lungs, multiple, relatively small, secondary foci of infiltration and abscess formation are formed. This clinical form of staphylococcal lung damage is characterized by a severe course and high mortality.
4. Bullous form of staphylococcal destruction of the lungs. - the most common variant of lung damage in staphylococcal infection. In this form, confluent foci of non-homogeneous infiltration are formed in the lungs, in which, as a result of the destruction of lung tissue, cavities (bullae) that do not contain exudate are formed within a few days from the onset of the disease. With adequate therapy, these cavities, which are not abscesses, undergo slow (over 6-10 days) reverse development, some of them completely disappear, and some remain in the form of residual air cysts. The course of this clinical form of staphylococcal infection is considered relatively favorable.

Hospital strains of Staphylococcus aureus are usually antibiotic-resistant.

Pneumonia caused by Pseudomonas aeruginosa

Pseudomonas aeruginosa is the causative agent of hospital pneumonia in most cases, especially in the postoperative period, in patients undergoing treatment in intensive care units, in patients receiving respiratory support in the form of artificial ventilation, etc. Community-acquired pneumonia caused by Pseudomonas aeruginosa develops in patients with bronchiectasis, cystic fibrosis, and in individuals receiving corticosteroid therapy. The disease begins acutely with high fever with chills, intoxication and respiratory failure rapidly increase, and arterial hypotension develops. Cough with purulent sputum and hemoptysis are noted.

Physical examination reveals signs of focal lung lesions. Characteristic is the very rapid appearance of new inflammatory foci in the lungs, as well as a tendency to pleural complications (pleurisy, pleural empyema, pneumothorax) and to abscess formation of pneumonia.

The disease is characterized by a particularly severe course and high mortality rate, 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 suppression of the aerobic microflora of the oropharynx by 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 typical for neurological patients, patients with impaired consciousness, the act of swallowing, as well as in people suffering from alcoholism and drug addiction.

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

Pneumonia in respiratory viral infections

Acute respiratory viral infections (ARVI) of various etiologies are combined into one group based on 1) a single mechanism of infection transmission (airborne), 2) localization of the main pathological process mainly in the respiratory tract and 3) a similar clinical picture of the disease.

Currently, more than 200 viruses are known that cause acute respiratory viral infections in humans. Of these, the most important are influenza viruses A and B, parainfluenza, respiratory syncytial virus (RSV), and adenoviruses.

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

In children under three years of age, 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, dormitories, etc.). In adults, the risk of viral pneumonia also increases in the presence of concomitant bronchopulmonary and cardiovascular diseases and immunodeficiency diseases. In the latter 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 winter epidemics.

Usually, respiratory viruses penetrate and replicate in the epithelial cells of the mucous membrane of the trachea, large and medium bronchi, causing a picture of acute hemorrhagic tracheobronchitis. Damage to small bronchi and respiratory parts of the lungs with influenza, adenovirus infection is less common. For RS-virus infection, on the contrary, damage to the epithelium of small bronchi and bronchioles is characteristic, only then does the inflammation spread to larger bronchi.

On the 3rd-6th day of the disease, a bacterial infection joins in. Having easily overcome the protective barriers of the lungs already damaged by viruses, bacterial pathogens cause inflammation in the respiratory sections 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 blood test is largely determined by the prevalence of viral or bacterial infection. In severe viral infections complicated by pneumonia, leukocytosis is often absent, and in some cases there is a tendency for leukopenia to develop.

The diagnosis of viral or viral-bacterial pneumonia can be verified using modern methods of virological research. For this purpose, biological samples (nasal swabs, nasopharyngeal and pharyngeal smears, sputum, aspiration rinsing waters) are placed in a special cooled environment and delivered to a virological laboratory.

The following methods are most often used to detect and identify viruses:

1. Isolation of a virus culture is the “seeding” of the obtained sample onto various tissue cell cultures and detection of the cytopathogenetic activity of viruses.
2. Determination of viral antigen using immunofluorescence and enzyme-linked immunosorbent assay.
3. Serological methods - determination of the titer of specific antiviral antibodies in the blood serum.
4. Polymerase chain reaction (PCR) method.

