Symptoms of pneumonia

The symptoms of pneumonia and the outcome of the disease are determined by the interaction of many factors:

• biological properties of the causative agent of pneumonia;
• individual characteristics of the pathogenesis of pneumonia;
• the state of the bronchopulmonary defense system;
• the presence of chronic diseases of the bronchopulmonary system in the patient;
• the presence of other concomitant diseases that reduce the patient's body's resistance;
• the presence of concomitant immunodeficiency conditions;
• the degree of involvement of immediate-type allergic reactions in the pathogenesis of pneumonia;
• the patient has bad habits - alcohol abuse, smoking, drug addiction;
• age of patients and other factors.

The clinical picture of any pneumonia consists of

1. signs of local pulmonary inflammation,
2. extrapulmonary manifestations of pneumonia,
3. laboratory and radiological changes characteristic of various types of pneumonia,
4. clinical manifestations of complications of the disease.

Let us consider the classic clinical picture of two clinical and morphological variants of the most common pneumococcal pneumonia - lobar (croupous) and focal.

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Lobar pneumococcal pneumonia

Lobar pneumococcal pneumonia is characterized by damage to an entire lobe (or segment) of the lung and the obligatory involvement of the pleura in the inflammatory process.

The second distinctive feature of lobar (croupous) pneumonia is the involvement in the pathogenesis of the disease of an immediate-type hypersensitivity reaction in the respiratory areas of the lungs, which determines the rapid onset of the disease, accompanied by a pronounced violation of vascular permeability. This reaction is based on preliminary sensitization of the macroorganism by antigens of the pathogen - pneumococcus, usually present in the upper respiratory tract. When the pathogen repeatedly enters the respiratory areas of the lung and the allergen comes into contact with mast cells and immunoglobulins located on their surface, an immunoglobulin-antiimmunoglobulin complex is formed, which activates the mast cell. As a result, its degranulation occurs with the release of a large number of inflammatory mediators, which initiates the inflammatory process in the lung,

It should be emphasized that activation of mast cells and 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 "stormy" hyperergic reaction develops, initiating the inflammatory process in the lung.

Lobar (croupous) pneumonia - Symptoms

Focal pneumonia (bronchopneumonia)

During examination, hyperemia of the cheeks, possibly slight cyanosis of the lips, and increased moisture of the skin are determined. Sometimes significant pallor of the skin is noted, which is explained by severe intoxication and a reflex increase in the tone of the peripheral vessels.

When examining the chest, a delay in the act of breathing on the affected side is detected only in some patients, mainly in those with confluent focal pneumonia.

Percussion over the lesion reveals a dull percussion sound, although if the inflammatory focus is small in size or deep in location, percussion of the lungs is uninformative.

Auscultation of the lungs is of the greatest diagnostic value. Most often, a pronounced weakening of breathing is determined over the affected area, caused by a violation of bronchial patency and the presence of multiple microatelectases in the inflammation focus. As a result, sound vibrations formed when air passes through the glottis, along the trachea and (partially) the main bronchi, do not reach the surface of the chest, creating the effect of weakening breathing. The presence of bronchial patency disorders explains the fact that even with confluent focal bronchopneumonia, pathological bronchial breathing is not heard as often as with lobar (croupous) pneumonia.

Focal pneumonia (bronchopneumonia) - Symptoms

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.

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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.

Peculiarities of symptoms of pneumonia of various etiologies