Symptoms of pneumonia
Last reviewed: 23.04.2024
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Symptoms of pneumonia and outcomes of the disease are determined by many factors interacting:
- biological properties of the causative agent of pneumonia;
- individual features of the pathogenesis of pneumonia;
- the state of the bronchopulmonary protection system;
- the patient has chronic bronchopulmonary system diseases;
- the presence of other concomitant diseases that reduce the resistance of the patient's body;
- presence of concomitant immunodeficiency states;
- the degree of involvement in the pathogenesis of pneumonia of allergic reactions of immediate type;
- presence of bad habits in the patient - abuse of alcohol, smoking, drug addiction;
- age of patients and other factors.
The clinical picture of any pneumonia consists of
- signs of local pulmonary inflammation,
- extrapulmonary manifestations of pneumonia,
- laboratory and radiologic changes, characteristic for various kinds of pneumonia,
- clinical manifestations of complications of the disease.
Let's consider a classical clinical picture of two clinico-morphological variants of the most widespread pneumococcal pneumonia - lobar (focal) and focal.
Shared pneumococcal pneumonia
Shared pneumococcal pneumonia is characterized by the defeat of a whole lobe (or lung segment) of the lung and mandatory involvement in the inflammatory process of the pleura.
The second distinctive feature of lobar pneumonia is participation in the pathogenesis of the immediate reaction hypersensitivity reaction in the respiratory zone of the lungs, which determines the rapid onset of the disease, accompanied by a pronounced impairment of vascular permeability. This reaction is based on the preliminary sensitization of the macroorganism by the pathogen antigens-pneumococci, as a rule, present in the upper respiratory tract. When the pathogen again enters the respiratory sections of the lung and contacts the allergen with mast cells and immunoglobulins located on their surface, an immunoglobulin-antiimmunoglobulin complex is formed that activates the mast cell. As a result, it degranulates with the release of a large number of inflammatory mediators, which initiates an inflammatory process in the lung,
It should be emphasized that the activation of the mast cell and the release of inflammatory mediators can also occur under the influence of physical factors (cold, excessive physical exertion, "cold" in the form of acute respiratory viral infection, etc.). If by this time the respiratory sections of the lungs are colonized by Streptococcus pneumoniae, a "violent" hyperergic reaction develops, initiating the inflammatory process in the lung.
Focal pneumonia (bronchopneumonia)
When examined, the hyperemia of the cheeks is determined, perhaps a small cyanosis of the lips, an increased moisture of the skin. Sometimes significant pallor of the skin is noted, which is explained by the pronounced intoxication and reflex increase in the tone of the peripheral vessels.
When examining the chest, the lag in the act of breathing on the side of the lesion is revealed only in a part of the patients, mainly in individuals with discharge focal pneumonia.
When percussion over the lesion, a blunt percussion sound is detected, although with a short extension of the inflammatory focus or deep location, percussion of the lungs is not informative.
The greatest diagnostic value is in the auscultation of the lungs. Most often, over the area of the lesion, a pronounced weakening of the respiration is determined due to a violation of bronchial patency and the presence of a multitude of micro-teleclases in the inflammatory focus. As a result, the sound vibrations produced when air passes through the vocal chink, along the trachea and (partially) the main bronchi, do not reach the surface of the chest, creating the effect of weakening the breathing. The presence of violations of bronchial patency explains the fact that even with draining focal bronchopneumonia, pathological bronchial breathing is not listened to as often as with lobar inflammation of the lungs.
Focal pneumonia (bronchopneumonia) - Symptoms
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.
[5]
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.