Pneumonia in influenza respiratory infection

In adults, the most common pathogens of viral-bacterial pneumonia are S. pneumoniae (in 30-60% of cases) and H. influenzae, combined with respiratory viruses, especially during winter epidemics. Influenza infection, even in the early stages of development, is characterized by the predominance of vascular disorders with the development of severe tissue edema and hemorrhages.

The disease begins acutely with a high body temperature (39°C and above), chills, symptoms of severe intoxication (sharp weakness, headache, pain in the eyeballs, muscles and joints, etc.). In severe cases, nausea, vomiting, and impaired consciousness occur. Within 24 hours, moderate signs of rhinitis (runny nose, watery eyes, nasal congestion) and tracheobronchitis (dry, painful cough, discomfort behind the breastbone) usually join these symptoms.

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 longer. A new "wave" of increased body temperature is noted (up to 40°C and above), intoxication increases, delirium, adynamia, headache appear. Cough is accompanied by the separation of mucous and mucopurulent sputum, sometimes with streaks of blood, shortness of breath, cyanosis, chest pain appear.

During an objective examination, physical signs of pneumonia can be detected: local shortening of the percussion sound, weakening of breathing, moist fine-bubble sonorous wheezing.

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

Pneumonia in parainfluenza respiratory infection

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

• a slight increase in body temperature to subfebrile levels;
• mild manifestations of intoxication;
• pronounced signs of acute laryngitis;
• moderate manifestations of rhinitis.

Unlike flu, parainfluenza begins gradually - with a slight malaise, chills, headache and a rise in body temperature to 37.5~38 C. Soon, nasal congestion, runny nose, and watery eyes appear. The most characteristic clinical sign of parainfluenza is acute laryngitis. Patients develop a sore throat, cough, sometimes "barking". The voice becomes rough, hoarse, and aphonia appears.

If parainfluenza is complicated by pneumonia, the patient's condition worsens, intoxication develops, body temperature rises, shortness of breath, cyanosis, cough with mucopurulent sputum, sometimes with an admixture of blood, appear.

Objective and radiological examination reveals signs characteristic of focal or focal-confluent pneumonia.

Pneumonia in adenovirus respiratory infection

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

The clinical picture of adenovirus infection is most characterized by pronounced swelling of the mucous membrane of the nose and pharynx, abundant serous-mucous discharge from the nasal cavity, sore throat when swallowing, cough, signs of conjunctivitis. Upon examination, the back wall of the pharynx is hyperemic, "loose", the tonsils are enlarged. Enlargement of the submandibular and cervical lymph nodes is possible. Adenoviruses often cause inflammation in the mucous membrane and lymph nodes of the intestine, which is manifested by abdominal pain and diarrhea.

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

Radiological examination reveals foci of pulmonary tissue infiltration, increased vascular pattern and enlarged mediastinal lymph nodes.

Pneumonia in respiratory syncytial virus infection

Respiratory syncytial virus (RSV), unlike influenza, parainfluenza and adenovirus infection, mainly affects small bronchi and bronchioles. Changes in the trachea and large bronchi are expressed to a lesser extent. Therefore, the most characteristic clinical manifestations of RSV infection are the development of bronchiolitis and bronchitis.

The disease begins acutely with a moderate increase in body temperature, chills and symptoms of intoxication. Soon a cough appears, a slight hyperemia of the back wall of the pharynx, arches, soft palate. A characteristic symptom of RSV infection is increasing dyspnea and difficulty exhaling (expiratory dyspnea), which is associated with inflammatory narrowing of the small airways - bronchiolitis. Sometimes respiratory failure quickly increases, mainly of the obstructive type. Diffuse cyanosis (hypoxemia) appears, sometimes a painful blush on the cheeks (hypercapnia). Dry and moist rales are heard in the lungs. X-ray can reveal small focal shadows and atelectasis, as well as pulmonary distension.

The development of pneumonia against the background of RS-virus infection is accompanied by increased intoxication, hyperthermia, and signs of respiratory failure. Percussion reveals local compaction of the lung tissue, and auscultation reveals weakened breathing, moist fine-bubble sonorous rales, and sometimes pleural friction noise.

Radiologically, infiltrative shadows are revealed against the background of increased pulmonary pattern. It should be remembered that pneumonias that developed against the background of RS-virus infection can be focal, focal-confluent, segmental and lobar in nature.

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